About this site

The purpose of this site is to teach and illustrate the current anesthesia gas machine, and related topics such as vaporization. The site is intended to benefit students, nurse anesthetists (CRNAs), physicians in anesthesiology, or anyone with an interest in anesthesia life-support equipment.

History of site

This site has been in existence approximately 4 years, originating as lecture notes for a graduate course in nurse anesthesia at the University of Detroit Mercy. These documents are copyright 2004. You may use them for any non-profit purpose.

The author

Michael Dosch CRNA is Associate Professor and Chair of Nurse Anesthesia at the University of Detroit Mercy. His interests include anesthesia equipment, physics as related to monitors and equipment, and statistics. He has taught anesthesia equipment for over a dozen years, as well as spoken at professional conferences, written a book chapter and published articles on the topic.

Author's Disclosure Statement & Disclaimer

The author has no ongoing financial relationship with the manufacturers of any devices mentioned here. Some of this material has been presented (sponsored in part by Datex-Ohmeda) at state and national meetings of the AANA. The author has served as an invited consultant to Dräger Medical.

The clinical recommendations made here are the author's personal opinions based on clinical practice, consultation with published materials and colleagues, and published research. Like all such clinical recommendations, they should be subjected to local peer review before adoption in other clinical settings.

Acknowledgments

The author gratefully acknowledges the assistance of Jeffery Feldman MD, Robert Clark and others at Dräger Medical, Telford Pennsylvania. Patrick Choate, Ann Marie Preece, and others from Datex-Ohmeda (Madison Wisconsin) have been most helpful.

Finally, my gratitude to the nurse anesthesia students, CRNAs and physician colleagues at the University of Detroit Mercy and St Joseph Mercy Oakland, who constantly challenge and inspire me.

Other resources for learning

Internet resources:

Draeger Medical Inc
Dräger Fabius GS and the Virtual Fabius GS Simulation, cosponsored by Dräger and the University of Florida. An animated picture of the gas flows within the machine and circuit. Useful for learning the machine and its checklist, as well as understanding how the gas machine behaves when various faults occur. The Virtual Fabius GS is a subsection of The Virtual Anesthesia Machine.
Waste Anesthetic Gases is well-worth reading and recent.
Siemens KION Anesthesia System
A Critical Review of the Siemens KION Anesthesia Workstation
The Narkomed 2B from the University of Michigan.
The Virtual Anesthesia Textbook has a list of suppliers’ web sites, and a chapter on the anesthesia gas machine which links to many related sites (as well as much other non-equipment-related information).
Good medicolegal information on equipment is relatively rare. A Bibliography on equipment and liability is published at the ASA Closed Claims Project. Also at that site is an ASA Newsletter article by Kaplan, which contains data on equipment problems, and how they impact patient safety. Another important complication often related to equipment is the problem of awareness- see Domino KB: Closed malpractice claims for awareness during anesthesia. ASA Newsletter 60(6):14-17, 1996.
Pediatric ventilation: Mechanical ventilators, High Frequency Ventilation Using A Pressure Controlled Strategy
Pressure Support/Pressure Control
Anesthesia Information Systems: The future of the "Anesthesia Machine"?
www.capnography.com has many good illustrations

Resources in print which are helpful

Dosch MP. Anesthesia Equipment. In J Nagelhout, K Zaglaniczny Eds. Nurse Anesthesia. 2nd ed. 2001: Saunders p. 245-86 . Many figures and tables, extensively illustrated and referenced.
J. Andrews' chapter in Miller Anesthesia 5th ed. Well written and recommended.
J. Dorsch & S. Dorsch. Understanding Anesthesia Equipment 4th ed 1999: Williams & Wilkins. It's the Brittanica in the field. A must for anyone with a serious interest (or purchasing responsibilities).
Ehrenwerth & Eisenkraft. Anesthesia Equipment. 1993: Mosby. Well written. The chapters on vaporization and electrical safety are the clearest writing on these thorny topics in print. Still a very worthwhile reference despite its age. According to the editors they are at work on the second edition.