THE ANESTHESIA GAS MACHINE Karen Garcia N747 Evidence Based Practice for Nurse Anesthesia.
Anesthesia Machine Intro
Transcript of Anesthesia Machine Intro
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Anesthesia Machine Intro
New Residents July 5, 2007
© Copyright 2000-2007, James H Philip, all rights reserved
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ADS1 Ready JHP
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Anesthesia Machine Intro
James H. Philip, MEE, MD, CCEAnesthesiologist, Director of (Anesthesia) Bioengineering, Brigham and Women’s Hospital
Medical Liaison, Department of Biomedical Engineering, Partners HealthCare SystemAssociate Professor of Anaesthesia, Harvard Medical School
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Patient Anesthetist
ORHospitalWorld
Work-station
observe(senses)
touch
Care Info(lab data, image..)
touchobserve(eyesears)
ADS, monitors,?computer
Inhalant Drugs IV Drugs, Fluids Other
Monitoring
requests
ClincalCare
Interactions
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Patient Anesthetist
ORHospitalWorld
Work-station
observe(senses)
touch
Care Info(lab data, image..)
touchobserve(eyesears)
ADS, monitors,?computer
Inhalant Drugs IV Drugs, Fluids Other
Monitoring
requests
ClincalCare
Interactions
Anesthesia Delivery System
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Workstation-Patient Interactions
Life Support with oxygen & breathingInhalant Drug (Gas & Vapor) DeliveryIntravenous Drug DeliveryIntravenous Liquid DeliveryMonitoringRecording
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Life Support (Oxygen)Inhalant Delivery
OtherIntravenous Drug DeliveryFluid DeliveryMonitoringRecording
Anesthesia Machine
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Anesthesia Machine Evolution
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1846 Morton Ether Inhaler
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Inhaler had limitations
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1850 improvement
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This 1850 version worked horizontal
with no hands required
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Open Circuit Inhaler
Open Circuit = Non-rebreathingPatient breathes in the ether vapor, breathes ether out (and it is discarded)Breathes in new ether vaporBreathes it out again (discarded)
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Manual Resuscitator
Open Circuit = non-rebreathing Circuit = what you set is what you get
Give sufficient oxygen to the reservoir bag (not to empty)
Reservoir bag gives 100% oxygen to the breathing bag
The Tidal Volume is determined by the close of your hand and a perfect seal.
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Manual Resuscitators
Bag Reservoir Hose Reservoir
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Needs a bag reservoirso you can see it provide 100% oxygen to the breathing bag by never emptying
Bag Reservoir
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Partial Rebreathing Circuits used in Anesthesia
Don’t throw all the exhaled vapor awayReuse as much as possibleSomehow (learn when you are ready) Remove (Absorb) CO2 and Rebreathe the Anesthetic
Partial rebreathing = semi-closed circuitAll USA ADSs use them
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1890 added a
Breathing Circuit
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1950added a work
surface
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Then, Drawers,
Temperature-compensated
vaporizers,Circuit,
Absorber, Common
gasoutlet
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1990 Integrated
Monitorsand
DataRecording
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Datex-Ohmeda
Central Display
(CD)ADS
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2000
Better ventilation for difficult patientsFGF-independent ventilationCorrects for circuit leaks
More sensitive to water vaporMonitors no longer integrated
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GE Aestiva
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Draeger Fabius
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Gas & Flow Monitor integratedCV Monitor not integrated
GE - Aisys
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Basics of the Anesthesia Delivery System
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Anesthesia Delivery System - ADS
Anesthesia MachineBreathing CircuitWorkspaceControl
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Anesthesia Machine delivers gases and vaporsinto a breathing circuit 2001
Provides continuous flow of -Oxygen for LifeAir to safely lower FIO2
Nitrous Oxide for partial anesthesiaAgent vapor for complete or partial anesthesia
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N O2 O2Air
(Continuous Flow) Anesthesia Machine
Vaporizer
1 2 3..
