AN APPROACH TO ANAESTHESIA

WORKSTATION
MODERATORS:
DR.B.SOWBHAGYA LAKSHMI,MD
PROFESSOR IN DEPT. OF ANAESTHESIOLOGY

DR.KRISHNA PRASAD,MD
ASSISTANT PROFESSOR

PRESENTED BY
DR.SIRISHA ANAPARTHI
PG IN ANAESTHESIOLOGY

 NO EQUIPMENT IS MORE INTIMATELY

ASSOCIATED WITH THE PRACTICE OF
ANAESTHESIOLOGY THAN THE
ANAESTHESIA MACHINE

THE ANAESTHESIA MACHINE

The anaesthesia
machine is a device
which delivers a
precisely-known but
variable gas mixture,
including anaesthetizing
and life-sustaining
gases.

HISTORY
The original concept of Boyle's machine was
invented by the British anaesthetist H.E.G. Boyle
in 1917. Prior to this time, anaesthetists often
carried all their equipment with them, but the
development of heavy, bulky cylinder storage and
increasingly elaborate airway equipment meant
that this was no longer practical for most
circumstances. The anaesthetic machine is
usually mounted on anti-static wheels for
convenient transportation.

HISTORY :
1917 Boyle machine with a water sight
feed type of flowmeter is introduced by
Henry Edmund Gaskin Boyle.
1920 A vapourizing bottle is incorporated
to the machine.
1926 A 2nd vaporizing bottle and by-pass
controls are incorporated.
1930 A Plunger device is added to the
vaporizing bottle.
1933 A dry-bobbin type of flowmeter is
introduced.
1937 Rotameters displayed dry-bobbin
type of flowmeters

Anesthetic Machines
Anesthetic machines began appearing at the end of the 19th century
Early anesthetic machines were utilized in dental anesthesia for
administration of N2O and O2
Initial machines were either:
Continuous flow continuous flow throughout inspiration and
expiration (eg. Heidbrink, Foregger, Boyle)
Intermittent flow flow of gas during inspiration only (eg.
McKesson)
Machines evolved to incorporate reducing valves, flow meters,
vaporizers and circuits with carbon dioxide absorption

Boyle Anesthesia Apparatus c. 1920

Modification of original machine
developed by Dr. Henry Boyle in 1917
Coxeter dry flow meter allowed
proportioning of O2, CO2 & N2O
Two glass vaporizing bottles
Bottom illustrations:
Case with accessories
Machine stand with four cylinder
yokes (2 each for N2O and O2) +
carrying handle

116a, 117

Foregger Metric Gas Machine

Montreal Model c. 1924
Modification of Richard von Foreggers
original metric gas machine for use with
cyclopropane
Eliminated reserve gas tanks, with
exception of O2, because of the
increased use of CO2 absorbers

Wet flowmeters used water

displacement to provide accurate
measurement while introducing
humidity to reduce the risks of interior
static

23

Waters Cannisters
(Waters to and fro) c. 1930
Ralph M Waters began experiments with CO2
absorption in 1915
Developed to and fro system through
which inspired and expired gases were
directed
Metal cylinder was packed with absorbent
alkaline granules resulting in economy of
gas use along with heat and moisture
conservation

109 a-c

McKesson Nargraf Machine

(Model H) c. 1920
Modification of Dr. E I McKessons Model A
machine of 1910
Reducing valves admit N2O and O2 into two
bags enclosed in metal drums at equal
pressures
Gases pass to percentage mixing chamber
with proportion controlled by dial
Intermittent flow is dependant upon patients
inspiration

119

Heidbrink Apparatus
(mixing head only) c. 1930
Modification of Dentist Jay
Heidbrinks original apparatus
introduced in 1912 for administration
of N2O and O2 primarily for dental
anaesthesia
Proportioning device and valves
reduced cylinder pressure of tank
gases to working pressures

143

Midget Kinet-O-Meter c. 1940

Modification of Dr. Heidbrinks earlier
apparatus to administer N2O / O2 for
dental anesthesia
Flow meter panel calibrated for oxygen,
nitrous oxide and cyclopropane along
with four cylinder yokes (two each for O2
and N2O)
Mounted on a pole to which chart stand
support is attached

