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SN1 Chapter 3

Small Animal Surgical Nursing (Tear, M) 4th Ed Chapter 3

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5 views12 pages

SN1 Chapter 3

Small Animal Surgical Nursing (Tear, M) 4th Ed Chapter 3

Uploaded by

Alyssa Babik
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Anesthetic Machine Paige Allen and Marianne Tear OUTLINE ‘Anesthetic Machine, 34 Conclusion, 44 ‘Components, 34 Key Points, 44 Leak Testing, 41 Review Questions, 44 Breathing Circuits, 42 (Oxygen Flow Rates, 44 LEARNING OBJECTIVES ‘fer completion ofthis chapter, the reader wil be abet: 2 Describe the function ofan anesthesia machine. {Ut the individual components of an anesthesia machine. {Describe the method for performing leak check of an anesthesia machine. + Describe the difference between rebresthing and nonre- breathing circuits and the indications for their use. + Describe how to calculate the size of rebreathing bag to be used. + Describe the use of different oxygen flow rates and the indications for their use. KEY TERMS ‘Atelectasis ‘Semi-closed system Closed system ‘Semi-open system Vaporizer Open system ANESTHETIC MACHINE _ "Anesthesia can be a stressful time for the veterinary technician. However, a thorough understanding of the components of the ‘machine, the flow of gas through the machine, and the options available to deliver the anesthetic gases tothe patient can reduce the stress level and can even make surgery a rewarding part of the technician's day. ‘The primary purpose of an anesthesia machine isto deliver inhalation anesthesia to the patient and then remove the un- needed gases from the patient and the surgery suite. The inhala- tion anesthetic gas is delivered to the patient through oxygen molecules; oxygen (O;) is the carrier gas for the anesthetic gas. [Another purpose of an anesthesia machine is to deliver oxygen as the sole gas, as in cardiopulmonary resuscitation (CPR). For the anesthesia machine to perform as intended, it must do the following: 1. Deliver 0, at a controlled rate. 2. Vaporize (turn a liquid into gas) a designated concentra tion of liquid anesthetic, mix the anesthetic with oxygen, and deliver the mixture to the patient, 34 43, Remove exhaled gases from the patient, then dispose of. gases through a scavenging system or recireulate them removing the carbon dioxide) to the patient. ‘The ability of the anesthesia machine to function po depends onthe equipment being in good repair being pr ‘maintained, and being used appropriately. "Anesthesia machines are configured in many forms, fon the manufacturer. Well-known producers of anesthesi chines include North American Matric (Fg. 3.1), Drager (Pigs and 3.3), and Ohmeda Medical Some machines are designed the simplest intent of delivering inhalation anesthesia (see Figs and 3.2) Other machines may have acessories and the abi provide automatic ventilation, multiple inhalation gs {eg isoflurane, sevoflurane), and space for placement and of monitoring devices (se Fig. 33). Regardless ofthe mac appearance, the basic function remains the same. Compononts ‘The anesthesia machine has many components work gether to perform is intended function. To best undett be Fig. 2.3 Complex anesthesia machine with mutile vaporizrs,storgo for menitoring davies, ane a ventiatr. how the machine works it is necessary to identify and under- stand each component. This basic information not only pro- vides a working knowledge of the machine but also assists the technician with troubleshooting problems in the event of @ ‘malfunction. ‘Tracing the oxygen flow through the machine al- lows a view of all the components ofthe machine. Oxygen Source "The oxygen source can be a localized cylinder or a large, cen- trally located source (Fig. 3.4). Cylinders are available in differ- ‘ent sizes; the two most common sizes are the E and H tanks. The E tanks are smaller and generally attached to the machine, ‘whereas the H tanks are lager and generally stand alone, away from the anesthesia machine, often chained against a wal, Tanks are color coded for easy recognition (green in the United States, White in Canada) and have a pressure reading of 2200 pounds peer square inch (psi) when full, regardless of the size. When ‘opening a tank, personnel should remember the rule of “righty tighty, lefty loosey.” When turning the valve clockwise (to the right, the tank is being closed; turning the valve counterclock- wise (tothe left) opens the tank. Using 100% O, from an oxygen source is justified