Babak Pourmollaabbassi
Ph.d Candidate of biomedical
engineering
Supply and compressed gases
Delivery system to anesthetic machine
Safety system
Anesthetic machine
Anesthetic breathing system
A device which delivers a precisely known but
variable gas mixture, including anesthetizing
and life sustaining gases
ventilator
Flow meter
bellow vaporizer
Corrugated
tube APL valve
Soda lime
Scavenging system
Cylinder
Cylinder bank
Liquid oxygen
Pipeline system
Cylinder system
The central gas pipeline supply system is the
primary source of gas supply for the anesthesia
machine
Oxygen, nitrous oxides, and often air are
delivered from their central supply source to the
operating room through a pipeline network
The tubing is color coded and connects to the pipeline inlet
of the machine through a noninterchangeable diameter-
index safety system (DISS) fitting that prevents incorrect
hose attachment
The check valve, located down stream from the pipeline
inlet, prevents reverse flow of gases (from machine to
pipeline, or to atmosphere)
Connector at user terminal
A. Quick connector (Quick-coupler)
Central gas pipeline supply system
Multiple gas cylinders Cryogenic tank
Machine’s pipeline inlet
Diameter-Index Safety System (DISS)
Cylinders attach to the machine via hanger yoke
that utilize a pin index safety system
Cylinder Oxygen Nitrous Oxide Air
Characteristics
Color White Blue Black/White
(green) (yellow)
State Gas Liquid and gas Gas
Contents (L) 625 1590 625
Empty Weight (kg) 5.90 5.90 5.90
Full Weight (kg) 6.76 8.80
Pressure Full (psig) 2000 750 1800
Characteristics of gas cylinders
Material: Molybdenum steel
Size: B, D, E, M, G, H or K
Size E H
Dimension 4.1/4” x 26” 9.1/4” x 51”
volume 4.8 L 43.6 L
Nitrous oxide 745 psig/1590 L 745 psig/ 15800 L
Oxygen 1900 psig/660 L 2200 psig/ 6900 L
Diameter index safety system
Pin index safety system
Machine’s pipeline inlet
Diameter-Index Safety System (DISS)
For small cylinder connection
High pressure system
Cylinder supply to pressure
regulator
Intermediate pressure
system
Pipeline supply to
proportioning system
Low pressure system
Flowmeters to common gas
outlet
High Intermediate Low Pressure Circuit
Receives gasses from the high pressure E
cylinders attached to the back of the
anesthesia machine (2200 psig for O2, 745 psig
for N2O)
Consists of:
Hanger Yolk (reserve gas cylinder holder)
Check valve (prevent reverse flow of gas)
Cylinder Pressure Indicator (Gauge)
Pressure Reducing Device (Regulator)
Usually not used, unless pipeline gas supply is
off
Hanger Yolk: orients and
supports the cylinder,
providing a gas-tight seal
and ensuring a
unidirectional gas flow into
the machine
Index pins: Pin Index Safety
System (PISS) is gas
specificprevents
accidental rearrangement of
cylinders (e.g.. switching O2
and N2O)
Hanger-yoke assembly
Reduces the high and variable pressures found in a cylinder
to a lower and more constant pressure found in the
anesthesia machine (45 psig)
Reducing devices are preset so that the machine uses only
gas from the pipeline (wall gas), when the pipeline inlet
pressure is 50 psig.