118

OUTLINE
The Machine
Gas Supply Systems:
Hospital pipeline
Cylinder
High Pressure System (exposed to cylinder pressure)
Intermediate Pressure System (exposed to pipeline press)
Low Pressure System (distal to flowmeter needle valve)
Circle System
CO2 Absorber System
Unidirectional Valves
Ventilator
Scavenger System

The Machine
Ohmeda

N.A.Drager (Narkomed)

Anesthesia Machine:
Jackson Memorial Hospital

ventilator

Flow
meter
bellow

vaporizer

APL valve
Corrugated
tube

Soda lime

Scavenging
system

Basic Schematics

The Anesthesia Machine

High

Intermediate

Low Pressure Circuit

PNEUMATIC SYSTEM
1. HIGH PRESSURE
a. Hanger Yoke
b. Power Failure Indicator
c. Pressure Regulators
2. INTERMEDIATE PRESSURE SYSTEM
a. Master Switch (Pneumatic
component)
b. Pipeline Inlet Connections
c. Pipeline Pressure Indicators
d. Piping
e. Gas Power Outlet
f. Oxygen Pressure Failure Devices
g. Gas Selector Switch
h. Second-Stage Pressure Regulator
i. Oxygen Flush
j. Flow Adjustment Control

3. LOW PRESSURE SYSTEM

a. Flowmeters
b. Hypoxia Prevention Safety Devices
c. Unidirectional (Check) valve
d. Pressure Relief Device
e. Low-Pressure Piping
f. Common (fresh) Gas Outlet
4.ALTERNATIVE OXYGEN CONTROL

Gas Supply Systems

Hospital Pipeline

Pipeline Trouble
Pipeline sources are not trouble free:
contamination (particles, bacteria, viral,
moisture), inadequate pressure, excessive
pressures, and accidental crossover (switch
between oxygen and some other gas such as
nitrous oxide or nitrogen) are all reported.

DISS
Pipeline inlets are connected with DISS
(diameter index safety system) noninterchangeable connections.
The check valve, located down stream
from the pipeline inlet, prevents reverse
flow of gases (from machine to pipeline,
or to atmosphere), which allows use of
the gas machine when pipeline gas
sources are unavailable.

PISS

PISS (pin-index safety system) prevents misconnection of a

cylinder to the wrong yoke. Keep cylinders closed except when
checking machine, or while in use (if O2 from pipeline is
unavailable)

Diagram showing
the index positions
of a cylinder valve.
Oxygen: 2 & 5
Nitrous oxide: 3 & 5
Air: 1 & 5
CO2: 1 & 6

Color coding of medical gas cylinders and their

pressure when full
Name of the gas

Body colour

Shoulder colour

Pressure (kPa)
(At room temp)

Oxygen

Black

White

13700

Nitrous Oxide

Blue

Blue

4400

Carbon dioxide

Grey

Grey

5000

Air

Grey

White/black
quarters

13700

Entonox

Blue

White/blue quarters

13700

Oxygen/helium

Black

White/brown
quarters

13700

LAPSE IN MAINTENANCE
Sudbury Ontario in the 1970s: 23 people died
because the N20 and O2 pipelines were crossed
over during repairs

Gas Supply Systems

Cylinder
Pin Index Safety System:

O2 2,5

N2O 3,5

High Pressure System

(parts which receive gas at cylinder pressure)
hanger yoke (including filter and unidirectional
valve)
yoke block (with check valves)
cylinder pressure gauge
cylinder pressure regulators

Hanger Yoke & Check Valve

Hanger Yoke
orients cylinders
provides
unidirectional flow
ensures gas-tight
seal.

Check Valve
minimize transfilling
allows change of
cylinders during use
minimize leaks to
atmosphere if a
yoke is empty.

CHECK VALVES

The check valve, located down stream from the

pipeline inlet, prevents reverse flow of gases
(from machine to pipeline, or to atmosphere),
which allows use of the gas from cylinder when
pipeline gas sources are unavailable.