because (1) the Os acts as a carrier forthe va~ porized anesthetic gas and delivers it to the patient, and (2) anesthetized patients have a decreased tidal volume, so an in- creased O; concentration will compensate for this decrease. Yoke ‘The yoke attaches the E tank, if sed, to the anesthetic machine, In addition to allowing the tank to be attached to the machine, the yoke provides additional safety to ensure that the wrong Fig. 24 Large H tanks a8 an oxygen £0 delivery gas is not used. E tanks are equipped with one outlet port arid two sill pin index holes. On O: tanks, dese ine up Pith the inlet and pins on the yoke. This prevents the accidental "use of another gas agent (Fig. 3.5). ‘Once the O; tank is turned on, the tank pressure gauge indicates the amount of compressed gas in the tank. The measurement is in pounds per square inch (psi) This gauge should be checked when the tanks first turned on and then frequently throughout Fig, 35 Parts of a size E compressed gas cvindsr ute pot el. pin index safety system holes Lerche T A ‘hos an! analgesia for veterinary technicians, ed the day. Because oxygen is the carrier for the anesthetic gas, its imperative that the tank does not run out of oxygen while a patient is under anesthesia, The first pressure-reducing valve in the system is found near the exygen source tank. Ths valve reduces the pressure leaving the tank and entering the machine to 40 to 50 psi, regardless of the pressure in the tank. The lower pressure gas is catried through the source lines to the anesthesia machine, ‘Next in the Bow of O is the oxygen flowmeter (Pig. 3.6). The flowmeter further reduces the pressure of the gas to 15 psi. This js very close to atmospheric pressure and is well tolerated by patients, Te flowmeter regulates how much O, i entering the Eystem and being delivered tothe patient. O; flow is measured in titers per minute (Limi) or mililiters per minute (mL/min). The O, flow is regulated by a knob at the bottom of the flow. meter, Personnel must take care to avoid excessive tightening of the knob when turning off the flow. When reading the flowme- ter, the float needs to be properly read. Ball flats are read on the sale where the middle of the ball sits on the graduations (fig, 3.7A). Floats with a point ate read atthe top of the float (Fig. 3.78). Graduations on the flowmeter may be in 100-mt- jnicrements until the 1-L level, then in 500-mL increments thereafter. ‘The fast flush valve, or oxygen flush, isthe next component on the machine, On many anesthesia machines the oxygen flush Valve is found near the oxygen flowmeter. The fast flush valve allows quick infusion of only oxygen into the breathing circuit, ‘and yoke. (yoke; (), wing mut (c}, ute valve; ( ripple of yoke: index ins om St Lous, 2017, Mosby) he he the igh The his by the in) got me- Lon ions ‘oat ml cents ton flush valve ut Fig. 28 Oxygen flowmeter. Note the graduations fo measuring nygen flow The lat is shown atthe bottom ofthe flowmeter, The fast flush valve Is to te right ofthe regulating kb. fig. 2.7 A, Ball Yost eadng 1 Teesion can occu bess, with a vaporizer out of the the ute 3Poszris bypassed withthe tubing arrangement of Fike agate herent isk in using this fash vale Re patent is connected to the machine, Because the va- fas byPased the patient receives straight oxygen, which ss eth of anesthesia. The fat fush valve should Wied ifthe presure relief, or pop-off, valve is closed. LB, Point last reaing 1 L, ‘This could lead to a dangerous increase in pressure in the pa tient’s lungs and atelectasis (complete or partial collapse of a lobe or the entire lung). The fast flush valve should never be used with 2 nonrebreathing system for two reasons. First, the pressure of oxygen coming out of the system is to0 high and. ‘may harm the patient, Second, the nonrebreathing systems use such a high oxygen flow thatthe valve's purpose becomes moots, | | | | CHAPTER 3_ Anesthetic Machine the high flows result in oxygen levels similar to those achieved ‘with the fast flush valve. Vaporizer “The vaporizer is usually found next when tracing On flow. Its primary function is to hold liquid anesthetic and to turn that liquid into a gis form that can be delivered to the patient in a controlled manner. The vaporizer inlet isthe point where the Oz enters the vaporizer to carry anesthetic gas molecules to the patient. The vaporizer outlet is the point at which the O» and anesthetic gas leave the vaporizer to enter the circuit. Up to this point the O flow has been “out of the