anesthesia machine intro 2011
TRANSCRIPT
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ADS1 Ready JHP
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Anesthesia MachineIntroduction
James H. Philip, MEE, MD, CCE Anesthesiologist, Director of Bioengineering
Brigham and Women’s Hospital
Associate Professor of AnaesthesiaHarvard Medical School
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PatientAnesthetist
OR
HospitalWorld
Work-station
observe(senses)
touch
Care Info(lab data,ima e..)
touchobserve(eyes, ears)
ADS, monitors,PIMS
Inhalant Drugs
IV Drugs, FluidsOther
Monitoring
requests
Clinic
CaInteraction
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PatientAnesthetist
OR
HospitalWorld
Work-station
observe(senses)
touch
Care Info(lab data,ima e..)
touchobserve(eyesears)
ADS, monitors,PIMS
Inhalant Drugs
IV Drugs, FluidsOther
Monitoring
requests
Clinic
CaInteraction
Anesthesia Delivery System
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Workstation - Patient Interactions
Airway control
BreathingCirculation
Drug delivery for anesthetization
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Workstation - Patient Interactions
Airway control
Breathing - safe gasesCirculation
Drug delivery for anesthetizationvapors, gases, IV
Intravenous Liquid DeliveryMonitoring
Recording
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ADS - Patient Interactions
Breathing - safe gases
Drug delivery for anesthetizationvapors, gases
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Anesthesia Machine Evolution
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1846 Morton Ether Inhaler
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Inhaler had limitations
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1846 version
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This 1850 version
worked horizontalwith no hands required
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Open Circuit Inhaler
Open Circuit = Non-rebreathingPatient breathes in the ether vapor,
breathes ether out (and it is discarded)Breathes in new ether vapor
Breathes it out again (discarded)
M l R it t
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Manual Resuscitator
Open Circuit =
non-rebreathing Circuit =
what you set is what you getWhat you put into the circuit is what the patient gets
Give sufficient 100% oxygen flow to the reservoir bag(not to empty)
Reservoir bag gives 100% oxygen to the breathingbag
The Tidal Volume and Minute Ventilation isdetermined by the size and frequency of thesqueeze of your hand and a perfect seal.
Breathing
“circuit”
M l R it t
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Manual Resuscitator
One-way valves make sure gas flows to the patient
A special valve allows exhaled gas to be removed
Breathing
“circuit”
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Manual Resuscitators
Bag Reservoir Hose Reservoir
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A bag reservoir
lets you see itprovides 100%
oxygen to thebreathing bag by
never emptyingandnever entrainingroom airBag Reservoir
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Partial Rebreathing Circuits are
used in AnesthesiaDon’t throw away all the exhaled gas
It contains expensive anesthetic vaporsReuse as much as possible
somehow (learn more later)Remove (Absorb) CO2 and
Rebreathe the anesthetic
Partial rebreathing = semi-closed circuit
All ADSs use them
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Rebreathing Ventilation
Is not for dummiesRequires knowledge and skill
Makes us different from other care providersEMT, Sedation RN,ED MD, Hospitalist,Others
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1890added a
BreathingCircuit
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1925
Draeger
1927
Foregger added CO2
absorbsion
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1950added
a worksurface
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Then,Drawers,
Temperature-compensatedvaporizers,
Circuit, Absorber,
Common
gasoutlet
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1990Integrated
Monitors
andData
Recording
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GE-Datex-
OhmedaCentralDisplay
(CD) ADS
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2000
Better ventilation for difficult patientsFGF-independent ventilationCorrects for circuit leaks
More sensitive to water vapor Monitors not integrated
2000
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2000
GE Aestiva
At BWH, now in
L&D andMOR for HeliOx
for ENT Surgerywhere low densityHelium moves throughnarrow orifices
2000
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2000Draeger
Fabius(BWH
many ORs)
2005-2010 state-of-the-ar
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2005-2010 state-of-the-ar
GE Aisys MOR -many rooms
Draeger Apollo GS
MOR - 6 rooms
Not yet for CA1s
Basics of the Anesthesia Delivery System
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Basics of the Anesthesia Delivery System
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Anesthesia Delivery System - ADS
Anesthesia MachineBreathing Circuit
Ventilator
A th i M hi
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Anesthesia Machine
delivers gases and vaporsinto a breathing circuit 2001
Provides continuous flow of -
Oxygen for Life
Air to safely lower FIO2
Nitrous Oxide for partial anesthesia
Agent vapor for complete or partial anesthesia
(Continuous Flow) Anesthesia Machine
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N O2 O2Air
(Continuous Flow) Anesthesia Machine
Vaporizer
12 3..