Check Valve

CYLINDERS
The cylinder pressure regulator converts high,
variable cylinder pressure to a constant pressure
of approximately 45 psi downstream of the
regulator.
This is intentionally slightly less than pipeline
pressure, to prevent silent depletion of cylinder
contents if a cylinder is inadvertently left open
after checking its pressure.
Cylinder pressure gauge indicates pressure in the
higher-pressure cylinder only (if two are opened
simultaneously).

Anesthesia Components
Anesthesia Machine
Frame

Regulator
Placed on O2 tanks to decrease pressure from
tank
2 types of tanks
E Tanks
650L @ 1800PSI
H Tanks
7100L @ 2200PSI

Output pressure
adjusted with knob

E cylinder Characteristics
Gas US (International)
O2
N2O
Air

Green (white)
Blue
(blue)
Yellow (B & W)

PSI

Capacity (L)

PISS

1900
745
1900

660
1590
625

2-5
3-5
1-5

**** Well use 2000psi for O2 instead of 1900psi****

HOW LONG BEFORE

O2 TANK IS EXHAUSTED???
-The time to exhaustion is calculated by dividing
the remaining O2 volume in the cylinder by the
rate of consumption of O2.
-Remaining volume in liters (L) in an E-cylinder
is calculated by dividing the cylinder pressure in
psig by 2000 psig and multiplying by 660 L.

EXAMPLE
If cylinder gauge reads 1,000 psig, this represents
(1000/2000) X 660 = 330 L left in that tank. The rate of
consumption of O2 during mechanical ventilation is the
sum of the O2 flow meter setting and the patients
minute ventilation (VT in L x RR in breaths/min).
If FGF is 0.5 L/min O2 and 1.0 L/min N2O and VT is 0.7
L and RR is 10 bpm, then the minute ventilation is
7 L/min (0.7L x 10 bpm)
* The total O2 consumption is 7.5 L/min. The expected
time to exhaustion is thus approximately 330 L divided
by 7.5 L/min = 44 min (ignoring the gas sampled by the
gas analyzer and leaks)

Intermediate Pressure System

Hospital Pipeline
Outlets

Machine piping guts

Hospital Pipeline
Inlets

Gauges-pipeline (intermediate press. )

Intermediate Pressure System

(receives

gases at low, relatively constant pressures (37-55

psi, = pipeline pressure)
(*For consistency well use 50 psi)
pipeline inlets and pressure gauges
ventilator power inlet
Oxygen pressure-failure device (fail-safe) and alarm
flowmeter valves
oxygen second-stage regulator
oxygen flush valve

OXYGEN PRESSURE FAILURE DEVICES

A Fail-Safe valve is present in the gas line supplying
each of the flowmeters except O2. This valve is
controlled by the O2 supply pressure and shuts off
or proportionately decreases the supply pressure of
all other gasses as the O2 supply pressure decreases
Historically there are 2 kinds of fail-safe valves
Pressure sensor shut-off valve (Ohmeda)
Oxygen failure protection device (Drager)

OXYGEN PRESSURE FAILURE DEVICES

Machine standard requires that an anaesthesia
machine be designed so that whenever the
oxygen supply pressure is reduced below normal,
the oxygen concentration at the common gas
outlet does not fall below 19%

PRESSURE SENSOR SHUT-OFF VALVE

Oxygen supply pressure opens the valve as long as

it is above a pre-set minimum value (e.g. 20 psig).
If the oxygen supply pressure falls below the
threshold value the valve closes and the gas in that
limb (e.g. N2O) does not advance to its flowcontrol valve.

Pressure Sensor Shut-Off Valve

OXYGEN FAILURE PROTECTION DEVICE

(OFPD)
Based on a proportioning principle rather than a
shut-off principle
It shuts off or proportionately decreases &
ultimately interrupts supply of N2O if O2 supply
pressure decreases
The pressure of all gases controlled by the OFPD will
decrease proportionately with oxygen pressure.

Oxygen Failure Protection

Device (OFPD)

OXYGEN SUPPLY FAILURE ALARM

The machine standard specifies that whenever
the oxygen supply pressure falls below a
manufacturer-specified threshold (usually 30
psig), a medium priority alarm shall blow within
5 seconds.

