Anaesthesia Machine

Done By:
    Bilal Al-Manasyeh
    Anas Satari
    Qabas Al-Hawamdeh
Anaesthesia Machine
• In recent years, the anaesthesia machine has been renamed the
anaesthesia delivery system, or anaesthesia workstation because
modern devices do more than simply delivering inhalational
anaesthesia.
• The term ‘‘Anaesthesia Machine’’ specifically refers to that component
of the anaesthesia delivery system that precisely mixes the compressed
and vaporized gases that are inhaled to control patient’s level of
consciousness , analgesia or both during surgical procedures.
Purposes of anaesthesia machine
• Provides oxygen 
• Accurately mixes anaesthetic gases & vapours 
• Enables patient ventilation 
• Minimizes anaesthesia related risks to patients & staff
Type of anaesthesia machine
• Continuous-flow anaesthetic machine or Boyle's machine :  which is
designed to provide an accurate supply of medical gases mixed with
an accurate concentration of anaesthetic vapour, and to deliver this
continuously to the patient at a safe pressure and flow.
• Intermittent-flow anaesthetic machines : which provide gas flow only
on demand when triggered by the patient's own inspiration.
Component of anaesthesia machine

• Oxygen source 
• Flowmeter 
• Vaporizer 
• Patient breathing circuit 
• Scavenging system 
• Heads-up display 
Medical gases

• The medical gases commonly used in operating rooms are oxygen,

nitrous oxide, and air. 
• Gases used in anaesthesia are usually supplied under high pressure
either in cylinders or as a piped gas supply. 
Characteristics of Medical Gas Cylinders
Pipelines
• Medical gases are delivered from their central supply source to the
operating room through a piping network. 
• The tubing is colour-coded and connects to the anaesthesia machine
through a non-interchangeable diameter-index safety system (DISS)
fitting that prevents incorrect hose attachment. 
• The anaesthetist should check that the pipeline pressure displayed on
the anaesthetic machine should indicate 400 kPa.
Flowmeters and gas flow regulation
• Valves
• Needle valves
• As the valve is opened, the orifice around the needle becomes larger
and flow increases.
Flowmeters
• Tapered glass tube containing a bobbin or ball, which floats
on the stream of moving gas. 
• Flowmeters are specifically constructed for each gas, since
the flow rate depends on both the viscosity and density of the
gas.
• Inaccuracy in flowmeters are due to:
    - The tube not being vertical.
    - Back-pressure, from for example, a ventilator. 
    - Static electricity causing the float to stick to the tube. 
    - Dirt causing the float to stick to the tube
 Bobbins and balls

Bobbin flowmeter, reading 2 L/min        Ball-float flowmeter, reading 2 L/min

Vapourisers
• The purpose of an anaesthetic vaporiser is to
produce a controlled and predictable
concentration of anaesthetic vapour in the
carrier gas passing through the vaporiser. 
• Most vaporisers are of the plenum type, which
consists of a vaporising chamber containing the
liquid anaesthetic, and a bypass. 
• Gas passing through the vaporising chamber
volatilises the anaesthetic and is then mixed
with the anaesthetic-free gas bypassing the
chamber, the proportion of vapour-containing
gas and bypass gas being controlled by a tap.
Factors affecting vaporiser output

• Flow through the vaporising chamber

• Efficiency of vaporization
• Temperature Time 
• Gas flow rate
• Carrier gas composition 
• Ambient pressure
 Breathing Circuits
• Breathing circuits link the patient to the anaesthesia machine.
Therefore, The function of the circuit is to; deliver Oxygen and
anaesthetic gases to the patient, providing  humidity and warmness
to inspired gases, and to eliminate Carbon Dioxide. 

• Types of Breathing Circuit:

     - Insufflation
     - Open-Drop Anaesthesia
     - Draw-Over Anaesthesia
     - Mapleson's Circuits
     - The Circle System
• INSUFFLATION: the blowing of anaesthetic gases across a patient’s face, avoiding
direct connection between a breathing circuit and a patient’s airway. It used
mainly in children. 

