Medical Equipment 2

Modern Anesthesia Machine - Front

Modern Anesthesia Machine - Back
 Overview
Anesthesia devices are used in operating rooms in hospitals by medical
staff to ensure that operative and diagnostic procedures can be performed
on a patient without pain in an unconscious and relaxed state.

In its most basic form, the anesthesia machine:

Receives medical gases from a gas supply.
Controls the flow and reduces the pressure of desired gases to a safe
level.
Vaporizes volatile anesthetics into the final gas mixture.
Delivers the gases to a breathing circuit connected to the patient’s
airway.
Functional Schematic
Internal Schematic Examples
 Gas supply
Most machines have gas inlets for oxygen, nitrous oxide, and air.
Compact models often lack air inlets.
Other machines may have a fourth inlet for helium, heliox, carbon
dioxide, or nitric oxide.

Machines have two gas inlet pressure gauges for each gas:
For pipeline pressure,
For cylinder pressure.
 Pipeline Inlets

Oxygen and nitrous oxide (and often air) are delivered from their central
supply source to the operating room through a piping network.
The tubing is color coded and connects to the anesthesia machine through
a noninterchangeable diameter-index safety system (DISS) fitting that prevents
incorrect hose attachment.
One-way check valve prevents retrograde flow of gases into the pipeline
supplies.
It should be noted that most modern machines have an oxygen (pneumatic)
power outlet that may be used to drive the ventilator or provide an auxiliary
oxygen flowmeter.
 Pipeline Inlets: Installation
The pipeline terminates at various locations within the hospital.
A connector is installed at these termination points to allow the interface of
various pieces of medical equipment, such as the anesthesia machine or ventilator.
The connectors installed at each outlet of the pipeline are subject to detailed
requirements.
Two basic types of connectors are used:
The quick coupler, which allows rapid connection and disconnection of fittings
and hoses.
A noninterchangeable thread system called the diameter index safety system.
Both systems have gas-specific fittings to prevent incorrect connections.
All outlets, hoses, and quick couplers should be properly labeled and color coded.

Quick couplers Wall connections Hoses with the DISS fittings

(outlets) DISS
 Check valve
The flow of oxygen from the wall supply opens the pipeline inlet valve.
If the wall supply hose were disconnected with the tank oxygen in use, the
pressure of oxygen in the machine would force the check valve to its seated
position, preventing loss of oxygen via this connector.
 Cylinder Inlets
Cylinders attach to the machine via hanger-yoke assemblies that utilize a pin
index safety system to prevent accidental connection of a wrong gas cylinder.
The gas cylinders are also color coded for specific gases to allow for easy
identification.

.
 Bourdon pressure gauge

Cylinder pressure is usually measured by a Bourdon pressure gauge.

Flexible tube within this gauge straightens when exposed to gas pressure,
causing a gear mechanism to move a needle pointer.
 Pressure Regulators
Unlike the relatively constant pressure of the pipeline gas supply, the high and
variable gas pressure in cylinders makes flow control difficult and potentially
dangerous.
To enhance safety and ensure optimal use of cylinder gases, machines utilize a
pressure regulator to reduce the cylinder gas pressure to 45–47 psig before it enters
the flow valve.
Gas in the high pressure chamber of the regulator passes through the valve to
the low pressure outlet.
It exerts a force on a diaphragm that acts
to close the valve.
The force from a spring acts in the opposite
direction on the diaphragm to keep the valve
open and the regulator is manufactured so
that equilibrium between these two forces is
reached at the desired outlet pressure.
 Oxygen Supply Failure
Protection Devices
Whereas the oxygen supply can pass directly to its flow control valve.
Nitrous oxide, air (in some machines), and other gases must first pass
through safety devices before reaching their respective flow control valves.
In other machines, air passes directly to its flow control valve; this allows
administration of air even in the absence of oxygen.
These devices permit the flow of other gases only if there is sufficient
oxygen pressure in the safety device and help prevent accidental delivery
of a hypoxic mixture in the event of oxygen supply failure.
 Oxygen Flush

Pressing this control button results in an oxygen flow of 35–75 L/min.