5
21
3
4
6
78
9
21
3
4
6
78
9
55
21
3
4
6
78
9mL/mL/mL/mL/m
300
200
100
400
50
600
900
000
Isoflurane
SevofluraneDesflurane FGF
(Fresh
Gas
Flow)
Common
Outlet
Flow Tubes
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Flow Tubes
Oxygen and Gas Delivery
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Oxygen and Gas Delivery
Mechanical
Physical knobs
Rotameters,
GE Aestiva, Aespire
Oxygen and Gas Delivery
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Oxygen and Gas Delivery
Mechanical
Physical knobs
Rotameters, Digital meters
Draeger Fabius
Draeger Apollo
Draeger Fabius
Draeger Apollo
Oxygen and Gas Delivery
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Oxygen and Gas Delivery
Electronic
Virtual knobs
Digital meters
GE Avance, Aisys
% Oxygen in FGF
NOT inspired - be careful
GE Avance, Aisys
V i T
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Vaporizer Types
MechanicalPenlon Sigma for isoflurane, sevofluraneGE Tec 3,4,5,7 for isoflurane, sevoflurane
GE Tec 6 for desflurane (electro-mechanical)Draeger Vapor 19, 2000 for all agentsDirect-reading, temperature-compensated
ElectronicGE Aladin for all agents
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Anesthesia Machine
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AnesthesiaMachineSchematic
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AnesthesiaMachineSchematic
N2OSERVICE
SIMPLIFIED ANESTHESIA MACHINE SCHEMATIC DIAG
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O2
2000psi
O2
SERVICEINLET55psi
35 psi
35 psi
50 or 250ml/min
NEEDLEVALVE
FAILSAFEVALVE
CALIBRATEDVAPORIZERS
Fresh Gas Flow (
OXYGENFLUSHVALVE[first]
ON/OFFSWITCH
CHECK VALVE PRESSURE
REGULATOR
SERVICEINLET55 psi
O2
N2O
FREGAS
Flush Flow(last)
[Anesthetizinggases flow]
COMMON
OUTLET
N2O
750psi
N2O
750psi
O2
2000psi
FILTER
WALL
DISSdiameter
indexsafetysystem
CONNEC- TION
O2
N2O
DS I
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Patient Breathing Circuit
Allows cyclic flow
To and from the patient(AKA Breathing)
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Patient Breathing Circuit
First address spontaneous
and manual ventilation
C
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Circle absorption anesthetic
breathing circuit
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flipped
The Circle-Absorber System
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Sampled
Exhaust
Expired
CO2
Ab-
sorb-ant
200 mL/min
InspiredFresh
Gas Flows
Rebreathed
The Circle-Absorber System
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Exhaust
Expired
CO2
Ab-
sorb-ant
200 mL/min
InspiredFresh
Gas Flows
Rebreathed
The Circle-Absorber System
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Exhaust
Expired
CO2
Ab-
sorb-ant
InspiredFresh
Gas Flows
Rebreathed
The Circle-Absorber System
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Exhaust
Expired
CO2
Ab-
sorb-ant
InspiredFresh
Gas Flows
Rebreathed
To Patient
The Circle-Absorber System
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Exhaust
Expired
CO2
Ab-
sorb-ant
InspiredFresh
Gas Flows
Rebreathed
From Patient
The Circle-Absorber System
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Exhaust (APL)
Expired
CO2
Ab-
sorb-ant
InspiredFresh
Gas Flows
Rebreathed
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The Circle-Absorber System
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Exhaust (APL)
Expired
CO2
Ab-
sorb-ant
InspiredFresh
Gas Flows
Rebreathed
Manual ventilation requires Exhaust Pressure > 0
The Circle-Absorber System
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Exhaust (APL)
Expired
CO2
Ab-
sorb-ant
InspiredFresh
Gas Flows
Rebreathed
Gases (O2, N2O, Agent)
The Circle-Absorber System
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Exhaust
Expired
CO2
Ab-
sorb-ant
InspiredFresh
Gas Flows
Rebreathed
Gases
No CO2
rebreathed
The Circle-Absorber System
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Exhaust
Expired
CO2
Ab-
sorb-ant
InspiredFresh
Gas Flows
Rebreathed
Gases
No CO2
No
The Circle-Absorber System
