üMedical gas sources
üCylinder parts, Pipeline & O2 Concentrators
üAnesthesia machine
üDifferent anesthetic breathing systems
(including different Mapleson circuits )
üScavenging system
üWorking mechanism and features of anesthetic
machine ventilator
Anesthesia machine
Anesthesia machine cont.…
Introduction
• What Is an Anesthesia Machine?
• The anesthesia machine is a complex piece of equipment
consisting of many components.
• Simply put, an anesthesia machine is designed to deliver fresh gas
(typically oxygen and air or nitrous oxide) and anesthetic vapor to
a patient through a breathing circuit and allow for spontaneous,
manual, or mechanical ventilation.
Anesthesia machine cont.…
• Much of the design is focused on minimizing the waste of anesthetic
vapors and preventing contamination of the operating room (OR)
environment with anesthetic gases.
• The anesthesia machine receives medical gases (oxygen, nitrous oxide,
air) under pressure and provides a continuous and accurate flow of
each gas individually.
üInstantaneous control of concentrations of oxygen and anesthetic
vapor delivered to the patient.
Anesthesia machine cont.…
üHave the capabilities of an intensive care ventilator.
üEasy to use and never break down or malfunction and
also without any potential to injure a patient.
ØUnfortunately, the ideal anesthesia machine does not
exist.
• So the informed clinician must understand the capabilities
and limitations of the machine(s) they use for patient care.
• The anesthetic machine consists of:
1. Gas supplies
2. Pressure gauges
3. Pressure regulators (reducing valves)
4. Flowmeters
5. Vaporizers
6. A common gas outlet
7. A variety of other features, e.g. High-flow oxygen flush, pressure-relief valve and oxygen supply
failure alarm and suction apparatus
Anesthesia machine cont.…
vGAS SUPPLY
• Most machines have gas inlets for oxygen, nitrous oxide,
and air.
• Separate inlets are provided for the primary pipeline gas
supply that passes through the walls of health care
facilities and the secondary cylinder gas supply.
• Machines therefore have two gas inlet pressure gauges for
each gas: one for pipeline pressure and another for
cylinder pressure.
Anesthesia machine cont.…
ØPipeline Inlets
• Oxygen and nitrous oxide (and often air) are delivered
from their central supply source to the operating room
through a piping network.
• The tubing is color coded and connects to the anesthesia
machine through a noninterchangeable diameter-index
safety system (DISS) fitting that prevents incorrect hose
attachment.
Anesthesia machine cont.…
ØCylinder Inlets
• Cylinders attach to the machine with a pin index safety
system to prevent accidental connection of a wrong gas
cylinder.
• The gas cylinders are also color-coded for specific gases to
allow for easy identification.
Anesthesia machine cont.…
vPressure gauge
• This measures the pressure in the cylinder or pipeline.
• The pressure gauges for oxygen, nitrous oxide and medical
air are mounted in a front-facing panel on the anesthetic
machine .
• Some modern anesthetic machine designs have a digital
display of the gas supply pressures.
Anesthesia machine cont.…
ØComponents
• A robust, flexible and coiled tube which is oval in cross-
section.
• It should be able to withstand the sudden high pressure
when the cylinder is switched on.
• The tube is sealed at its inner end and connected to a
needle pointer which moves over a dial.
• The other end of the tube is exposed to the gas supply.
Anesthesia machine cont.…
ØMechanism of action
• The high-pressure gas causes
the tube to uncoil.
• The movement of the tube
causes the needle pointer to
move on the calibrated dial
indicating the pressure.
Anesthesia machine cont.…
1. Each pressure gauge is color coded and calibrated for a
particular gas or vapour.
• The pressure measured indicates the contents available
in an oxygen cylinder.
• Oxygen is stored as a gas.
• This is not the case in a nitrous oxide cylinder since it is
stored as a liquid and vapour.