circle,” assuming the an- esthesia machine being used has the vaporizer out ofthe circle. ‘The citcle,” or circuit is the loop that the gases travel to cycle in and out of the patient when a rebreathing system is use. ‘Vaporizers are calibrated internally fora specific type of in~ halation anesthetic. Only the type of anesthetic for which the machine has been calibrated should be used in the vaporizer. {All designs of vaporizers have some style of indicator window at the base ofthe unit. This window allows determination of the amount of liquid anesthetic remaining in the machine. Once the level reaches one-half to one-quarter remaining, liquid an- esthetic should be added to avoid running out during a proce- ‘dure. Ideally the machine is refilled each evening at the lose of ‘business to prevent employee exposure to anesthetic agents. If the vaporizer does need tobe filled while the machine is in use, ‘personnel must be sure to turn off the vaporizer before filling it. This action prevents the anesthetic from bubbling out and contaminating the environment with anesthetic furnes. Some vaporizers have two indicator windows, one to show anesthetic level and one to show when to refi. Vaporizers have some type ‘of device to determine the amount of anesthetic being delivered to the system. Depending on the type of vaporizer, this amount is determined as a percentage or just a setting on the dial ‘Vaporizers should be serviced annually to ensure « properly functioning mechanism. Inthe event that a vaporizer needs to bbe shipped for servicing, it should be drained of any liquid an- esthetic to avoid any accidental spill or leaks during shipping. If the machine is tipped, the vaporizer should be serviced to en- ‘sure that it is still delivering the correct anesthetic percentage Precision vaporizers are the most commonly used. Nompre- cision vaporizers may still be available, Nonprecision vaporizers are seen less and less in veterinary medicine with the develop ‘ment of safer inhalant anesthetics that require precision vapor- izers, Inhalants used in nonprecision vaporizers are not even available anymore. A nonprecision vaporizer is basically a glass Canister that allows liquid anesthetic to vaporize at an uncon~ ‘tolled rate. The construction of the nonprecision vaporizer does not permit compensation forthe three factors discussed in the next section that affect anesthetic vaporization. Precision Vaporizer Precision vaporizes (Fig. 3.8) are used with high-vapor-pressure anesthetics and ate always found out of the circle. The liquid phase of a high-pressure anesthetic vaporizes easily and quickly and must be delivered in a controlled state. If uncontrolled deliv- ery occurs, the concentration of the drug in the carrier gas could Fig. 38 \soflurane precision veporizer. casily become excessive and dangerous. Three factors affect vapor- {ger function and are compensated for in the precision vaporizer: (1) temperature, (2) gas flow rate, and (3) back pressure. Firs, if the room temperature is cold, the amount of volatile anesthetic vaporized may be less than the amount indicated on the cil. Ina ‘warm oom, however, the amount of anesthetic vaporized may be rmuch higher, and therefoce& higher level wil be delivered tothe patient than indicated on the dal setting, The precision vaporize {constructed with insulation to the liquid anesthetic chamber, 50 the problems with temperature are eliminated. “The second factor that the precision vaporizer compensate for is the carrier gas flow rate. The O flow rate can affect the amount of vaporized anesthetic delivered to the patient. Bx tremely high flows (10 L/min) or extremely low flows (<500 mL/min) are difficult to compensate for, and therefore they should not be used routinely. In a vaporizer that is compen sated, the amount of vaporized gas will match the amount ine dicated on the dial, As the Op flow rate is reduced from 300 200 to 100 mL/min, the teliability of the dial setting beeo ‘more questionable, Because the flow is reduced, less fresh ga8 being delivered. Even though the amount of vaporized 235 ing sent to the circuit is constant, the amount of gas deliv to the patient is reduced. Vaporizer settings for lower O. fh rates need to be adjusted to deliver the amount of anesthetic that is actually desired. Newer precision vaporizers compen for the carter gas flow and will deliver the amount of anes agent selected on the dial “Te third factor affecting vaporizer function and compe tion is back pressure (increased pressure in the circuit) Va iets