Limitations of Fail-Safe Devices/Alarms

Fail-safe valves do not prevent administration of
a hypoxic mixture because they depend on
pressure and not flow.
These devices do not prevent hypoxia from
accidents such as pipeline crossovers or a
cylinder containing the wrong gas

Contd.
These devices prevent hypoxia from some
problems occurring upstream in the machine
circuit (disconnected oxygen hose, low oxygen
pressure in the pipeline and depletion of the
oxygen cylinder)
Equipment problems that occur downstream
(for example leaks or partial closure of the
oxygen flow control valve) are not prevented by
these devices.

Oxygen Flush Valve (O2+)

Receives O2 from pipeline
inlet or cylinder reducing
device and directs high,
unmetered flow directly to
the common gas outlet
(downstream of the
vaporizer)
Machine standard requires
that the flow be between 35
and 75 L/min
The ability to provide jet
ventilation
Hazards
May cause barotrauma
Dilution of inhaled anesthetic

Second-Stage Reducing Device

Located just upstream of the flow control valves
Receives gas from the pipeline inlet or the
cylinder reducing device and reduces it further
to 26 psig for N2O and 14 psig for O2
Purpose is to eliminate fluctuations in pressure
supplied to the flow indicators caused by
fluctuations in pipeline pressure

LOW PRESSURE SYSTEM

Extends from the flow control valves to the
common gas outlet
Consists of:
Flow meters
Vaporizer mounting device
Check valve
Common gas outlet

Flowmeters
-Thorpe tube is an older term for flowmeters.
-Components: needle valve, indicator float, knobs, valve
stops.
-Flow increases when the knob is turned counterclockwise
(same as vaporizers).
-At low flows, the annular-shaped orifice around the float is
(relatively) tubular so (according to Poiseuille's Law) flow is
governed by viscosity. (laminar flow)
-At high flows (indicated on the wider top part of the float
tube), the annular opening is more like an orifice, and
density governs flows. (turbulent flow)

Low Pressure System

Distal to Flowmeter Needdle Valve
Flow Meters- measures and indicates the rate of gas flowing through it.
Variable orifice/Thorpe tube-constant press. flow meters.
Rate of flow r/t: 1) pressure drop across the constriction
2) size of annular opening
3) Physical properties of the gas
(viscosity and density)

Indicator, float or bobbin-

FLOW

1) rotometers
2) non-rotating floats
3) ball floats
Sequence of flowmeters tubes is very important
to decrease chance of hypoxic mixture.,
Gas flow is from left to right, O2 on right side.
Any leak in flowmeters will vent other gas out or
entrain air before O2 is added to gas mixture decreasing
chance that O2 will be lost or diluted.

Flowmeter assembly
When the flow control valve is
opened the gas enters at the
bottom and flows up the tube
elevating the indicator
The indicator floats freely at a
point where the downward
force on it (gravity) equals the
upward force caused by gas
molecules hitting the bottom
of the float

Arrangement of the FlowIndicator Tubes

In the presence of a flowmeter leak

(either at the O ring or the glass
of the flow tube) a hypoxic mixture
is less likely to occur if the O2
flowmeter is downstream of all
other flowmeters
In A and B a hypoxic mixture can
result because a substantial
portion of oxygen flow passes
through the leak, and all nitrous
oxide is directed to the common
gas outlet
* Note that a leak in the oxygen flowmeter
tube can cause a hypoxic mixture, even
when oxygen is located in the
downstream position

CONTD.
Needle valve can be damaged if it is closed
with force
Flowtube (Thorpe tube) is tapered (narrower
at bottom) and gas-specific
If gas has 2 tubes, they are connected in series
with a single control valve

CONTD
Care of flowmeters includes ensuring that:
floats spin freely
qualified service personnel regularly maintain gas
machines
an O2 analyzer used always (of course, the readings are
erroneous during use of nasal cannula)
one never adjusts a flowmeter without looking at it
one includes flowmeters in visual monitoring sweeps
one turns flowmeters off before opening cylinders,
connecting pipelines, or turning machine "on".