Anesthesia machine cont.…
2. A pressure gauge designed for pipelines should not be
used to measure cylinder pressure and vice versa.
• This leads to inaccuracies and/or damage to the pressure
gauge.
3. If the coiled tube rupture, the gas vents from the back of
the pressure gauge casing.
• The face of the pressure gauge is made of heavy glass as an
additional safety feature.
Anesthesia machine cont.…
vPressure regulator (reducing valve)
• Gas and vapour are stored under high pressure in cylinders.
• Unlike the relatively constant pressure of the pipeline gas supply,
the high and variable gas pressure in cylinders makes flow
control difficult and potentially dangerous.
• To enhance safety and ensure optimal use of cylinder gases,
machines utilize a pressure regulator to reduce the cylinder gas
pressure to 45 to 47 psig.
• The pressure inside an E-type oxygen cylinder typically ranges
from 1800 to 2200 psi (pounds per square inch) when full.
Anesthesia machine cont.…
• Regulators protect the components of the anesthesia
machine against pressure surges.
• The use of pressure regulators allows low-pressure piping
and connectors to be used in the machine.
• This makes the consequences of any gas leak much less
serious.
• They are positioned between the cylinders and the rest of
the anesthesia machine
ü The service capacity for an e-cylinder carrying oxygen is
1900 psi.
üThe volume of oxygen in an e-cylinder is 660 liters.
ü Now entering the values listed above:
ü660 L / 1900 psi = remaining contents (in L) / gauge pressure
(in psi)
ü The 0.35 comes from dividing 660 by 1900.
0.35 x psi on gauge
ümintus rmaind in the cylinder=
L/min to be delivered
Anesthesia machine cont.…
vComponents
üAn inlet, with a filter, leading to
high-pressure chamber with a
valve.
üThis valve leads to a low
pressure chamber and outlet.
üA diaphragm attached to a
spring is situated in the low
pressure chamber.
Anesthesia machine cont.…
• Mechanism of action
1. Gas enters the high-pressure chamber and passes into the
low-pressure chamber via the valve.
2. The force exerted by the high-pressure gas tries to close the
valve.
• The opposing force of the diaphragm and spring tries to open
the valve.
• A balance is reached between the two opposing forces.
• This maintains a gas flow under a constant pressure of about
400 kPa (50psi).
Anesthesia machine cont.…
• Once the pressure has been reduced to a safe level, each gas
must pass through flow control valves and is measured by
flowmeters before mixing with other gases.
• Entering the active vaporizer, and exiting the machine’s
common gas outlet.
• These valves control the flow through the flowmeters by
manual adjustment.
• Increasing the flow of a gas is achieved by turning the valve
in an anticlockwise direction.
Anesthesia machine cont.…
• Flowmeters
• Flowmeters measure the flow rate of a gas passing
through them.
• They are individually calibrated for each gas.
• Calibration occurs at room temperature and atmospheric
pressure (sea level).
• For flows above 1 L/min, the units are L/min, and for
flows below that, the units are 100 mL/min
Anesthesia machine cont.…
• Components
• A flow control (needle) valve.
• A tapered (wider at the top), transparent plastic or glass
tube.
• A lightweight rotating bobbin or ball.
• Bobbin-stops at either end of the tube ensure that it is
always visible to the operator at extremes of flow.
Anesthesia machine cont.…
• Mechanism of action
1. When the needle valve is opened,
gas is free to enter the tapered
tube.
2. The bobbin is held floating within
the tube by the gas flow passing
around it.
• The higher the flow rate, the higher
the bobbin rises within the tube.
Anesthesia machine cont.…
[Link] effect of gravity on the
bobbin is counteracted by the
gas flow.
4. The clearance between the
bobbin and the tube wall
widens as the gas flow
increases.
Anesthesia machine cont.…
5. The reading of the flowmeter is taken from the top of the
bobbin When a ball is used, the reading is generally taken
from the midpoint of the ball.