exposed to pressurized gas may release additional thetic agent, increasing the concentration in the circuit ‘occurs when a patient is “bagged.” Modern precision vaPo are designed to adjust for any increase in pressure so that the amount of anesthetic released is not affected. Precision vaporizers are designed to eliminate or reduce the cffect ofthese three factors on the liquid anesthetic and its va~ porization. Precision vaporizers have a dial that shows, in a percent unit, the amount of anesthetic that is being delivered to the circuit Unidirectional Inspiratory Valve ‘The unidirectional inspiratory vale, also called the inspiration valve or inspiratory flutter vale, is @ component of anesthesia, ‘machines designed to allow movement of gases in only one di- rection (Fig. 3.9). It consists of a thin, plastic circular piece {wafer) that moves each time the patient inspires. As the patient inspires, the gases are moved through this valve, then through corrugated tubing, and are delivered via the endotracheal tube to the patient. When the patient inspires, this valve opens, and it doses when the patient exhales, allowing for a one-way oF unidirectional low of gases. Negative-Pressure Relief Valve ‘The next part in many anesthesia machines isthe negative-pres- sure relief valve (Fig. 3.98). This valve is primarily intended as a safety device. If negative pressure is detected in the system, this, ‘ale wil allow room air to enter the system. Negative pressure may occur, for example, if the oxygen source is empty. Without this safety device, the patient would be without oxygen. The negative-pressue reli valve allows room air into the system, thereby providing 21% O: rather than no O>. Negative pressure ‘may also result if an active scavenging system is being used with the vacuum set to0 high or ifthe Oz flow rate is too low. Corrugated Breathing Tubing and Y Piece Gases pass through the tubing as the patient inspires and ex- Pites, This corrugated tubing is available ina variety of materi- als, lengths, and diameters. Although there is no formula to determine the size of tubing to use, shorter tubing with a ESSU calif vale; (e, und wave), manometer CHAPTER 3 Anesthetic Machine ae smaller diameter generally is used for smaller patients, weighing 7 to 20 kg Larger tubing is used with patients weighing more than 20 kg, It is important to remember that this tubing is not unidirectional; tube ends can be placed on either the inspira- tory valve or the expiratory valve. The unidirectional valves determine gas flow direction. The tubes come together at a ¥ piece that connects to the patient either via the endotracheal tube or mask. Unidirectional Expiratory Valve ‘The unidirectional expiratory valve, expiratory flutter valve, functions on the same premise as the inspiratory valve, except it works with expired gases (Fig. 3.9C). As the patient exhales, the gases travel though the corrugated tubing to the unidirec- tional expiratory valve. As with the inspiratory valve, a wafer of plastic moves as the expired gases pass through the valve. The ‘movement ofthese two valves may indicate the patient’ respi- ration for the anesthetist. Adjustable Pressure Relief Valve ("Pop-Off” Valve) ‘The adjustable pressure relief valve, or pop-off valve, is generally located close to the unidirectional expiratory valve (Fig. 39D), ‘The pop-off valve has several functions in the anesthesia ma~ chine, First, it can act as a vent. When in the completely open Position, the pop-off valve prevents buildup of pressure in the system. This is important because if pressure builds up in the system, the alveoli ofthe lungs expand and may rupture, leading to atelectasis Second, the pop-off valve can be used to determine flow rate techniques (e., low flow). When varying degrees of “open’ are used (ie, the pop-off valve is partially opened), df= ferent Os flow rates can be used. Higher flow rates need to be used with a wide-open pop-off valve, and lower flow rates can be ‘used with the valve partially closed or “closed,” meaning mostly closed, (The only time the pop-off valve should be completely closed is when “bagging” the patient, and even then itis only ‘temporarily closed because the patient cannot breathe against @ Beg iin liters) | | hydroxide fime (Sodasorb, WR Grace, Columbia, MD). The crystals absorb the exhaled CO,, and the resulting chemical Sction produces heat, water, and a color change. ‘The crystals have a pH indicator added to allow for the color change. Once the crystals have undergone the chemical