Anesthesia Gas Machine- Table of Contents

The Anesthesia Gas Machine 2009

Michael P. Dosch CRNA MS
University of Detroit Mercy Graduate Program in Nurse Anesthesiology.
The url for this site is http://www.udmercy.edu/crna/agm/.

All sections were revised June 2009. The sections on ventilators, pre-anesthesia checklist, and new gas machine models underwent extensive revision at that time.

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DRE is a professional supplier of new, preowned, and refurbished anesthesia machines, surgical tables, patient monitors, surgery lights, and a wide variety of used medical equipment.

Table of Contents

Introduction	History of site, Author's Disclosure statement, Acknowledgments, How to contact author, Other resources for learning.
Components and systems	Introduction Numbers to remember General features of all anesthesia gas machines Features required by standard Path of gases within the machine Five tasks of oxygen Supply, Processing, Delivery, Disposal model Manufacturers
Supply of gases & electricity	Gas sources Pipeline Cylinders Standards Capacity, color, markings Component parts Storage handling and installation Medical gases Use Electrical power supply Failures and faults (What happens when pipeline oxygen pressure or electrical power is lost?)
Fail-safe, Flowmeters, Hypoxic guard	Fail-safe system Flowmeters How they work Traditional glass flowmeters Transitional (hybrids with needle valve controls, electronic capture and display) Electronic flow control, capture, and display Function (flowmeters for FGF, auxiliary oxygen, scavenging, and common gas outlet) Using flowmeters safely Proportioning systems (Hypoxic guard)
Vaporizers	Physical principles Classification Vaporizer interlock Operating principles of variable bypass vaporizers How to fill vaporizers How much liquid agent does a vaporizer use per hour? Hazards and safety features of contemporary vaporizers Current models
Breathing circuits	Classification Breathing circuits- Non rebreathing (Mapleson and Bain) How do they work? Fresh gas flow requirements Pethick Test for the Bain Circuit Circle System King (limb within limb) Advantages and disadvantages
CO2 absorption	General characteristics and composition Chemistry- soda lime Safe use Changing canisters Clinical signs of exhaustion
Ventilators	Classification Bellows classification New ventilator modes and settings (VCV, PCV, PC-VG, SIMV-Vol, SIMV-Pressure, PSV) Typical ventilator alarms New features Piston ventilators Flexibility (New modes) Accuracy at lower tidal volumes Compliance and leak testing Fresh gas decoupling versus compensation Suitability for low flows Current models Dräger Divan, Apollo, Fabius GS GE ADU, Aisys, Avance, Aespire, Aestiva Other; Paragon, Anestar Older or obsolete ventilators
Using breathing circuits and ventilators	Humidification Choosing the best fresh gas flow Low flows How to denitrogenate ("preoxygenate") Malignant hyperthermia implications for equipment. Ventilator and Breathing circuit problems and hazards Increased inspired carbon dioxide (troubleshooting and treatment)
Scavenging	Scavenging Systems Purpose Types Practice guidelines Components Hazards Avoiding occupational exposure to waste anesthetic gas
Machine checklist 2008 Medicolegal Cleaning & sterilization	Anesthesia gas machine checklist 2008 Pre-Anesthesia Checklist (PAC) 2008 Electronic checklists- what to add at the end Minimum test under life-threatening conditions Older anesthesia gas machine checklist Negative pressure leak check Medicolegal Risk management, Quality assurance, Monitoring standards, Manufacturing standards Cleaning and sterilization Sterilization-Moist heat, liquid and gas sterilization methods Care of specific equipment
New gas machines	Dräger Medical Inc. (Telford, Pennsylvania) Narkomed 6000/6400, Fabius GS, Apollo GE (Madison Wisconsin) Aisys, Avance, Aespire, ADU, Aestiva, Aestiva MRI Other Paragon, Anestar Older or obsolete Narkomed (GS, Julian, MRI, Mobile, 2C, 4), Kion, Ohmeda (Modulus SE, Excel 210/110)
Purchasing equipment	Education and training Advanced ventilation, Computer and monitor integration, Low flows, Laryngeal mask airway and mechanical ventilation, Electronic Checkout Operating costs Installation of new machines
Test yourself	Question and answer format.