6. There is a stop on the oxygen flow control valve to ensure a
minimum oxygen flow of 200–300 mL/min past the needle
valve.
• This ensures that the oxygen flow cannot be discontinued
completely.
• This safety feature helps ensure that some oxygen enters the
breathing circuit even if the operator forgets to turn on the
oxygen flow.
vProblems in practice and safety features
• The flow control knobs are color-
coded for their respective gases.
• The oxygen control knob is
situated to the left (in the UK) .
• In the United States and Canada,
the oxygen control knob is
situated to the right.
• Problem may encounter if used
with different color and shape.
Anesthesia machine cont.…
• A crack in a flowmeter may
result in a hypoxic mixture .
• To avoid this, oxygen is the last
gas to be added to the mixture
delivered to the back bar.
• Flow measurements can
become inaccurate if the
bobbin sticks to the inside wall
of the flowmeter.
Anesthesia machine cont.…
• Flowmeters are designed to be read in a vertical position,
so any change in the position of the machine can affect
the accuracy.
• Oxygen/Nitrous Oxide Ratio Controller Another safety
feature of anesthesia machines is a linkage of the nitrous
oxide gas flow to the oxygen gas flow;
• This arrangement helps ensure a minimum oxygen
concentration of 25%.
Anesthesia machine cont.…
vVaporizers
ØIntroduction
• Many inhalational anesthetics agents
are liquids under normal storage
conditions and need to be in a vapour
form before they can be administered
to a patient.
• Volatile an aesthetics delivered via the
inhalational route are titrated by
means of a vaporizer.
Anesthesia machine cont.…
ØLAWS OF VAPORIZATION
• Molecules of a liquid have a mutual attraction for each
other (a phenomenon called cohesion), which is sufficiently
great for them to remain in close proximity.
• But they also possess varying degrees of kinetic energy
and are in constant motion, colliding with each other.
• If the liquid has a surface exposed to air or other gasses, or
to a vacuum, some molecules with a high kinetic energy
will escape from this surface, resulting in the process of
evaporation or vaporization.
Anesthesia machine cont.…
• The molecules from the liquid, which exist in the gaseous
phase, are known collectively as a vapour.
• This vapour exerts a pressure on its surroundings, which is
referred to as vapour pressure.
• If the space above the liquid is enclosed, some of the
molecules that have escaped while moving freely in the
gaseous state will collide with the surface of the liquid and
re-enter it.
Anesthesia machine cont.…
qFactors affecting vaporization of a liquid
1. Temperature
• Vaporization is increased if the temperature of the liquid
is raised, since more molecules will have been given
sufficient kinetic energy to escape.
• If the liquid is heated, a point is reached at which
vaporization now occurs.
• The liquid is now boiling and this temperature is its
boiling point.
Anesthesia machine cont.…
• At this temperature, the SVP ( saturated vapor pressure)
of the liquid is equal to the ambient atmospheric pressure.
• The boiling point of a liquid may therefore vary with
atmospheric pressure.
2. Volatility
• The speed at which a liquid vaporizes depends not only on
its ambient temperature and pressure, but also on its
volatility.
Anesthesia machine cont.…
• A more volatile liquid has weaker cohesive forces between its
molecules, such that they require less energy (i.e. a lower
temperature) to vaporize.
• This is reflected in a higher SVP at any temperature and a
lower boiling point.
3. The surface area of the liquid
• The greater the surface area of the liquid, the more space there
is for molecules to leave the liquid.
• The rate of vaporization is, therefore, also proportional to the
surface area of the liquid.
Anesthesia machine cont.…
• At temperatures encountered in the operating room, the molecules of
a volatile anesthetic in a closed container are distributed between the
liquid and gaseous phases.
• The gas molecules bombard the walls of the container, creating the
saturated vapor pressure of that agent.
• Vapor pressure depends on the characteristics of the volatile agent
and the temperature.
• The greater the temperature, the greater the tendency for the liquid
molecules to escape into the gaseous phase and the greater the vapor
pressure
Anesthesia machine cont.…
qRemoval of vapour from the vicinity of liquid
• If the container holding the liquid is not closed, molecules
will still leave the liquid and some will escape into the
atmosphere.
• If a gas is passed across the surface of the liquid, vapour
will be removed more quickly allowing fresh vapour to
form.
• Vaporization is, therefore, proportional to gas flow
(convection) across the surface of the liquid (provided the
temperature of the latter remains constant).
Anesthesia machine cont.…
vVAPORIZING SYSTEMS
• The various organic liquids that possess anesthetic
properties are
ütoo potent to be used as pure vapours
üand so are diluted in a carrier gas such as air and/or
oxygen, or, nitrous oxide and oxygen.
• The device that allows vaporization of the liquid anesthetic
agent.
• and its subsequent admixture with a carrier gas for
administration to a patient is called a vaporizer.
Anesthesia machine cont.…
• Vaporization requires energy (the latent heat of
vaporization), which results in a loss of heat from the
liquid.
• Vaporizers contain a chamber in which a carrier gas
becomes saturated with the volatile agent.
• A liquid’s boiling point is the temperature at which its
vapor pressure is equal to the atmospheric pressure.
Anesthesia machine cont.…
• As the atmospheric pressure decreases (as in higher
altitudes), the boiling point also decreases.
• Anesthetic agents with low boiling points are more
susceptible to variations in barometric pressure than
agents with higher boiling points.
• Among the commonly used agents, desflurane has the
lowest boiling point (22.8°C at 760 mm Hg).
Anesthesia machine cont.…
vMechanism of action
1. The calibration of each vaporizer is agent-specific.
2. FGF is split into two streams on entering the vaporizer.
• One stream flows through the bypass channel and the other,
• Smaller stream (typically less than 20% of total), flows
through the vaporizing chamber.
• The two gas streams reunite as the gas leaves the vaporizer.
Anesthesia machine cont.…
3. The vaporization chamber is designed so that the gas
leaving it is always fully saturated with vapour before it
rejoins the bypass gas stream.
• This should be achieved despite changes in the FGF.
4. Full saturation with vapour is achieved by increasing
the surface area of contact between the carrier gas and
the anesthetic agent.
Anesthesia machine cont.…
• This is achieved by having wicks saturated by the
inhalational agent or by bubbling the gas through the
liquid.
• The presence of wicks increases significantly the internal
resistance of the vaporizer.
Anesthesia machine cont.…
5. The desired concentration is obtained
by adjusting the percentage control dial.
• This alters the amount of gas flowing
through the bypass channel to that
flowing through the vaporization
chamber.
6. In the modern designs, the vapour
concentration supplied by the vaporizer
is virtually independent of the FGFs
between 0.25 and 15 L/min.
Anesthesia machine cont.…
• All modern vaporizers are
agent specific and
temperature corrected,
• Capable of delivering a
constant concentration of
agent regardless of
temperature changes or flow
through the vaporizer.
Anesthesia machine cont.…
• The vapor pressures of most anesthetic agents at room
temperature are much greater than the partial pressure
required to produce anesthesia.
• To produce clinically useful concentrations, a vaporizer
dilutes saturated vapor.
• This can be accomplished by splitting the fresh gas flow
that passes through the vaporizer.
Anesthesia machine cont.…
• Given that these vaporizers are agent specific, filling them
with the incorrect anesthetic must be avoided.
• For example, unintentionally filling a sevoflurane specific
vaporizer with halothane could lead to an anesthetic overdose.
• First, halothane’s higher vapor pressure (243 mm Hg versus
157 mm Hg) will cause a 40% greater amount of anesthetic
vapor to be released.
• Second, halothane is more than twice as potent as sevoflurane
(MAC 0.75 versus 2.0).