Proportioning Systems

Mechanical integration
of the N2O and O2
flow-control valves
Automatically
intercedes to maintain a
minimum 25%
concentration of oxygen
with a maximum
N2O:O2 ratio of 3:1

Low Pressure System

Safety Devices-Purpose is to decrease risk of hypoxic mixture
* Mandatory Minimum O2 Flow- factory preset minimum O2 flow that
always flows when machine is on.
* Minimum O2/N2O Ratio 1:3
Device or proportioning system: Flow valves linked mechanically or
pneumatically so O2 cannot be set below 25%.
Alarm will
signal if O2/NO2 ratio falls below preset value
* O2/NO2 Proportioning Device-Automatically mixes O2 and NO2 to setting
selected on dial

Hypoxic breathing is POSSIBLE

hypoxic guard systems CAN permit hypoxic
breathing mixtures IF:
wrong supply gas in oxygen pipeline or cylinder,
defective pneumatic or mechanical components,
leaks exist downstream of flow control valves, or
if third inert gas (such as helium) is used.

SAFETY MECHANISMS IN LOW PRESSURE

SYSTEM
Oxygen must enter the common manifold
downstream to other gases
It prevents hypoxia in event of proximal
gas leak
Oxygen concentration monitor and alarm
prevent administration of hypoxic gas
mixtures in event of a low-pressure
system leak, thus precisely regulating
oxygen concentration

Safety in flowmeter
subassembly
Each flowmeter is housed in an
independent, colour coded pin specific
module
Oxygen flowmeter is placed downstream
Backpressure check valve
Link device
Backlight display

FLOW CONTROL VALVE ASSEMBLY

Oxygen flow control valve is physically

distinguishable from other gas knobs
It projects beyond control knob of other gases
Its diameter is larger
Placement of knobs at a distance
All are colour coded

HYPOXIA PREVENTION SAFETY DEVICES

Mechanical integration of the N2O and O2 flowcontrol valves

Automatically intercedes to maintain a minimum 25%
concentration of oxygen with a maximum N2O:O2
ratio of 3:1

LIMITATIONS OF THE SYSTEM

Machines equipped with proportioning systems can
still deliver a hypoxic mixture under the following
conditions:
Wrong supply gas
Defective pneumatics or mechanics (e.g. the Link-25
depends on a properly functioning second stage
regulator)
Leak downstream (e.g. broken oxygen flow tube)
Inert gas administration: Proportioning systems
generally link only N2O and O2

Low Pressure System

Vaporizers- Classification:
A. Method of regulating output concentration
1. Concentration calibrated
2. Measured flow
B. Method of vaporization
1. Flow over
2. Bubble Through
3. Injection
C. Temperature compensation
1. Thermocompensation
2. Supplied heat
D. Specificity
1. Agent specific
2. Multiple agent
E. Resistance
1. Plenum
2. Low resistance

VAPORIZERS
Vapor Pressure (VP) Molecules escape from a
volatile liquid to the vapor phase, creating a
saturated vapor pressure at equilibrium
VP is independent of Atmospheric Press
VP increases with Temperature
VP depends ONLY on the Physical Characteristics of
the Liquid & on its Temperature

CLASSIFICATION
Variable bypass
Fresh gas flow from the flowmeters enters the
inlet of any vaporizer which is on. The
concentration control dial setting splits this stream
into bypass gas (which does not enter the
vaporizing chamber), and carrier gas (also called
chamber flow, which flows over the liquid agent)

CLASSIFICATION
Flow over
Carrier gas flows over the surface of the liquid
volatile agent in the vaporizing chamber (as
opposed to bubbling up through it (as in the
copper kettle and Vernitrol)

CLASSIFICATION
Temperature compensated
Equipped with automatic devices that ensure steady
vaporizer output over a wide range of ambient
temperatures
Agent-specific
Only calibrated for a single gas, usually with keyed
fillers that decrease the likelihood of filling the
vaporizer with the wrong agent
Out of circuit
As opposed to (much) older models such as the Ohio
#8 (Boyle's bottle) which were inserted within the
circle system.