reaction, they red pleted, Fresh crystals are easily crushed, but depleted crys tire very hard and may exhibita color change from white t let (Fig 3.11). When isoflurane is used, the color change ma¥] evident only while the crystals are exposed to the anesthetic ‘Once the vaporizer is turned off, the color will disappes™ tals should be disposed of and replenished when no more th to ofthe crystals inthe canister display a color change: hours of use should be tracked, rather than using @ st frame of every week or every two weeks, to determine whem replenish the crystals. Crystals should be changed afer tight hours of use regardless of color change. posed of in the regular trash, Local health departments hhave other guidelines or ordinances; these can be const 10m) = Vole Sx 16D = Volume) 0 mL ‘so a 1 Lrbrathing bag beeause 600 mis ss than 1000 mL 1 ‘laa s2b ‘When the crystals are replaced, the old material cam be Fig. 2.11 Carbon cloxide (CO,)oarister. The machine isin use with @ paltent tached. Farially depleted crystals are evident by the color thange atthe top ofthe canister the canister in increments, and the canister should be shaken to settle the crystals. About half an inch of air space is left at the top of the canister to allow proper gas flow over the crystals Scavenging System Its important to use some type of system to evacuate waste gases (WAGs) from the anesthesia machine and out of the Surgery suite, Two types of scavenging systems are available: active and passive. Active scavenging systems are mechanical deviees attached to the anesthesia machine and then con nected to general building source that produces a vacuum to femove the gases, These systems are generally incorporated ito the building plans for anew fait. The centrally located ‘vacuum in this system removes the gases from the anesthesia Iachine and then evacuates the waste out of the building. Anesthesia machines require a local vacuum control on the Machine as well as hosing to connect to the central source, Similar tothe oxygen hose used to connect with the general ‘oxygen source, Passive scavenging aystems rly om gravity to remove the Beinn the oten, Aneesh hee of the ‘xpited gases and naturally gravitate to the lowest point. Tubing Stcha o the popoff valve can carry the anesthe waste as e 10am astivted-charcoal canister attached to the base 168.312) or stnd of the machine or to an ouside wal vent eS ‘canisters are attached, itis important that they be Pees that air can circle though the vents found on ttom of the canisters. Ifthe canisters are placed on the {fies these vents are eficctively plugged. To ensure that the GRRE selectively scavenging the waste gases ite use needs to land documented. The canister should be weighed Fig. 3.12 Actvatec-charoal scavenger canister for waste anesthetic go, witha gram scale before is first use and before being suspended ‘on the machine. After each use, or om a set schedule, the canister should be reweighed, and the weight recorded on the canister. Once the unit has gained 5O grams (g) from the initial weight, it should be disposed of because it will no longer adequately absorb the waste gas. Canisters can be disposed of in the regular ‘wash, Hoses from the pop-off valve that attach to an outside ‘wal vet should be no longer than 20 fet; longer hoses would compromise the systems function. Scavenging to a vent limits the mobility ofthe anesthesia machine, but this arrangement is appropriate if the machine remains in the same area all the time. Scavenging of waste gas to the floor without any type of collection or evacuation is unsafe and should not be done. Leak Testing Properly functioning equipment is extremely important in an esthesia, Technicians are responsible for maintaining equip- ment and should take this responsibilty seriously. In addition to the use of a scavenging system, leak testing the machine aids in reducing or eliminating any gas that may be inappropriately leaving the system. (Is sometimes referred to asa low pressure test because it tests for leaks in the circuit where the pressure hnas been reduced.) Before every use, the anesthesia machine shouldbe leak tested, IF the machine was cleaned or replenished ‘or if hoses or bags were changed, the potential exists fora leak in the system. Box 3.3 outlines the steps for performing a ma- chine leak test. Machine leak tests should be performed only with a rebreathing circuit. “Any area on the machine has the potential for leaking, but some sites are more likely than others to develop leaks. One