üInterlock Devices
• Interlock (vaporizer exclusion) systems prevent
more than one vaporizer from being turned ON
at the same time.
• Checking the interlock device should be part of
the anesthesia apparatus checkout procedure.
• If a vaporizer from one manufacturer is
attached to an anesthesia machine of another
manufacturer, the interlocking mechanism
should be checked to make sure that it works
properly.
Anesthesia machine cont.…
ØHazards
[Link] Agent
• Anesthesia personnel can detect the presence of a volatile
agent but cannot identify an agent by smell.
• If an agent of low potency or low volatility is placed in a
vaporizer designed for an agent of higher potency or volatility,
the effect will be an output of less than the dial reading.
• Conversely, if an agent of high potency or volatility is used in
a vaporizer intended for an agent of low potency or volatility, a
dangerously high concentration may be delivered.
Anesthesia machine cont.…
üIf a vaporizer is filled with the wrong agent, it must be
completely drained and all liquid discarded.
üGas should be allowed to flow through it with the
concentration dial fully ON until no agent can be detected
in the outflow.
üDraining cannot be relied on to completely empty a
vaporizer and remove the agent from the wicks.
Anesthesia machine cont.…
[Link]
ØIf some vaporizers are tipped more than 30 degrees, liquid
from the vaporizing chamber may get into the bypass or
outlet.
• If this occurs, a high concentration will be delivered when
the vaporizer is first used.
ØTipping can be prevented by mounting vaporizers
securely and handling them with care when they are
removed.
Anesthesia machine cont.…
• Vaporizers should be turned OFF or placed in a travel (T)
setting if they are being moved.
• Should tipping occur, a high flow of gas should be run
through the vaporizer with the concentration dial set at a
low concentration until the output shows no excessive
concentration.
• Many new vaporizers have a mechanism that blocks the
entrance and exit from the vaporizing chamber.
Anesthesia machine cont.…
• This prevents the problems associated with tipping the
vaporizer when it is transported.
• Consult the user manual.
[Link]
ØIf a vaporizer is overfilled, liquid agent may enter the fresh
gas line and lethal concentrations may be delivered.
Anesthesia machine cont.…
ØAnother result of overfilling may be complete vaporizer
failure so that it produces no output.
ØMost vaporizers have the filling port situated so that
overfilling cannot occur.
ØIf a vaporizer is tipped during the filling process, it is
possible that it could be overfilled.
ØThe vaporizer should be securely attached to the
anesthesia machine and vertical when it is filled.
Anesthesia machine cont.…
[Link] Vapor Output
• The most common cause of no vapor output is an empty vaporizer.
• Incorrect vaporizer mounting can result in little or no vapor output.
• In most cases, this can be detected by checking for leaks with the
vaporizer ON.
• An overfilled vaporizer may deliver no vapor.
• Blood entering the vaporizer can cause vaporizer failure.
• If an anesthesia machine is turned OFF and then ON again,
electronic vaporizer settings may default to zero.
Anesthesia machine cont.…
vCommon (Fresh) Gas Outlet
• The common gas outlet is where the anesthesia machine ‘ends’.
• At the common gas outlet, the gas mixture made at the flowmeters,
plus any inhaled anesthetic agent added by the vaporizer, exits the
machine and enters the fresh gas tubing that conducts it to the
breathing system.
• In contrast to the multiple gas inlets, the anesthesia machine has
only one common gas outlet that supplies gas to the breathing
circuit.
• Unlike older models, some newer anesthesia machines measure
and report common outlet gas flows.
Anesthesia machine cont.…
vAdjustable pressure limiting valve
• The adjustable pressure-limiting (APL)
valve, sometimes referred to as the
pressure relief or pop-off valve,
• This is a valve which allows the
exhaled gases and excess FGF to leave
the breathing system.
• It does not allow room air to enter the
breathing system.