Vaporizer Interlock Mechanism

Safety mechanism that allows ONLY one vaporizer at a
time to be opened

VAPORIZERS SAFETY MECHANISMS

Arrangement of vaporizers on back bar

Colour coded, agent specific key filling system
Interlock device
Select-a-tec system
Firmly secured

VAPORIZER INTERLOCK MECHANISM

Safety mechanism that allows ONLY one vaporizer at a
time to be opened

Circle System
Circle System- CO2 absorber housing and absorber, unidirectional valves,
inspiratory and expiratory ports, fresh gas inlet, APL valve, pressure gauge,
breathing tubes, Y-piece, reservoir bag, bag/vent switch selector, respiratory gas
monitor sensor.

The Circuit: Circle System

Arrangement is variable, but to
prevent re-breathing of CO2, the
following rules must be followed:
Unidirectional valves between the
patient and the reservoir bag
Fresh-gas-flow cannot enter the
circuit between the expiratory valve
and the patient
Adjustable pressure-limiting valve
(APL) cannot be located between the
patient and the inspiratory valve

Circle System

CO2 Absorber System: Housing (canister support), Absorbent, baffles, side tube
Unidirectional Valves-aka Flutter valves, one way valves, check valves, directional valves,
dome valves
Canister-Air space 50%, void space 42%, pore space 8%
Soda Lime: 4% Sodium Hydroxide, 1% potassium hydroxide, 14-19% H2O,
and calcium hydroxide to make 100%,
Silica and kielselguhr for hardness
Indicator for color change with exhaustion of CO2 absorption capabilities
CO2+H2OH2CO3
2NaOH+2H2CO3+Ca(OH)2 CaCO3+NaCO3+4H2O
heat released 13,700 cal./mole CO2 absorbed
Barium Hydroxide Lime: 20% Barium hydroxide, 80% calcium hydroxide,
and +/- potassium hydroxide,
Indicator for color change with exhaustion of CO2 absorption capabilities
Ba(OH)2 . 8H2O+CO2BaCO3+9H2O
9H2O+9CO2 9H2CO3
9H2CO3+9Ca(OH) 2 9CaCO3+18H2O
2KOH+H2CO3 K2CO3+2H2O
Ca(OH)2+K2CO3 CaCO3+2KOH
Regeneration (color change loss) with rest can occur. Appears new but is exhausted

Granule size 4-8 mesh- 4 mesh equals strainer with 4 openings/inch

Circle system

CO2 Absorber System

canister locking lever

Removing both canisters

& soda lime

canisters unlocked

Exhausted soda lime

Removing canister & soda

lime

Replacing fresh soda

lime

Circle System
Advantages:

Relative stability of inspired concentration

Conservation of respiratory moisture and heat
Prevention of operating room pollution
PaCO2 depends only on ventilation, not fresh gas
flow
Low fresh gas flows can be used

Disadvantages:
Complex design = potential for malfunction
High resistance (multiple one-way valves) = higher
work of breathing

Unidirectional or check valve

Located between vaporizer and common gas
outlet reduces the pressure increase due to
back pressure caused by IPPV

Circle system

Unidirectional Valves

Unidirectional valves-aka flutter valves, one way valves, check valves,

directional valves, dome valves.
Found on Inspiratory and Expiratory flow ports

Ohmeda Machine

Narkomed Machine

Ventilator
Ventilator Components: Driving gas supply, injector, controls, alarms,
safety-release valve, bellows assembly, exhaust valve, spill valve,
connection for ventilator hose

Bellows assembly

Ventilator controls

CONTD.

Driving gas supply or power gas supply-O2 pneumatically drives (compresses)

ventilator bellows
Injector or Venturi mechanism-Increases the flow of driving gas by using the
BERNOULLI Principle- As a gas flow meets a restriction, its lateral pressure drops.
Any opening in the tube at this constriction will entrain air (suck air in)
Controls-Adjusts Flow, Volume, Timing, and Pressure of the driving gas that
compresses the bellows
Pneumatic-Uses pressure changes to initiate changes in respiratory cycle
Fluidic or fluid logic-Uses gas streams through channels in solid material.
Allow forcompact ventilator
Electronic-Electronic control of many addition ventilation parameters
powered by a driving gas on newer machines. Must have both power and
pnuematics.
Alarms-ASTM standards group alarms into three levels: High, Medium, Low
Priority correlates to;operator immediate action, prompt action,or awareness. Loss
of main power is the only required alarm with a required duration of at least 2
minutes
Safety relief valve-aka pressure limiting valve, drving gas pressure relief valve.
Vents driving gas if factory pre-set pressure is reached (65-80 cm H2O) or
adjustable set pressure is reached.

