ANAESTHESIA MACHINE

Need for anesthesia

- Surgical methods of treatment consists mainly of operations which are normally carried out
under some form of an aesthesia. An aesthesia serves the following two functions:
1) It ensures that patient does not feel pain and minimizes patient discomfort
2) It provides the surgeon with favorable conditions for the work
- When anesthesia is given so that the patient losses consciousness, it is called ‘general
anesthesia’.
- In general anaesthesia, the anaesthetic agent is administered to the patient so that it reaches the
brain via blood stream. The usual method is inhalation anaesthesia in which gaseous anaesthetic
agents are introduced via the lungs.
- Examples of such agents are:
 Diethyl ether
 Chloroform
 Halothane
 Nitrous oxide(laughing gas)
- In the superficial stages of anaesthesia, the patient can breathe for himself – spontaneous
ventilation.
- At greater depth anaesthesia, it may be necessary to support the patient with artificial ventilation
known as controlled ventilation.

Delivery of anaesthesia

- The anaesthetic delivery system consists of the following:

 Anaesthesia machine
 Patient breathing circuit
 Ventilator
 Air way equipment

Anaesthesia machine

it consists of:
 Gas supply
 Delivery unit
 Anaesthetic vaporizer
Breathing circuit
It consists of:
 Closed loop breathing tubing containing two unidirectional breathing valve and an
adjustable pressure limiting (APL) valve
 A CO₂ absorber
 A means of venting excess gases (scavenging)
 Humidifier
 Callapsable reservoir bag
Mechanical ventilator
Is used for positive pressure ventilation.
Air way managing equipment
- It includes the mask and endotracheal tube which interface the patient with the breathing circuit.

ANAESTHETIC MACHINE
 - Is a device which is used to deliver a precisely known but variable gas mixture including
anaesthetic and life sustaining gases to the patient’s respiratory system.
- Variable concentration gas mixture of oxygen, nitrous oxide and anaesthetic vapour like ether or
halothane is sustained from machine and it is made to flow through the breathing circuit to the
patient.
- It is composed of two systems namely:
 The gas supply delivery unit – tubing and flow meters which are interconnected
 The anaesthetic vapour which is used to produce anaesthetic vapour from
volatile liquid.
Gas supply system
- Is either from central supply or portable cylinders.
- Centralized gas supply: consists of bulk or cylinder storage for main and reserve supply – control
equipment ie valves, pressure regulator, distribution pipe-line and numerous supply outlets. Gas
supplied is regulated and maintained at 275-345Kpa (40-50Psi) at the wall outlet.
- Gases are supplied to the anaesthetic machine via central system via a flexible horse.
- In order to avoid mis-identification non-interchangeable connectors are used to each end of the
horse- O₂, N₂O
- In addition to the connector design, color coded hoses for each specific gas are utilized
- Gas cylinder located in yokes attached to the anaesthesia machine is also another source of gas
supply.
- Yoke - most anaesthesia machines are provided with two yokes for fitting O₂ and N₂O cylinders.
In order to prevent during placement of cylinder in the Yoke two pins located in the yoke must fit
 the corresponding holes drilled into the tank neck. This identification system is referred to as “pin
index safety system”. It has been standardized to prevent the accidental fitting of a wrong
cylinder to the yoke.

Pressure regulator

- It reduce cylinder gas pressure to 275Kpa (40Psi) before the gas flows through the machine.

Pressure gauge

- Attached to the cylinder to indicate the contents of the gas in the cylinder. For oxygen the
operating range of the gauge is 150kg/cm².
- When the indicator shows that the cylinder pressure has taken below minimum it should be
replaced.
Fail safe system

- The pressure safety system will not allow nitrous oxide to flow unless oxygen supply pressure
exist in the machine.

Schematic diagram of an anaesthesia machine

Oxygen Flush Valve
- Provides a high flow (35-75 L/min) of oxygen directly to the common gas outlet
- Bypasses the flowmeters and vaporizers
Gas delivery unit
- From the fail-safe system, the gas is directed to the flow delivery unit
- Two methods have been used to accomplish delivery and control of the gas mixture: gas
proportioning and gas mixing.
- In a gas proportioning system, the delivered concentration of each gas constituent is the function
of a pre-determined, precisely controlled ratio of proportionality which is independent of the
total gas flow
- Most current anaesthesia machines use gas mixing. In this technique, the flow rate of each
constituent is independently controlled and measured by a delivery unit consisting of a needle
valve and a rotameter.
- During the administration of anaesthesia, it may be necessary to fill the patient breathing circuit
with oxygen at a rate higher than what the gas delivery unit can supply. For example, such a
situation exists any time the patient is disconnected to the breathing circuit.