This prevents gas use from the cylinder even if the cylinder
is left open (i.e. saves the cylinder for backup if the wall gas
pipeline fails)
Cylinders should be kept closed routinely. Otherwise, if the
wall gas fails, the machine will automatically switch to the
cylinder supply without the anesthetist being aware that
the wall supply has failed (until the cylinder is empty too)
Receives gasses from the regulator
or the hospital pipeline at
pressures of 40-55 psig
Consists of:
Pipeline inlet connections
Pipeline pressure indicators
Piping
Gas power outlet
Master switch
Oxygen pressure failure devices
Oxygen flush
Additional reducing devices
Flow control valves
Mandatory N2O and O2, usually
have air and suction too
Inlets are non-interchangeable
due to specific threading as per
the Diameter Index Safety
System (DISS)
Each inlet must contain a check
valve to prevent reverse flow
(similar to the cylinder yolk)
Machine standard requires that an anesthesia machine be
designed so that whenever the oxygen supply pressure is
reduced below normal, the oxygen concentration at the
common gas outlet does not fall below 21%
Oxygen supply pressure opens the valve as long as it is
above a pre-set minimum value (e.g. 20 psig)
If the oxygen supply pressure falls below the threshold
value the valve closes and the gas in that limb (e.g. N2O),
does not advance to its flow-control valve
The machine standard specifies that whenever the oxygen
supply pressure falls below a manufacturer-specified
threshold (usually 30 psig) a medium priority alarm shall
blow within 5 seconds
Fail-safe valves do not prevent administration of a hypoxic
mixture because they depend on pressure and not flow
These devices do not prevent hypoxia from accidents such
as pipeline crossovers or a cylinder containing the wrong
gas
Receives O2 from pipeline inlet or cylinder reducing device
and directs high, unmetered flow directly to the common
gas outlet (downstream of the vaporizer)
Machine standard requires that the flow be between 35 and
75 L/min
The ability to provide jet ventilation
Hazards
May cause barotrauma
Dilution of inhaled anesthetic
Located just upstream of the flow control valves
Receives gas from the pipeline inlet or the cylinder
reducing device and reduces it further to 26 psig for N2O
and 12-16 psig for O2
Purpose is to eliminate fluctuations in pressure supplied to
the flow indicators caused by fluctuations in pipeline
pressure
Mechanical
integration of the N2O
and O2 flow-control
valves
Automatically
intercedes to maintain
a minimum 25%
concentration of
oxygen with a
maximum N2O:O2
ratio of 3:1
Extends from the flow control valves to the common
gas outlet
Consists of:
Flow meters
Vaporizer mounting device
Check valve
Common gas outlet
When the flow control valve is
opened the gas enters at the bottom
and flows up the tube elevating the
indicator
The indicator floats freely at a point
where the downward force on it
(gravity) equals the upward force
caused by gas molecules hitting the
bottom of the float
* Note that a leak in the oxygen flowmeter tube can
cause a hypoxic mixture, even when oxygen is located
in the downstream position
A vaporizer is an instrument designed to change a liquid
anesthetic agent into its vapor and add a controlled
amount of this vapor to the fresh gas flow
Advantages:
Relative stability of inspired concentration
Conservation of respiratory moisture and heat
Prevention of operating room pollution
PaCO2 depends only on ventilation, not fresh
gas flow
Low fresh gas flows can be used
Disadvantages:
Complex design = potential for malfunction
High resistance (multiple one-way valves) =
higher work of breathing
Carbon dioxide absorbents
Function:
• conserving gases and volatile
agents
• decreasing OR pollution
• avoiding hazards of carbon
dioxide rebreathing.
Sodalime
Baralime
NaOH 5 %, Ca(OH)2 94 %, KOH 1 %, silica
Indicators : ethyl violet
CO2 + H2O --> H2CO3
H2CO3 + 2 NaOH (or KOH) --> Na2CO3 (or K2CO3) + 2 H2O + Energy
Na2CO3 (or K2CO3) + Ca(OH)2 --> CaCO3 + 2 NaOH (or KOH)
Advantages
Simply, light weight, easy to positioning
Remote anesthesia
Low resistance
Disadvantages
Require high FGF, more pollution
loss more heat and water from airway
Carbon dioxide retention
Ayre’s T-piece circuit
(Mapleson E)
most suitable in oxygen
therapy
caution : require high flow of
humidified oxygen
Jackson Rees circuit
(Mapleson F)
most suitable in pediatric
anesthesia (BW < 20 kg.)
require high flow 2-3 times of
minute ventilation
Scavenging is the collection and removal of
vented anesthetic gases from the OR
Scavenging may be active (suction applied) or
passive (waste gases proceed passively down
corrugated tubing through the exhaust grill of
the OR)
8 Categories of check:
Emergency ventilation equipment
High-Pressure system
Low-Pressure system
Scavenging system
Breathing system
Manual and automatic ventilation system
Monitors
Final Position