Bernoullis Principle
At constriction:
Flow is higher
Pressure is lower

Ventilator
Bellows Assembly:
Housing- Usually made of hard rigid clear plastic
Bellows; ASCENDING-standing, upright. Compressed downward
during inspiration. ASCEND DURING EXPIRATION
Pressure is always positive. PEEP 2-4 cm H2O.
DESCENDING-hanging, inverted. Compressed upward during
inspiration. DESCEND DURING EXPIRATION. Weight of bellows results in
negative airway pressure during exhalation until bellow refilled.

IMPORTANT difference between ascending and descending is that when there is a major leak
or disconnect, the ascending bellows will collapse (unless prevented by scavenging system).
When a disconnection occurs with a descending bellows system,
the ventilator will continue its upward movement anddownward
movements, drawing in room air and driving gas during its
descent and discharging it during the upward movement.
Gas flow during upward movement may generate enough
pressure such that the low pressure alarm is not activated.

Remember that the type is described by how the bellows move

during EXPIRATION

What type is
shown?

Scavenger System
Scavenger System consists of: 1) gas collecting assembly, 2) a transfer
means, 3) the interface, 4) gas disposal tubing, 5) gas disposal assembly.
(some or all components may be combined).
ASTM standard fitting size for scavenger
hoses 19 mm ( international standard 30mm) to prevent incorrect
connection to breathing hoses (22mm).

2
4&5

1
4&5

Scavenging Systems
Protects the breathing
circuit or ventilator
from excessive positive
or negative pressure.

Scavenging Systems

Miscellaneous safety mechanisms

Antistatic wheels and locking of wheels

Backup battery
Pressure relief valve
Common gas outlet with retaining device
to prevent disconnection
Provide temporary electrical power (> 30
min) to monitors and alarms in event of
power failure

IN A NUTSHELL
ESSENTIAL FEATURES

PURPOSE

Non-interchangeable gas specific

connections to pipeline inlets (DISS) with
pressure gauges, filter and check valve

Prevent incorrect pipeline attachments;

detect failure, depletion, or fluctuation

Pin Index Safety system for cylinders with

pressure gauges, and at least one oxygen
cylinder

Prevent incorrect cylinder attachments;

provide backup gas supply; detect depletion

Low oxygen pressure alarm

Detect oxygen supply failure at the common

gas inlet

Minimum oxygen/nitrous oxide ratio

controller device (hypoxic guard)

Prevent delivery of less than 21% oxygen

Oxygen failure safety device (shut-off or

proportioning device)

Prevent administration of nitrous oxide or

other gases when the oxygen supply fails

Oxygen must enter the common manifold

downstream to other gases

Prevent hypoxia in event of proximal gas

leak

CONTD.
Essential features

Purpose

Oxygen concentration monitor and alarm

Prevent administration of hypoxic gas

mixtures in event of a low-pressure system
leak; precisely regulate oxygen
concentration

Automatically enabled essential alarms and

monitors (e.g. oxygen concentration)

Prevent use of the machine without

essential monitors

Vaporizer interlock device

Prevent simultaneous administration of

more than one volatile agent

Capnography and anaesthetic gas

measurement

Guide ventilation; prevent anaesthetic

overdose; help reduce awareness

Oxygen flush mechanism that does not pass

through vaporizers

Rapidly refill or flush the breathing circuit

Danger

Unpleasant Surprises

Checking Anesthesia Machines

8 Categories of check:
Emergency ventilation equipment
High-Pressure system
Low-Pressure system
Scavenging system
Breathing system
Manual and automatic ventilation system
Monitors
Final Position

Anesthesia Machine Checkout

Steps 1-3:
Emergency Ventilation Equipment
*1. Verify Backup Ventilation Equipment is Available &
Functioning
High Pressure System
*2. Check Oxygen Cylinder Supply
a. Open 02 cylinder and verify at least half full (about 1000
psi).
b. Close cylinder.
*3. Check Central Pipeline Supplies
a. Check that hoses are connected and pipeline gauges read
about 50 psi.