• OPEN-DROP ANESTHESIA: Ether or Chloroform dripped onto a gauze-covered

mask, then applied to the patient’s face. Not used in modern medicine.

• DRAW-OVER ANESTHESIA: nonrebreathing circuits that use ambient air as the

carrier gas.

• The insufflation and draw-over systems have several disadvantages:

   - poor control of inspired gas concentration (poor control of depth of anesthesia)
   - mechanical drawbacks during head and neck surgery
   - pollution of the operating room with large volumes of waste gas
Mapleson's Circuits

• Is preferable than Insufflation and Draw-over systems; as it solves some

of their disadvantages.
• The relative location of these components determines circuit
performance and is the basis of the Mapleson's classification.
• Classified into 6 types (A, B, C, D, E, and F).
• The main goal is to assist respiration and prevent rebreathing.
• Components:-

    Corrugated Breathing Tubes made of

either; rubber (reusable)
or plastic (disposable) , this creates a low-
resistance pathway and a potential reservoir for
anesthetic gases.
    Fresh Gas Inlet (FGI)
    Adjustable Pressure-Limiting Valve (APL
Valve, Pressure-Relief Valve, Pop-Off Valve) ;
allows gases to exit the circuit as pressure rises.
  - Open in Spontaneous Breathing 
  - Partially closed in Controlled Breathing

    Waste-gas Scavenging System; for exiting

gases.
    Reservoir Bag (Breathing Bag); a reservoir
for the anaesthetic gas, and a method for
positive pressure ventilation.
    Patient Connection (I.e., Face Mask)
• It consist of a three-way T-tube connected to the fresh gas outlet
(F), a breathing bag (B) and a reservoir tube (R). The other end of
the reservoir tube is connected to the patient (P) and a spring-
loaded expiratory valve (V).
Mapleson's A (Magill Circuit)
• FGI is near reservoir bag, APL valve is near face mask.
• The most efficient Mapleson's circuit for spontaneous ventilation. 
• Poor choice during controlled ventilation.
• Enclosed Magill system is a modification that improves efficiency. 
• Coaxial Mapleson A modification (Lack's Circuit) provides waste gas
scavenging.
 Mapleson's B
• FGI and APL valve are close to face mask (FGI being just distal to APL valve).
• Fresh gas flows are conveniently available because the FGI is near the APL valve.  
• In order to prevent rebreathing fresh gas flow should be around 20-25L/min.
• Mapleson's A is more efficient.
 Mapleson's C (Waters’ to-and-fro)
• Similar to Mapleson's B, but it has a shorter breathing tube.
• It does not have a corrugated tube.
 Mapleson's D
• Interchanging the position of APL and FGI transforms Mapleson's A into D.
• It is efficient during controlled ventilation; since fresh gas flow forces alveolar air
away from the patient and toward the APL valve. This alters the fresh gas requirements.
• It is also modified into Bain circuit. 
 Bain Circuit
• It is a popular modification of the Mapleson's D
system.
• A coaxial version of the Mapleson's D system
that incorporates the FGI tubing inside the
breathing tube. 
• This decreases circuit's bulk and
retains efficiently the heat and humidity
(inspired gas is warmed by the expired gas).

• Disadvantage: the possibility of kinking or

disconnection of FGI tube.
 Mapleson's E (Ayre’s T-piece)
• Does not have an APL valve nor a Reservoir bag. FGI is near to patient's mask.
• Exhalation tubing should provide a larger volume than tidal volume to prevent
rebreathing. Scavenging is difficult.
• Not good for spontaneous breathing.
• Used for pediatric patients weighted up to 30 Kg.
 Mapleson's F (Jackson-Rees’ modification)
• It is a Mapleson E with an open-ended reservoir bag connected to the end
of the breathing tube (operator end) , it allows controlled ventilation and
scavenging.
• Does not have an APL valve.
• Requires higher fresh gas flow.
• Not good for spontaneous breathing.
 The Circle System
• The Circle System aids the breathing system by avoiding the problems that are caused
the Mapleson's circuits (as; waste of anaesthetic agent, pollution of the Operating Room,
loss of patient's heat and humidity) and this is achieved by adding components to the
breathing system, as:
  