Vapour delivery
- The various liquid that possess anaesthetic properties are too potent (strong) to be used as pure
vapours.
- They are thus diluted in a carrier gas such as air and/or oxygen or nitrous oxide and oxygen.
- The device that allows vaporization of liquid anaesthetic agent and mixture with carrier gas for
administration to a patient is called – vaporizer.
 - In order to provide a stable and predictable concentration of anaesthetic vapour, the vaporizers
include suitable method of obtaining calibrated dilution anaesthetic agents to the patient. This
can be done by several means:

i) Variable Bypass Vaporizers

- Carrier gas flow from the flow-meter is split into streams in a known ratio: one stream which is
called “chamber flow” flows over the liquid agent while the other stream goes through the
bypass path and does not enter the vaporizing chamber. Final concentration can be controlled
by varying the splitting ratio between the vaporizer gas and the bypass gas using an adjustable
valve.
ii) Measured flow vaporizers
- In these devices, the anaesthetic agent is heated to a temperature above the boiling point (so
that it behaves as a gas) and is then metred into the fresh gas flow.

Safety related inter-locks in the vaporizers

- Only one vapourizer is turned on
- Gas enters only the one which is on
- Trace vapour output is minimized when the vapourizer is off
- Vapourizers are locked into the gas circuit, thus ensuring that they are seated correctly
- Other important safety features are followed including keyed filters and secured mounting to
minimize tipping (tilting) which may obstruct the working of the valves.
Delivery system
Patient breathing system:
- The function of a patient breathing system is to deliver anaesthetic and respiratory gases to and
from the patient. It describes both the mode of operation and the apparatus by which
inhalation agents are delivered to the patient.
- The breathing system can be:
 Rebreathing type
 Non-rebreathing type
i) Rebreathing type: this refers to rebreathing of some or all of the previous exhaled gases,
including CO₂ and water vapour.
ii) Non-rebreathing type: fresh gas is delivered to the patient and re-breathing of previously
exhaled gases is prevented.
. The non-rebreathing valve is so designed that when it is open to admit inspiratory gas, it
does not permit the flow from the expiratory part to get through it. When the patient
exhales, the reverse happens, as the inspiratory valve is occluded and the expiratory valve is
opened to allow expiratory gases to escape.

Circle system
- it is most popular breathing cct.
- It is closed loop with large bore of iron pressure. It is delivered into inspiratory and expiratory
point
- It has got valves, a CO₂ absorber cct gas venting (scavenging) reservoir bag, masks and
endotrached tubes.
- Patients are connected to the absorber by two corrugated hoses, one inspiratory and the other
expiratory
- The absorber contains a carbon dioxide absorbent (soda lime) in a canister.
- During inspiration, gas moves through the absorber from either the reservoir bag or ventilator
bellows and inspiratory valve into the inspiratory limb of the circuit. The pressure difference
between the inspiratory and expiratory limbs keeps the uni-directional expiratory valve close.
- During exhalation, the pressure differential reverses. The inspiratory valve closes and the
expiratory valve opens, allowing the exhaled gas to flow into the reservoir bag or ventilator
bellows and absorber.
- APL or the pop-off valve enables the anaesthetist to control the circuit volume and pressure by
the regulation of gas venting from the circuit.
- Circuit exhaust is either carried into the room or collected by a gas scavenging system
- The bag allows the accumulation of gas during exhalation so that a reservoir is available for the
next inspiration. It provides a means for visually monitoring the spontaneous breathing pattern of
the patient and buffers increases in breathing circuit pressure.

Humidification
- Dry gases supplied by the anaesthesia machine may cause clinically significant discretion of
mucus. This may contribute to retention of secretion and the mucus flow may cease. Lung
compliance may fall, therefore air or anaesthetic gases need to be humidified.
Ventilation
- An integral component of the anaesthetic delivery system is the ventilator. It provides a positive
force for transporting respiratory and anaesthetic gases into aphetic patient
- It provides a positive pressure ventilation at a controlled minute volume(Tidal volume, Rate).
- They operate either electrically, mechanically or pneumatically.
- The bellows communicate directly with the breathing circuit and causes a pre-selected volume of
gas to flow into the patient.
- The ventilator is either located within the mainframe of the anaesthesia machine or is attached
as an accessory unit. The outlet of the ventilator connects directly to the patient breathing circuit
of the anaesthetic delivery system at the location and in place of the breathing reservoir bag.
Patient circuit
- It consists of anti-static rubber tube, a chrome plated tube fitting, breathing bag, valves and face
masks.
- The face mask is designed to fit the patient’s face perfectly without any leaks and yet to exert the
minimum of pressure which might depress the jaws and cause respiratory obstruction.
Name the parts: