PHYSICAL PRINCIPLES
OF COMMONLY USED
GADGETS &
MONITORS
IN ANAESTHESIA
Presenter : Dr. pemala simick
Moderator : [Link] n. saxena
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PATIENT MONITORING
KEY ASPECT OF
ANAESTHESIA
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Devices enhance & extend our senses.
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DEVICES ???Complex & intimidating
UNDERSTAND ANTICIPATE &
& INTERPRET RECOGNISE
DATA ERRORS
HOW
THEY
WORK?
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MATTER ENERGY
Physics
Anaesthetic monitors measure & monitor :
how much mass?
what energy state?
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COMMONLY USED MONITORS &
GADGETS
• 1) Pulse oximeter
• 2) Capnometer
• 3) Gas Analysers
• 4) BP Monitors - NIBP
- IBP
• 5) ECG
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• 6) Defibrillator
• 7) Flow measurement
• 8) Venturi principle
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PULSE OXIMETRY
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Light
Absorbed
Transmitted Reflected
SPECTROPHOTOMETRY
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• Beer – Lambert law :If a known intensity of
light illuminates a chamber of known
dimensions then the conc. of the dissolved
substances can be determined if the incident
& transmitted light intensity is measured.
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C = ( 1 ) log( I0)
(dα) ( I1 )
Where:
C = Conc. of the dissolved substance
d = path length of light d
α = absorption constant for the dissolved substance
I0 = intensity of incident light
I1 = intensity of transmitted light
Red & infrared light (wavelength – 0.6-1µ) generally used
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Pulse oximetry is based upon two physical principles:
Oxyhemoglobin and Absorbance of both
wavelengths has a pulsatile
deoxyhemoglobin
component, between the
absorbs red and infrared source and the
light differently detector.
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• Light is emitted from light sources (LED) which goes across the
vascular bed and reaches the light detector/sensor.
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• Beer's Law: Amount of light absorbed is proportional to the
concentration of the light absorbing substance
• By measuring how much light reaches the light detector
knows how much light has been absorbed.
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• Lambert's Law: Amount of light absorbed is proportional to
the length of the path that the light has to travel
in the absorbing substance
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• Conventional oximeters use only 2 wavelengths of light
660nm(Red)
940nm (Infrared)
Recent devices employ eight light wavelengths rather than the
usual two, making it capable of measuring COHb and
MetHb
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• Oxy Hb absorbs more infrared light than red light
• Deoxy Hb absorbs more red light than infrared light
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• The pulse oximeter works out a ratio by comparing how much
red light and infra red light is absorbed by the blood.
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• Using this ratio, the pulse oximeter can then work out the
oxygen saturation.
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• Pulse oximeter analyses arterial blood→ “pulsatile” → change in
absorbance
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• Skin and other tissues also absorb some light.
• “Non pulsatile” / "non arterial" tissues : No change in absorbance
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Changin Non-
g changing Final
Absorba absorban signal
nce ce
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• Computer subtracts the non changing part of the absorbance
signal from the total signal.
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• Signal Artifact
Problem : Identification of the fluctuating absorbance pattern of
arterial blood in a sea of artifacts.
ADDITIONAL
ADDITIONAL LOW
LIGHT
LIGHT
ABSORBERS
ABSORBERS PERFUSION
VENOUS SIGNAL
PULSATION ARTIFACT
AMBIEN
T LIGHT
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pulse oximeter
low perfusion.
amplifies the
Weak signal signal
“static,”/noise
also is amplified
At the high
amplifications
“analyze” this noise signal
and generate an SpO22
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CAPNOMETRY
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Capnometers
Use Beer- Lambert law to analyse CO2 in the expired gas
Infrared technology - commonest technology
• Blackbody radiation technology:
Uses a heated element called
blackbody emitter as a source
of infrared light..
• Microstream technology
Utilizes laser-based technology
to generate infrared emission
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2 types of devices
Mainstream /Non-diverting Sidestream/diverting
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• Because N2O absorbs IR (IR absorption spectra of N20 = 4.5
µm & C02 = 4.3 µm),its presence can give falsely high C02
readings.
• Solution : Use a narrow band IR filter that only transmits the
wavelength most strongly absorbed by C02 (about 4.3 µm).
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• Water can condense on IR cell and interfere with CO2
measurements.
• Decrease in partial pressure of water due to condensation can
increase CO2 values.(because of temp differences between
the patient's airway and the measuring unit)
• Accumulation in the line can cause occlusion.
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• Oxygen does not absorb IR light
Inhalational agents do not affect CO2 measurement
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OXYGEN
ANALYSERS
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2 Principles
Paramagnetic
Electrochemical Analysis
Analysis
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• Paramagnetic Analysis :
• When introduced into a magnetic field,
some substances locate themselves in
the strongest portion of the field
→ paramagnetic.
• oxygen → paramagnetic gas
• When a gas that contains oxygen is
passed through a magnetic field,
the gas will expand and contract,
causing a pressure wave that is
proportional to the oxygen partial pressure.
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• Electrochemical analysis
GALVANIC CELL /FUEL CELL :Oxygen diffuses through the sensor
membrane and electrolyte to the cathode, where it is reduced, causing a
current to flow→ proportional to the partial pressure of oxygen in the
gas
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• POLAROGRAPHIC ELECTRODE : When a polarizing voltage is applied to
the cathode, electrons combine with the oxygen molecules and reduce
them to hydroxide ions. A current that is proportional to the oxygen
partial pressure in the sample flows between the anode and cathode.
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ANAESTHETIC GAS
ANALYSERS 39
• MASS SPECTROMETRY: Principle used by gas analysers
• The mass spectrograph separates gases of different
molecular weight on the basis of their mass:charge ratios
→ the composition and amount of each anaesthetic gas in a
sample can be determined.
• It measures concentration in vol %
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• e
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• a
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• Other methods:
1) Gas Chromatography
2) Piezoelectric method
3) Raman Spectrometry
4) Refractometry
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BP MONITORS
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BLOOD PRESSURE MEASUREMENT
NON- INVASIVE INVASIVE
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NIBP
• SBP is estimated by return of the pulse flow after occlusion of
an artery is released.
• Return of flow detected by :
Palpation of the artery
Recording with a Doppler device
Using a pulse oximeter
• Automated NIBP monitors use a sophisticated application of
this principle.
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• Monitor the oscillating signal generated in the cuff by the
arterial pressure changes (oscillometry).
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IBP
• A liquid manometer
Height of the fluid determines the mean pressure at the tip
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• The pressure is mathematically derived by the formula :
P = ρgz
Where :
P = pressure exerted by the liquid column (in Pascals)
ρ = density of the fluid (in kg/cm3)
g = acceleration due to gravity (in N/kg)
z = height of the liquid column (in m)
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Dynamic pressure measurement
(Transducer)
• Manometers cannot respond to rapid changes in the pressure
because of its inertia i.e. the mass of the liquid column resists
rapid changes in height.
• Accurate measurement of rapidly changing arterial pressure
requires pressure transducers which changes resistance or
capacitance in response to changes in the pressure.
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• This principle is used in invasive arterial pressure monitoring.
• A liquid filled tube is connected to the intra-arterial catheter
which is connected to an external pressure transducer
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• “Wheatstone bridge”
• Network of 4 resistors with a battery/DC voltage source(EMF)
between A & C & a voltmeter connected between B & D.
• Voltmeter is in balance when theres ‘zero’ potential difference
between B & D.
From Ohm’s law: (V = IR)
R1 = R s
R2 Rx
If Rs is the adjustable std. resistor &
R1 & R2 are fixed resistors then Rx
(the unknown resistance) can easily be
measured.
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R1 = Rs
R2 Rx
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• Resonance : Depending on the frequency ,the system can
either ↑ or ↓the oscillations.
• The frequency that causes the maximum amplification is
called the natural /resonant frequency.
fo = 1 π (k/m)1/2
2
• fo = resonant frequency.
• k = resistance offered by
an elastic body to
deformation
• m = mass
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Clinical application :
• Stiffer ([Link] compliant) tubing or a shorter length of
tubing (less mass) produces higher natural frequencies .i.e. a
much higher pulse rate is required before amplification of
values occur.
• Bubbles should be eliminated from the system as it adds to
elasticity ↓ing the resonant frequency.
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ECG
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• The small electric currents produced by the electrical activity of
cardiac muscle spread an electrical field throughout the body
(conductor)
• This can be recorded at various sites on the surface of the body
as ECG signals by electrodes (leads) placed at specific locations .
• Output of these leads is amplified, filtered, and displayed on
electronic devices
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.
Multiple resistances and capacitances
in the tissues between the heart
& electrodes reduce the voltage
signal at the skin
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According to Fourier analysis,
any waveform can be transformed
into a number of sine waves of
different frequencies which when
algebraically combined constructs
the original waveform
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DEFIBRILLATOR
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• Conductor – Any substance that allows flow of electrons.
• Insulator – Any substance that opposes this flow.
• Current - Movement of the electrons through a conductor.
• If the flow is always in the same direction – Direct current.
• If flow reverses direction at regular intervals – Alternating current.
• Impedance – Sum of forces that opposes electron movement in
an AC circuit.
• Capacitance – measure of a substance’s ability to store charge.
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• Defibrillator : Electric charge is stored in a capacitor &
then released in a controlled fashion.
Capacitor
Switch
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• When we deliver a shock-
switch completes circuit
from the capacitor
to electrodes
stored energy
in the capacitor is released
Current flows through the patient’s
chest & heart
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Current waveform delivered
Monophasic: Biphasic:
Current flows in one Current reverses direction
direction between between electrodes
electrodes during shock
Biphasic waveforms deliver both a
positive and a negative current on a
single application thus utilizing
significantly lower energy levels. 64
Current = Potential Difference
Resistance
↓
Resistance
Firm paddle
pressure
Proper ↑ Electrode
contact with size
gels
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• “Polarization of electrodes”
• If a DC voltage is applied between two body surface electrodes, current
flows through the tissues between them & positive and negative ions
migrate
• DC
Cathode Anode
• .
++++++++ --------
EMF which opposes the EMF that
set up the original current
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• This has 2 harmful effects:
• 1) accumulation of a local concentration of toxic ions near electrode
sites, can cause burns or tissue necrosis.
• 2)↑ed impedance attenuates the ECG signal for several seconds after
defibrillation or DC cardioversion.
Solution :
• Use of silver and silver chloride electrodes : “nonpolarisable”
• Application of prolonged DC voltage avoided.
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MEASUREMENT OF
FLOW
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• Flow (Q): Vol. of fluid passing a particular surface area per unit
of time
Flow (F) = Quantity (Q)
Time ( t)
• SI unit : m3/s
MC measured in mL/sec or L/min
• Sometimes written as ΔQ (rate of change of mass or volume).
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• Flow is affected by:
• Tube diameter : Flow α diameter
• Length : Flow α 1 .
length
• Viscosity : Measure of the "friction within the fluid"
Flow α 1 .
viscosity
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• The Hagan-Poiseuille equation brings together all of the
variables that determine flow
ΔQ = ΔP πd4 ΔQ - flow
128 η l P - pressure difference
d - diameter of tube
η - viscosity
l - length of tube
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FLOW
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• Molecules are moving in straight lines but they are not
uniform in their velocity
• If the mean velocity = v,
then the molecules at the centre of the tube are moving at 2v (twice
the mean),
whilst the molecules at the side of the tube are almost
stationary.
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Molecules are more disorganised and begin to swirl with the
formation of eddy currents
Flow is less ordered & eddy currents ↑ resistance.
Greater energy input is required for a given flow rate
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Reynolds number = v ρd
η
v = velocity
ρ = density
d = diameter
η = viscosity
< 2000 laminar flow.
2000-4000 transitional flow
>4000 turbulent
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• As the diameter ↑es, the Reynolds number increases.
• Eventually if the diameter ↑es enough, it will exceed the length of
the tube→orifice
Flow through tube Laminar Depends on viscosity
Flow through orifice Turbulent` Depends on density
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• Flowmeter
Constant pressure, variable orifice (tradename
”Rotameters”).
Cone shaped tubes
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• Bourdon tube : Constant orifice & variable pressure
• As flow Q increases, the gradient of P1 to P2 increases and causes
the flattened metal tube to uncoil and move the pointer
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Flowing fluids in tubes generate velocity and pressure
Pressure is a form of potential energy Flow/Velocity is a form of Kinetic energy
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Potential kinetic Total
(pressure) (flow) mechanic
energy energy al energy
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VENTURI
• A Venturi tube is a circular tube with a gradual contraction
and expansion in diameter
• Bernoulli effect:
For conservation of mass and energy to apply, as we restrict
the flow by narrowing the tube, the speed increases; the
pressure on the walls decreases to keep the total energy
constant.
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• Venturi mask
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• Nebulisers
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• Bain circuit
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• Humidifiers
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• New monitors are being developed almost
continuously, but new physical principles are
revealed only rarely.
• The science of physics is a constant effort to
understand, simplify, and predict their
behavior in quantitative terms
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THANK
YOU
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