5
21
34
6789
21
34
6789
55
21
34
6789
mL/mL/mL/mL/m
300
200100
400
50
600900
000
IsofluraneSevofluraneDesflurane FGF
(FreshGasFlow)
CommonOutlet
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Flow Tubes
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Sevo Iso Des
Direct-reading temperature-compensated
Vaporizers
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Agent-specificFiller Port
Dial ReleaseAttachment
LeverDial
Direct Reading
Vaporizer
ExclusionInterlock
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Dial Setting
2
3
4
5
1
2 4
1
2
3
4
5
6
06 8 10
Flow rate (L/min O2)
% is
oflu
rane
0
Performance curve, Tec 4(Isotec 5%)
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Anesthesia Machine
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Anesthesia Machine
Schematic
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O2
2000psi
O2 SERVICE
INLET55psi
35 psi
35 psi
50 or 250ml/min
NEEDLEVALVE
FAILSAFEVALVE
CALIBRATEDVAPORIZERS
Fresh Gas Flow (FGF)
OXYGEN FLUSHVALVE[first]
ON/OFFSWITCH
CHECKVALVE PRESSURE
REGULATOR
N2OSERVICE
INLET 55 psi
O2
N2O
FRESHGAS HOSE
Flush Flow(last)
[Anesthetizinggases flow]
COMMON OUTLET
N2O
750psi
N2O
750psi
O2
2000psi
FILTER
WALL
DISSdiameter
indexsafetysystem
CONNEC-TION
O2
N2O
D S I
SIMPLIFIED ANESTHESIA MACHINE SCHEMATIC DIAGRAM
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Patient Breathing Circuit
Allows cyclic flowTo and from the patient
(AKA Breathing)
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Circle absorption anesthetic breathing circuit
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flipped
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The Circle-Absorber System
Sampled
ExhaustExpired
CO2
Ab-sorb-ant
200 mL/min
InspiredFresh
Gas Flows
Rebreathed
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The Circle-Absorber System
Sampled
ExhaustExpired
CO2
Ab-sorb-ant
200 mL/min
InspiredFresh
Gas Flows
Rebreathed
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The Circle-Absorber System
Sampled
ExhaustExpired
CO2
Ab-sorb-ant
200 mL/min
InspiredFresh
Gas Flows
Rebreathed
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The Circle-Absorber System
Sampled
ExhaustExpired
CO2
Ab-sorb-ant
200 mL/min
InspiredFresh
Gas Flows
Rebreathed
To Patient
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The Circle-Absorber System
Sampled
ExhaustExpired
CO2
Ab-sorb-ant
200 mL/min
InspiredFresh
Gas Flows
Rebreathed
From Patient
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The Circle-Absorber System
Sampled
Exhaust (APL)Expired
CO2
Ab-sorb-ant
200 mL/min
InspiredFresh
Gas Flows
Rebreathed
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The Circle-Absorber System
Sampled
Exhaust (APL)Expired
CO2
Ab-sorb-ant
200 mL/min
InspiredFresh
Gas Flows
RebreathedGases (O2, N2O, Agent)
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The Circle-Absorber System
Sampled
ExhaustExpired
CO2
Ab-sorb-ant
200 mL/min
InspiredFresh
Gas Flows
RebreathedGases
No CO2 rebreathed
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The Circle-Absorber System
Sampled
ExhaustExpired
CO2
Ab-sorb-ant
200 mL/min
InspiredFresh
Gas Flows
RebreathedGases
No CO2
No
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The Circle-Absorber System
Sampled
ExhaustExpired
CO2
Ab-sorb-ant
200 mL/min
InspiredFresh
Gas Flows
RebreathedGasesNo CO2
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The Circle-Absorber System
Sampled
ExhaustExpired
CO2
Ab-sorb-ant
200 mL/min
InspiredFFGF , CDEL
FE FI
FE , CE
FI , CI
Gas Flows,Concentrations
~=
F = Flow C = Concentration
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The Circle-Absorber System
Sampled
ExhaustExpired
CO2
Ab-sorb-ant
200 mL/min
InspiredFFGF , CDEL
FE , CE
FI , CI
FE FI~=
CI~=
FFGF x CDEL
+FFGF x CDEL FE x CE
Inspired Concentration =Flow-weighted average ofFresh Gas and Expired GasConcentrations
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Low FGF
More rebreathingInspired more dependent on ExpiredInspired less dependent on Vaporizer