     - CO2 Absorber & Absorbent
     - FGI
     - Unidirectional Valves; Inspiratory & Expiratory
     - Breathing tubes; Inspiratory & Expiratory
     - Y-shaped connector
     - APL Valve
     - Reservoir Bag
     - Right angle (90°) connector
     - Ventilation Mask
• Carbon Dioxide Absorbent: to avoid hypercapnia
upon rebreathing alveolar gas (reserves heat and
humidity).
   Soda Lime (more common) and Barium Hydroxide
Lime are known absorbents.

• Unidirectional Valves: contains a ceramic or mica

disk resting horizontal on an annular valve seat, this
prevents reflux of gas in the circuit.
• The essential features of the circle absorber are:
    - Carbon dioxide absorber canister (C)
    - Breathing bag (B)
    - Unidirectional inspiratory (Vi) valve
    - Unidirectional expiratory (Ve) valve
    - Fresh gas supply (F)
    - Pressure-relief valve (V)  

• N.B.
   * The breathing system most used with anaesthesia machines is the Circle System.​
   * Bain circuit is occasionally used.​
Mechanical Ventilation 
• Ventilators generate gas flow by creating a pressure gradient between the
proximal airway and the alveoli.
• All modern anaesthesia machines are equipped with a ventilator, and they
usually have the double circuit system design (Pneumatically powered and
electronically controlled).
• Older units relied on the generation of negative pressure around and inside the
chest (e.g., iron lungs), whereas modern ventilators generate positive pressure
and gas flow in the upper airway.
• Types:-
   - Positive Pressure Ventilators
   - Negative Pressure Ventilators
Positive Pressure Ventilators
• The lungs are intermittently inflated by positive pressure
generated by a ventilator, and gas flow is delivered to the
airway.
• Able to use endotracheal or tracheostomy tube. 
• Volume-cycled ventilation 
    The ventilator delivers a pre-set tidal volume regardless of
the pressure generated. 
• Pressure-pre-set ventilation 
    The ventilator delivers a pre-set target pressure to the
airway during inspiration. The resulting tidal volume
delivered is therefore determined by the lung compliance
and the airway resistance.
Negative Pressure Ventilators (Iron Lungs)
• Applied negative pressure around the body or thoracic cavity; the
body of the patient is enclosed in an iron box or cylinder, and the
patient’s head protruded out of the end. 
 Humidification
• Prevention of cilial damage and reduced drying of secretions.
• As prolonged severe dehydration of the bronchial tree leads to
encrustation of mucus and bronchial or endotracheal obstruction,
particularly in neonates and patients with respiratory infection.
• Humidifiers added to the breathing circuit minimize water and heat loss.
• Prolonged humidification of gases by the lower respiratory tract leads to
dehydration of mucosa, altered ciliary function, and, if excessively
prolonged, could potentially lead to inspissation of secretions, atelectasis,
and even ventilation/perfusion mismatching, particularly in patients with
underlying lung disease.
• Types:-

        Passive: The simplest designs are condenser humidifiers or heat and moisture

exchanger (HME) units. They do not add heat or vapor but rather traps exhaled
humidification and heat, which is released upon the subsequent inhalation.

        Active: More effective in preserving moisture and heat. They add water to gas, by; 
   - passing the gas over a water chamber (pass-over humidifier) 
   - saturated wick (wick humidifier)
   - bubbling through water (bubble-through humidifier) 
   - mixing it with vaporized water (vapor-phase humidifier)

• Disadvantages of Humidifiers
  - Disconnection 
  - Overheating
  - Overhydration 
  - Infection
  - Circuit resistance 
  - Interference with other devices
Thank You