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Exhaust
Expired
CO2
Ab-
sorb-ant
Inspired
Fresh
Gas Flows
RebreathedGases
No CO2
The Circle-Absorber System
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Exhaust
Expired
CO2
Ab-
sorb-ant
Inspired
Fresh
Gas Flows
VE
Gas is sampled from circuit near patient for I/E measure
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Sampled
Exhaust
Expired
CO2
Ab-
sorb-ant
200 mL/min
Inspired
Fresh
Gas Flows
VE
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Mechanical Ventilation
Set with a switch (Elec or Mech)Exhaust Valve is out of circiut
Reservoir bag isIn circuit with Draeger piston
Out of circuit with GE bellows
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Low FGF
More rebreathing
Inspired more dependent on Expired
Inspired less influenced by Vaporizer
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The Anesthesia Workspace
Draeger Apollo
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GE Aisys at BWH
Workspace Setup
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MRSMAIDMachine
Room
Suction
Monitors
Airway
I V
Drugs
Workspace Setup
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MRSMAIDMachine
Room
Suction
Monitors
Airway
I V
Drugs
Workspace Setup
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MRSMAIDMachine
RoomSuction
Monitors Airway
I VDrugs
Suction off if:
DISS hose unscrewedWall switch off
Hose disconnect from Canister
Canister switch off
Insert seated incorrectly
Any hole open
Flap valve closed
because unit was shaken
or canister is full
Flexible hose kinkedFlexible hose stepped on
Perform Machine-Assisted Tests
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GE Modulus 2 Plus - none
GE Aestiva - Minor 12 Hour switch off and on
Circuit Oxygen Sensor Cal via SmartVent ventilator
GE Aisys - Major Most circuit tests are automated
Bellows volume & pressure can feel the circuitand make great ventilation modes
Draeger Fabius - Major
Most circuit tests are automatedVentilator Piston can feel the circuitand make great ventilation modes
Draeger Apollo – Major
almost everything
CALIBRATE OXYGEN
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MONITOR
Oxygen Monitor on & sensor in air with hole plugged.
Calibrate to 21%. Reconnect sensor in circuitThere is no separate oxygen monitor on Aisys or Apollo
These include integrated gas monitoring including FiO2
obtained by sampling the gas at the wye (AKA “ Y” )The separate sensor is a Clark Electrode
The sampled gas monitor is
Polarographic for the symetrical oxyen molecule andInfra-red absorbsion for all other assymetrical moleculesCO2, N2O, Isoflurane, Sevoflurane, Desflurane
CHECK MACHINE FOR GAS
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DELIVERYMachine On
Oxygen flows smoothly
Disconnect oxygen hose
Oxygen alarm sounds
Switch ON oxygen tank. Verify P > 1000 psi and Alarm
silences.
Tank off with wrench
Turn oxygen flow up
Alarm sounds oxygen failure
Connect oxygen hose to silence alarm.
Turn up nitrous and observe alarm and/or control.Negative Pressure Test - later
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CHECK CIRCUIT FOR INTEGRITY
Attach circuit including reservoir bag
Occlude “ Y” with thumbFlush and fill bag to 30 cmH2O.
Test pressure alarms
Open relief valve and verify that reservoir bag empties
Observe scavenger bag fil l and empty
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CHECK FUNCTION
CHECK VENTILATOR FOR FUNCTION
Ventilate Test Bag and observe no volume loss.
CHECK SCAVENGER FOR FUNCTION
Check that reservoir bag fil ls and empties. Check valvesnot stuck.
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This pre-use check is basic
We believe this will keep you and your patient safe
for the next few weeksFollowing the automated tests on Fabius, Aisys, Apollo
wil l test all the functions of your anesthesia machine
We will have an Anesthesia Machine Workshopnext month
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Thank you
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