View the Breathing CircuitThe Circle-Absorber System
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Absorber opened - w gas channels shown
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Absorber opened - w gas channels shown
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Exp
Insp
Absorber Assembly Top CoverOhmeda GMS 1985-2000-present
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The Anesthesia Workspace
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BWH Anesthesia Workspace
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Don’t clutter ADS with Airway EquipmentMy view
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MRSMAIDWorkspace Setup
MachineRoomSuctionMonitorsAirwayI V Drugs
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MRSMAIDWorkspace Setup
MachineRoomSuctionMonitorsAirwayI V Drugs
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MRSMAIDMachineRoomSuctionMonitorsAirwayI V Drugs
Workspace Setup
Suction off if:DISS hose unscrewedWall switch offHose disconnect from CanisterCanister switch off Insert seated incorrectlyAny hole openFlap valve closed
because unit was shakenor canister is full
Flexible hose kinkedFlexible hose stepped on
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Workshop this afternoon
Evelyn Fan, OR Clinical EngineerErnst Daniel, OR Clinical EngineerBMETs (Biomedical Equipment Technicians)
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BWH Biomedical Engineering OR Team
Ernst Daniel CE
Evelyn Fan CE
James Philip MD
Clair Cabral
Jeremy Essex
Ed Holmes
Rossiny Jacques
M Anthony Johnson
C Trevor Roberts
Frantz Teleau
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WorkshopADS Safety Check
Day Check Case Check
Anesthesia MonitorsZero/CalibrateAttaching trodesControlling monitor measurementsObserving results
Numerals nowNumeric TrendDigital Trend
These are in your Goals for Week 1, Week 2, Life !
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BWH July 2007 Abbreviated Pre-Use Check
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Perform Machine-Assisted TestsGE Modulus 2 Plus - noneGE Aestiva - Minor
12 Hour switch off and onCircuit Oxygen Sensor Cal via SmartVent
GE Aisys - MajorMost circuit tests are automatedBellows volume & pressure can feel the circuitand make great ventilation modes
Draeger Fabius - MajorMost circuit tests are automatedVentilator Piston can feel the circuitand make great ventilation modes
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Calibrate Oxygen Monitor
Oxygen Monitor ON & sensor in air with hole plugged. Calibrate to 21%. Reconnect sensor in circuit
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Check Machine for Gas Delivery
Machine OnOxygen flows smoothlyDisconnect oxygen hoseOxygen alarm soundsSwitch ON oxygen tank. Verify P > 1000 psi and Alarm
silences.Tank off with wrenchTurn oxygen flow upAlarm sounds oxygen failureConnect oxygen hose to silence alarm.Turn up nitrous and observe alarm and/or control.Negative Pressure Test - later
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Check Breathing Circuit for Integrity
Attach circuit including reservoir bagOcclude “Y” with thumbFlush and fill bag to 30 cmH2O.Test pressure alarms
NAD - Continuing pressure alarm, high pressure alarmOhmeda - High pressure relief
Open relief valve and verify that reservoir bag emptiesObserve scavenger bag fill and empty
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Check Function - Ventilator, Suction
CHECK VENTILATOR FOR FUNCTIONVentilate reservoir bag and observe no volume loss.
CHECK SCAVENGER FOR FUNCTIONCheck that reservoir bag fills and empties. Check valves
not stuck.
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Thank you
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James H. Philip, MEE, MD, CCE
Office Neville House NH 2-24E617 732-7330 Page [email protected]
http://local.bwh.harvard.edu/intranet
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End