of| the frst places to check isthe pop-off valve. This valve must be completely closed when doing the leak check. Ifthe pop-off _ouapren 2 Anesthet BOX 3.3. Steps for Performing an Anesthesi Pemeiernmcs Comet oxygen hose to oxygen source orn on ea onygen sours ‘ath cic t be used. 2 check vapoie fo adequate eve of uid anesthaic 4 & ‘Senurly cud patient end of outwith thm or palm of hand ‘Comgltaly lose popf vale 6 Denese fst sh vv vil = rosure eading of 40cm 0 rests indicate a lak 2, Hthereis na leak, protec to step 12. ‘I thre ia ea, tm on oxygen ow to 200 mL 40. ieakis cected—indcat bya stable needle onthe manameter—0 futher actions needed. Proceed to step 12 4). Mleak isnot cote, perform machine maintnence io determin oration fesk se tet fo posse cations af ek) Cnet ek +12, Wihowt emavig the occlusion from the patient end ofthe crit open the pop aff valve Therebreting bag sould date, 13. moe hand orthunb rom eeu en. Ye Chock scavenging syste to ensure that connections ae iat | 15, Completaly open popaf vate salve is left open, there i no way for pressure to build up in the System, Even ifthe pop-off valve is only partially closed, a leak wll result, so complete closure of this valve is ertical. Another Tommon place for leaks isthe eebreathing bag or the corrugated hosing, Many of these products are intended as single-tse items but the economics of veterinary medicine often dictate their rouse, Anesthetic gas can degrade the integrity of the rub per in these items, and areas of thinning or microscopic holes an develop. Ifthe leak is isolated to the bag or hoses, these items should be discarded and replaced with new equipment ‘Another place fora leak isthe occluding of the Y piece. If the ¥ pee isnot fully occluded with finger or the palm of the hand, a leak may persist. Other, more subtle areas ofthe anesthesia machine that may leak include the metal rings on the inspiratory and expiratory valves If removed or loosened for cleaning purposes, the rings Tay not have been securely replaced and fully tightened. An- ther place for a leak is the CO; absorber. When the canister is femoved to replenish the crystals, the tightening mechanism nay easily be left a lite loose. Finally, all the tubing on the Inachine is continually exposed to the detrimental effects of esthetic gas, which may ead to small, barely detectable holes in the tubing. Regardless ofthe location ofthe leak, it needs to be corrected ‘before the machine is used. | | | nthe manote. +7 Dbverve noodle of manometer fr declining mavenent, which would ae | Breathing Circuits ‘The size of the patient determines the breathing circuit that should be used to deliver anesthetic gases, There are two types Of circuits: eebreathing and nonrebreathing that can further be subdivided into semi-closed, closed, semi-open, and open de~ pending on the amount of expired gases that are recirculated into the system, Rebreathing Circuit ‘The rebreathing circuit is useful because it allows the recircula- tion of some expired anesthetic gases and permits a lower flow ‘of oxygen because some ofthe gases are rebreathed. This circuit $s used with patients that have a body weight greater than 7 Kg. ‘The traditional circuit is two corrugated hoses connected at one end by a ¥ piece (Fig. 3.13A-B). The hosing can be plastic or uber and the ¥ piece can be plastic or metal. The open end of the tubing is placed on the inspiratory and expiratory valve ‘openings on the anesthesia machine “An alternative to the traditional rebreathing circuit is the Universal F circuit (SurgiVet, Waukesha, WI) (Fig. 3.14). This circuit is used with patients weighing more than 7 kg and offers Some distinct advantages over the traditional ciruit. The de- sign of the inspiratory tube inside the expiretory tube allows the inspired gases to be warmed by the expired gases surround: ing the tube. The single-tube design is also beneficial in offering Fig. 2.19 A, Lagedameter rebreating orci. breathing circuit. 