BREATHING SYSTEMS

Prof. Dr. (Mrs.) A. Mehrotra

Breathing System
DEFINITION

The concentration of gases and vapors actually delivered to the patient by anaesthetic circuit used to connect the patient to the anaesthetic machine. It is most vital as it maintains the respiratory function.

Breathing System
The successful out come of the anaesthetic procedure depends on
Selection of breathing system Design of breathing system Function of Breathing system

Qualities of Ideal Anaesthetic Breathing System

Provide adequate inspired oxygen concentration Efficient elimination of exhaled CO2 Adequate exchange of anaesthetic gases and vapors It should have minimal mechanical dead space.

Qualities of Ideal Anaesthetic Breathing System (Contd.)

Low Resistance to Gas flow Convenient to sterilize It should permit spontaneous , manual and controlled ventilation It must protect patient from barotrauma Minimal running cost

Classification of Breathing Systems

Open Semi Open Closed Semi closed Circuit A fully bounded circuit with provision for venting of excess gases
Semi closed Rebreathing circuit Semi closed absorption circuit Non Rebreathing circuit

This classification allows rigid definition of any circuit under given condition of use.

Open System
In the Open system volatile anaesthetic agent is administered to the patient with atmospheric air as a vehicle
Open drop method Gravity method Insufflation method Ayre T Tube

Open Drop Method

Advantages Equipment is simple Difficult to administer over dose of anaesthetic agent Wide margin of safety

Open Drop Method

Disadvantages Composition of inhaled vapors is quiet variable Difficult to maintain smooth and even anaesthesia Wastage of anaesthetic agents Oxygen supply depends upon atmosphere and improper use of equipments Skin irritation or erythema of the face and eyes

Gravity Method
Anaesthetic gases and anaesthetic vapors may be allowed to flow into some form of semi open system System is created by a simple cylindrical moat conforming to facial contour Gases and vapors are heavier than air . They gravitate to the patient

Insufflation Method
Delivered in to patients pharynx or larynx Insufflation system is created Method can be initiated by the use of catheter By metal tube & nipple With small endotracheal tube

Ayres T Tube
Example of open or semi open system T Tube is having rubber extension Rebreathing can be avoided Length of tube should be equal to tidal volume

SEMI OPEN SYSTEM

Definition
A system of anaesthesia in which the patients respiratory system is open to the atmosphere

Method
A folded towel is encircled around open drop mask

CLOSED SYSTEM
Definition The closed system of inhalation anaesthesia allow no escape of anaesthetic mixtures .For this,
Reservoir is required Complete Rebreathing No access to the atmosphere

System is safe CO2 must be removed System was developed through the work of Ralph Waters

Requirement for the Closed System

An absorbent for carbon dioxide. Absorbent should be fresh. Dead Space must be minimal All fitting must be tight Mask should be applied properly Apertures diameter should be 2.5 cm There are two methods
To and fro method Circle system

SEMI CLOSED SYSTEM ( Magill System )

Definition It may be defined as one on which the patients respiratory system is completely closed to the atmosphere on inspiration. In 1954 Mapleson classified semi closed anaesthetic system according to
Position of expiratory valve Position of reservoir bag and described as Mapleson Systems A,B,C,D,E

Mapleson System D is modified to Bain's Circuit Mapleson System A is modified to Lack Circuit

Mapleson A Circuit
It is best used in anaesthesia Fresh gases should be equal to alveolar minute volume Can be used with assisted r controlled ventilation Fresh gas should be 70% of the respiratory minute volume It is economical

Mapleson B Circuit
Fresh gases is towards the patient end Used for spontaneous , assisted and controlled ventilation Less efficient for spontaneous ventilation More efficient for controlled ventilation

Mapleson C Circuit
Corrugated tube is shortened Almost equally efficient for spontaneous and controlled ventilation Offers no advantage and no more used

Mapleson D Circuit (Bains Circuit)

Adjustable pressure limiting valve is brought near the bag Bain modified the Mapleson D system and made it a coaxial system in which fresh gases are delivered through inner tube so that mixing of fresh gases and exhaled gases does not occur. It is most common used circuit in anaesthesia It is choice for controlled ventilation.

Advantages

Bains Circuit

Light weight Corrugated tubing is long (1.8 meters) , so good for head and neck surgeries where anesthetist is away from patient There is less fire hazard as exhaled gases escape away from the machine Resistance is less (<0.7 cm of water) Sterilization is easy Disadvantage Inner tube may become folded or kinked causing obstruction or may get disconnected.

Mapleson E Circuit
It is Ayres T piece with corrugated tubing . It is a pediatric circuit It is not a complete circuit so modified by Jackson and Rees by attaching a bag to it It is the circuit only for spontaneous respiration but can be utilized for controlled ventilation by intermittently occluding the end of expiratory limb.

Mapleson F Circuit
Jackson and Rees Circuit It is a pediatric circuit used for children < 6 year of age or less than 20 kg. Type E and Type F circuit do not have any valve ( valve less circuit) and this is to decrease the resistance .

Summary of Semi Closed Circuits

Circuit Fresh Gas Flow Spontaneous Type A Type B Type C Type D Type E Type F Equal to Minute Volume 2x 2x Minute Volume Minute Volume 3 2.25 2.25 1.6 3 Controlled x Minute Volume x Minute Volume x Minute Volume x Minute Volume x Minute Volume

2.5 x Minute Volume 2.5 x Minute Volume 2.5 x Minute Volume

1.5 - 2 x Minute Volume

THANK YOU