Anesthesia machine cont.…
• It allows control of the pressure within the breathing
system and the patient’s airway.
• Is usually fully open during spontaneous ventilation but
must be partially closed during manual or assisted bag
ventilation.
• The APL valve often requires fine adjustments.
Anesthesia machine cont.…
• If it is not closed sufficiently excessive loss of circuit
volume due to leaks prevents manual ventilation.
• At the same time, if it is closed too much or is fully closed,
• A progressive rise in pressure could result in pulmonary
barotrauma (e.g., pneumothorax) or hemodynamic
compromise, or both.
Anesthesia machine cont.…
• As an added safety feature, the APL valves on modern
machines act as true pressure-limiting devices that can
never be completely closed;
• The upper limit is usually 70 to 80 cm H2O.
• When fully open, a pressure of less than 1 cm H2O is
needed to actuate it.
Anesthesia machine cont.…
ØComponent
1. The APL valve has three ports: the inlet, the patient and
the exhaust.
• The latter can be open to the atmosphere or connected to
the scavenging system using a shroud.
2. A lightweight disc rests on a knife-edge seating. The
disc is held onto its seating by a spring.
• The tension in the spring, and therefore the valve’s
opening pressure, are controlled by the valve dial.
Anesthesia machine cont.…
vAdvantages
üPermits control of the airway pressure during positive
pressure ventilation.
üPermits application of PEEP.
üFacilitates scavenging.
Anesthesia machine cont.…
• Disadvantages
üWater vapour may condense on the disc, causing it to stick. Discs
are made of a hydrophobic material to reduce the likelihood of this.
üValves introduce greater resistance and are less suitable for small
children.
üThis is the reason the APL valve is absent from the Mapleson E
and F systems.
üBarotrauma may result from inadvertent closure of the APL valve.
üAdds bulk to the breathing system.
Anesthesia machine cont.…
vEmergency oxygen flush
• This is usually activated by a non-locking
button.
• When pressed, pure oxygen is supplied from the
outlet of the anesthesia machine.
• The flow bypasses the flowmeters and the
vaporizers.
• A flow of about 35–75 L/min at a pressure of
about 400 kPa is expected.
• The emergency oxygen flush is usually
activated by a non-locking button and using a
self-closing valve.
Anesthesia machine cont.…
• It is designed to minimize unintended and accidental
operation by staff or other equipment.
• The button is recessed in a housing to prevent accidental
depression.
vOxygen supply failure alarm
• Many designs are available but the characteristics of the
ideal warning device are as follows:
Anesthesia machine cont.…
1. Activation depends on the pressure of oxygen itself.
2. It requires no batteries or mains power.
3. It gives an audible signal of a special character and of
sufficient duration and volume to attract attention.
4. It should give a warning of impending failure and a
further alarm that failure has occurred.
Anesthesia machine cont.…
5. The alarm should be positioned on the reduced pressure
side of the oxygen supply line.
6. It should be tamper proof.
7. It is not affected by backpressure from the anesthesia
ventilator.
Anesthesia machine cont.…
• In modern machines, if the oxygen supply pressure falls
below 200 kPa, the low-pressure supply alarm sounds.
• With supply pressures below 137 kPa, the ‘fail safe’ valve
will interrupt the flow of other gases to their flowmeters
so that only oxygen can be delivered.
• The oxygen flow set on the oxygen flowmeter will not
decrease until the oxygen supply pressure falls below 100
kPa.
Anesthesia machine cont.…
vAuxiliary Oxygen Flowmeter
• An auxiliary (courtesy) oxygen flowmeter is a self-
contained flowmeter with its own flow control valve,
flow indicator, and outlet.
• It is not affected by computer control.
• It usually has a short tube with a maximum flow of 10
L/minute and a barbed fitting on the outlet for
connection to a face mask or nasal cannula.
• It is used to supply oxygen to the patient without
turning ON the anesthesia machine.