8, Smaleamet! Fig. 8:14 Univorsl Fcebresthing circuit (a, connects to the Fe ube; (9), connects to the hnspiratory valve; (el, connects * exaiatory ale, tess congestion at the head and mouth. This advantage is espe cially appreciated during a dental prophylaxis ‘The rebreathing cieuits ean be divided into the semi-closed and closed systems based on the amount of exhaled gases that are allowed to reenter the system for rebreathing The semi-closed system is the most common rebreathing circuit used in veterinary medicine. The pop-off valve is open and allows for the escape of most of the exhaled gas to the Scavenger system. There is partial rebreathing of expired gas. The closed system involves the total rebreathing of expired sss. The pop-off valve is closed or almost closed. The patient rebreathes the expired gases after the CO; is removed by the ab- sorber. While the system is economical, has lower flow rate and lower vaporizer settings, and is environmentally safe as WAGS are not released, it can pose dangers forthe patent. Because the pa tient is rebreathing expired gases, there isthe possibilty of oxy gen depletions because the pop offs closed, there can be a dan eros increase in the pressure in the system. Therefore constant ronitoring is required The nonrebreathing circuits used so that none or very litle of, the gases are rebreathed. Patients weighing les than 7k ben- eft the mos from the use ofthis circuit because ofthe low gas resistance, The ise ofthis cic requires high flow of oxygen toensire adequate levels of anesthetic. The CO, absorber and presre manometer are bypassed, Arnsjor advantage of the nonrcbreathing system is that it tas low resistance for breathing for the patient. Fresh gases are constantly being provided to the patient with minimal effort eqhired of the patient. The design and high lows ofthe non- rebreathng system allow the gases to be delivered at the endo tracheal tube andthe patent merely breathes a normal respira tion and takes in fresh, new gases Nonbreathing circuits come in several configurations, They 86 organized using the Mapleson clasfication sytem, A-E These include the Maglcircit, Ayre T-pece, and Bain coal Get Fg 3.15 shows two examples of nonrebeathing circus There are disadvantages tothe sem-open system, Patients Tose moistre and body heat more readily due to the increased iygen lw rte. There i no conservation of gases and manual ventilation is difficult. The Bin circuit maybe mounted toa device called a univer Si contol arm or Bain Block. This device has a reservoir bag Pop-off valve, and pressure manometer (Fig. 3.16). Maskand tank induction are other types of nonrebreathing Sttis-Theyareconsdered open systems and do nat allow for {Gethin of expe yas, Masi allow for he pid adiin- of oxygen an anesthesia o patients that either cannot eins or in which intubation maybe delayed. Anesthesia 4#e used in induction fr patents that are intractable fen ‘experience extensive stress with handling. open osiems have sveal disadvantages, They do not Einsn open airway and do not protect agains aspiration. lbp chamber induction does na alow for lose moni the patient. chambers that Fig. 3.18 A, Mosiiod Jackson Rosse nonrebrosthing circuit. 8, Modified ‘apiesan nonrabreathing cxcut, Fig. 3.18 Bain Block. (oto by Marianne Tear cuarren 3 Anesthetic Machi ‘OXYGEN FLOW RATES Depending onthe typeof breathing czcult and patent nee inoprate O> low ates shouldbe employed Providing 245 Ghat oxygen tothe patient i cca but wsing an excessive ‘amount of oxygen is wasteful Rabreathing circuits generally use a high Os flow rate for snduetion and recovery with arge-volume delivery of gs. This petpetates a speedy induction and asi ina gic Fee: ere stenance ows for rebreathing circuits are significantly less Tham the induction and recovery flow rates. Only enough oxy. fe to match the patent’ sda volume is needed beens Th aon to the fresh gas being supplied, the patient is rebreath= ig some of the gases already inthe sytem, Usually a buf aad in calculating the flow to allow for large breaths that nay be given to of taken by the patent (Box 34) TLonecbreathing systems also use high Os flow rates (see shox 34), but the flows remain ata constant high flow whether the patient is undergoing indction, maintating the desired depth of anesthesia, or eecovering, Continuous high flow res eo ccessary to provide adequate gases tothe patient, Smaller patents cannot rebreathe any of the gases because ofthe. dit ashe in moving that rmuch air with cach respiration, Fresb fuses need to be provided to these patients at all mes Ex Paro es a | Rateating Syst Patieots >? \ | edn 5019100 igi wth asian of Sid | Maintnanee: 20 to 4 rein bt ot ess than SOD mL/in Fecovery- 0 to 100 ign wit maxim of § Win | Rewovesting Sine: oes <7 \ Induction 200 mig/in aineneree: 00 miAgiin a kal enay roca higher induction and re “Large breed pet covery flows (3-5 Limi Sy erg wit rocommeandations fom 700 t0 400 mLkginin: | omover 200 ekgirin is typical used concLusiON on an baa ere weary ec However,» thorough understanding of the components of the Howe hee ch an he UO