Introduction

History of site, Author's Disclosure statement, Acknowledgments, How to contact author, Other resources for learning.

Components and systems

Introduction
Numbers to remember
General features of all anesthesia gas machines
- Features required by standard
- Path of gases within the machine
- Five tasks of oxygen
- Supply, Processing, Delivery, Disposal model
Manufacturers

Supply of

gases & electricity

Gas sources

Pipeline
Cylinders

Standards
Capacity, color, markings
Component parts
Storage handling and installation
Medical gases
Use

Electrical power supply
Failures and faults (What happens when pipeline oxygen pressure or electrical power is lost?)

Fail-safe,

Flowmeters,

Hypoxic guard

Fail-safe system
Flowmeters
- How they work
  - Traditional glass flowmeters
  - Transitional (hybrids with needle valve controls, electronic capture and display)
  - Electronic flow control, capture, and display
- Function (flowmeters for FGF, auxiliary oxygen, scavenging, and common gas outlet)
- Using flowmeters safely
Proportioning systems (Hypoxic guard)

Vaporizers

Physical principles
Classification
Vaporizer interlock
Operating principles of variable bypass vaporizers
How to fill vaporizers
- How much liquid agent does a vaporizer use per hour?
Hazards and safety features of contemporary vaporizers
Current models

Breathing circuits

Classification
Breathing circuits- Non rebreathing (Mapleson and Bain)
- How do they work?
- Fresh gas flow requirements
- Pethick Test for the Bain Circuit
Circle System
- King (limb within limb)
Advantages and disadvantages

CO2 absorption

General characteristics and composition
Chemistry- soda lime
Safe use
- Changing canisters
- Clinical signs of exhaustion

Ventilators

Classification
- Bellows classification
New ventilator modes and settings (VCV, PCV, PC-VG, SIMV-Vol, SIMV-Pressure, PSV)
Typical ventilator alarms
New features
- Piston ventilators
- Flexibility (New modes)
- Accuracy at lower tidal volumes
  - Compliance and leak testing
  - Fresh gas decoupling versus compensation
- Suitability for low flows
Current models
- Dräger Divan, Apollo, Fabius GS
- GE ADU, Aisys, Avance, Aespire, Aestiva
- Other; Paragon, Anestar
Older or obsolete ventilators

Using breathing circuits and ventilators

Humidification
Choosing the best fresh gas flow

Low flows

How to denitrogenate ("preoxygenate")
Malignant hyperthermia implications for equipment.
Ventilator and Breathing circuit problems and hazards

Increased inspired carbon dioxide (troubleshooting and treatment)

Scavenging

Scavenging Systems

Purpose
Types
Practice guidelines
Components
Hazards

Avoiding occupational exposure to waste anesthetic gas

Machine checklist 2008

Medicolegal

Cleaning & sterilization

Anesthesia gas machine checklist 2008

Pre-Anesthesia Checklist (PAC) 2008
Electronic checklists- what to add at the end
Minimum test under life-threatening conditions
Older anesthesia gas machine checklist

Negative pressure leak check

Medicolegal

Risk management, Quality assurance, Monitoring standards, Manufacturing standards

Cleaning and sterilization

Sterilization-Moist heat, liquid and gas sterilization methods
Care of specific equipment

New gas machines

Dräger Medical Inc. (Telford, Pennsylvania)
- Narkomed 6000/6400, Fabius GS, Apollo
GE (Madison Wisconsin)
- Aisys, Avance, Aespire, ADU, Aestiva, Aestiva MRI
Other
- Paragon, Anestar
Older or obsolete
- Narkomed (GS, Julian, MRI, Mobile, 2C, 4), Kion, Ohmeda (Modulus SE, Excel 210/110)

Purchasing equipment

Education and training
- Advanced ventilation, Computer and monitor integration, Low flows, Laryngeal mask airway and mechanical ventilation, Electronic Checkout
Operating costs
Installation of new machines

Test yourself

Question and answer format.