Anesthesia Machine Checkout

Steps 4-7:
Low Pressure Systems
*4. Check Initial Status of Low Pressure System
a. Close flow control valves and turn vaporizers off.
b. Check fill level and tighten vaporizers' filler caps.
*5. Perform Leak Check of Machine Low Pressure System
a. Verify that the machine master switch and flow control valves are OFF.
b. Attach "Suction Bulb" to common Fresh gas outlet.
c. Squeeze bulb repeatedly until fully collapsed.
d. Verify bulb stays fully collapsed for at least 10 seconds.
e. Open one vaporizer at a time and repeat 'c' and 'd' as above.
f. Remove suction bulb, and reconnect fresh gas hose.
*6. Turn On Machine Master Switch and all other necessary electrical equipment.
*7. Test Flowmeters
a. Adjust flow of all gases through their full range, checking for smooth operation of floats and
undamaged flowtubes.
b. Attempt to create a hypoxic 02/N20 mixture and verify correct changes in flow and/or alarm.

Anesthesia Machine Checkout

Scavenging System
*8. Adjust and Check Scavenging System
a. Ensure proper connections between the scavenging
system and both APL (pop-off) valve and ventilator relief
valve.
b. Adjust waste gas vacuum (if possible).
c. Fully open APL valve and occlude Y-piece.
d. With minimum 02 flow, allow scavenger reservoir bag to
collapse completely and verify that absorber pressure gauge
reads about zero.
e. With the 02 flush activated allow the scavenger reservoir
bag to distend fully, and then verify that absorber pressure
gauge reads <10 cm H20.

Anesthesia Machine Checkout

Breathing System
*9. Calibrate 02 Monitor
a. Ensure monitor reads 21% in room air.
b. Verify low 02 alarm is enabled and functioning.
c. Reinstall sensor in circuit and flush breathing system with 02.
d. Verify that monitor now reads greater than 90%.
10. Check Initial Status of Breathing System
a. Set selector switch to "Bag" mode.
b. Check that breathing circuit is complete, undamaged and unobstructed.
c. Verify that C02 absorbent is adequate.
d. Install breathing circuit accessory equipment (e.g. humidifier, PEEP valve) to be used
during the case.
11. Perform Leak Check of the Breathing System
a. Set all gas flows to zero (or minimum).
b. Close APL (pop-off) valve and occlude Y-piece.
c. Pressurize breathing system to about 30 cm H20 with 02 flush.
d. Ensure that pressure remains fixed for at least 10 seconds.
e. Open APL (Pop-off) valve and ensure that pressure decreases.

Anesthesia Machine Checkout

Manual and Automatic Ventilation Systems

12. Test Ventilation Systems and Unidirectional Valves
a. Place a second breathing bag on Y-piece.
b. Set appropriate ventilator parameters for next patient.
c. Switch to automatic ventilation (Ventilator) mode.
d. Fill bellows and breathing bag with 02 flush and then turn ventilator ON.
e. Set 02 flow to minimum, other gas flows to zero.
f. Verify that during inspiration bellows delivers appropriate tidal volume and that during
expiration bellows fills completely.
g. Set fresh gas flow to about 5 L/min.
h. Verify that the ventilator bellows and simulated lungs fill and empty appropriately
without sustained pressure at end expiration.
i. Check for proper action of unidirectional valves.
j. Exercise breathing circuit accessories to ensure proper function.
k. Turn ventilator OFF and switch to manual ventilation (Bag/APL) mode.
l. Ventilate manually and assure inflation and deflation of artificial lungs and appropriate
feel of system resistance and compliance.
m. Remove second breathing bag from Y-piece.

Anesthesia Machine Checkout

Monitors
13. Check, Calibrate and/or Set Alarm Limits of all Monitors
Capnometer, Pulse Oximeter, Oxygen Analyzer, Respiratory Volume
Monitor (Spirometer), Pressure Monitor with High and Low Airway Alarms
Final Position
14. Check Final Status of Machine
a. Vaporizers off
b. AFL valve open
c. Selector switch to "Bag"
d. All flowmeters to zero
e. Patient suction level adequate
f. Breathing system ready to use

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meaning from everyday experience