sane ee ey aed ing on the manometer should not exceed 1. Each component of the anesthesia machine has a specific purpose and must be in good working order fr the machine 2, The flowmeter reduces the oxyuen Pres presse of 15 psi which s wel tolerated by he patent 45, The use of the fast flush valve should be avoided whenever © patient is connected tothe anesthetic machine, 4, Daly the liquid anesthetic for which a vaporizer has Been ‘calibrated should be used in the vaporizer 1, When reading flowmeter with a ball loa, read where the a. point sits. b. top of the ball sts . middle of the ball sit. 4. bottom of the ball sits. 2 The oxygen flush valve of the anesthetic machine is used 10 a. prevent atelectasis in an anesthetized patient }, increase flow of inbalant anesthetic to the patient. circuit. +. The function ofthe vaporizer is to 1 hange the liquid inhalant anesthetic to gas form. 1, change the gas inhalant anesthetic to liquid form. a any the oxygen needed for respiration into the body. &. allows gas low only one way within the anesthesia circuit 4, What isthe approximate tidal volume of « 40-lb dog a. 180 ml 400 mL © allow quick infusion of oxygen into the breathing circu, 4 improve oxygen flow in a nonrebreathing anesthesia 5, The pressure reali 20 can H,O when a patient is being ventilated. 46. THEO, absorber removes carbon dioxide from the xa breath of the patient. _ nopropiate avenging of waste anesthetic gas is eset for the safety of the staf, 900 mL 4. 1,500 mL in the anesthesia system? ‘a, Negative-pressure relief valve D. Uniditectional expiratory valve ‘c, Unidirectional inspiratory valve . Adjustable pressure relief valve ‘The only time the pop-off valve should be closed whet patient is attached to a semi-closed rebreathing ans circuit is when ‘a. inducing the patient. . using lower oxygen flow rates. ‘c using bigher oxygen flow rates. 4. the anesthetist is providing mamual ventilation. What part of the anesthesia machine measures the in the system? ‘a, Flowmeter b, Manometer ; | | ician. of the stions duce art of r «. Tank pressure gauge 4. Negative-pressure relief valve ‘8. Which isthe correct flow of oxygen in the anesthesia ma~ chine? ‘a, Oxygen source, pressure-reducing valve, flowmeter, va- porize, unidirectional expiratory valve, breathing tube, patient b. Oxygen sour, flowmeter, pressure-reducing valve, va- porizer unidirectional inspiratory valve, breathing tube, tient Orygen source, pesurreding vs, flowmeter, porizer, unidirectional inspiratory valve, breathing tube, patient d. Oxygen source, vaporizer, flowmeter, pressure-reducing, valve, unidirectional expiratory valve, breathing tube, patient 9, When should the CO, absorbent crystals of an anesthesia machine be changed? a, Once per week b, Bvery M4 days ©. Afier 6 to 8 hours of use 4. When % of the crystals change color 10, Which part of the anesthesia machine regulates how much ‘oxygen enters the anesthetic circuit? a. Flowmeter b. Manometer «©. Pop-off valve 4. Unidirectional inspiratory valve 1, When should a passive waste anesthetic gas canister be dis- posed off a. When the canister weighs 50 g 'b. When the canister is to % full BIBLIOGRAPHY _ Sasser JM, MeCurnin DM, editors: MeCurnin's clinical textbook for ternary technicians, ed 8, St Lous, 2014, Saunders. “ean, Barcham S: Practical math for veterinary technicians, Minne- | apolis2019, Bluedoor. ___OHAPTER3 Anesthetic ‘& When ¥ of the granules have changed color 4. When the canister weighs 50 g more than its initial weight How often should an anesthesia machine be leak tested? a. Daily . Before each use & Once per week 4. Once per month When manual ventilation is being performed, the pop-off valve should be a. opened and remain open after the manual ventilation breath is complete. b. open and then closed after the manual ventilation breath is complete. closed and remain closed after the manual ventilation breath is complete. 4, closed and then opened after the manual ventilation breath is complete. Negative pressure exists in the anesthesia system when a. using a closed system. B. the oxygen source is depleted. . using chamber induction. 4. high-flow anesthesia is being used. What rebreathing bag would you choose for a 32-Ib dog? a. 0251, boost ell a1 What is the fanction of oxygen in the anesthesia circuit? 17, What are the three factors that affect vaporizer function? 2 2B. rs 15. “Thomas JA, Lerche P: Anesthesia and a 5, St Louis, 2017, Mosby. malgesia for veterinary tehmicians,

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