Activated by non-locking button using self-closing valve.
 Flow control and Flowmeters
When the knob of the flow control valve is turned counterclockwise, a needle
valve is disengaged from its seat, allowing gas to flow through the valve.
Touch- and color-coded control knobs make it more difficult to turn the wrong
gas off or on.
As a safety feature the oxygen knob is usually fluted, larger, and protrudes
farther than the other knobs.
 Flow control and Flowmeters

Some flowmeters have two glass

tubes, one for low flows and
another for high flows:
The two tubes are in series and
are still controlled by one valve.

A dual taper design can allow a

single flow meter to read both
high and low flows.
 Flow control and Flowmeters

Some anesthesia machines have electronic flow control and measurement.

In such instances, a back-up conventional auxiliary oxygen flowmeter is
provided.
 Oxygen/Nitrous Oxide Ratio Controller
Another safety feature of anesthesia machines is a linkage of the nitrous
oxide gas flow to the oxygen gas flow; this arrangement helps ensure a
minimum oxygen concentration of 25%.
The oxygen/nitrous oxide ratio controller links the two flow valves either
pneumatically or mechanically.
It should be noted that this safety device does not affect the flow of a third
gas (eg, air or carbon dioxide).
 Anesthetic Agent Vaporizers
Volatile anesthetic agents are used to achieve unconsciousness.
halothane, isoflurane, desflurane, sevoflurane.
Anesthetic agent vaporizer converts anesthetic agent from liquid to vapor and
mix it with fresh gas at preset concentration.
Concentration of saturated agent vapor is much higher (20 fold) than
therapeutically necessary.
Vaporizer is primarily designed to reduce high saturation concentration
of, e.g., 30% to concentration required during anesthesia, e.g., 2%
Fresh gas flow is divided into two partial flows:
Flow with gas containing anesthetic agent
Flow which bypasses the vaporizer without anesthetic agent
 Mechanical Vaporizer
Turning a single calibrated control knob counterclockwise to the desired
percentage diverts an appropriate small fraction of the total gas flow into the
carrier gas, which flows over the liquid anesthetic in a vaporizing chamber,
leaving the balance to exit the vaporizer unchanged.
Temperature compensation is achieved by a strip composed of two different
metals welded together.
The metal strips expand and
contract differently in response
to temperature changes.
Electronic Vaporizers
 Breathing circuit
In clinical practice there are two different types of breathing systems: the
rebreathing system and the non-rebreathing system.
Non-rebreathing systems are used in intensive care ventilators.
The exhaled gas is released into the ambient air.
Rebreathing systems are used in anesthesia because of the costs of the
gases in anesthesia devices.
The components of a circle system include:

(1) CO2 absorber

(2) Fresh gas inlet
(3) Inspiratory unidirectional
valve and inspiratory breathing tube
(4) Y-connector
(5) Expiratory unidirectional valve
and expiratory breathing tube
(6) APL valve
(7) Reservoir
 Carbon dioxide (CO2) absorber
CO2 absorber is the characteristic feature of a rebreathing system.
The soda lime contained in the absorber bonds the CO2 in the exhaled air.
At the same time, the chemical reaction produces heat and moisture,
which contributes to gas heating and humidification.
 Unidirectional Valves

Unidirectional valves, which function as check valves, contain a ceramic

or mica disk resting horizontally on an annular valve seat.
Forward flow displaces the disk upward, permitting the gas to proceed
through the circuit.
Reverse flow pushes the disk against its seat, preventing reflux.
 Adjustable Pressure-Limiting Valve
(APL valve)
As anesthetic gases enter the breathing circuit, pressure will rise if the gas
inflow is greater than the combined uptake of the patient and the circuit.
Gases may exit the circuit through an APL valve, controlling this pressure
buildup.
Exiting gases enter the waste-gas scavenging system.
APL valves allow a variable pressure threshold for venting.
Partial closure of the APL valve limits gas exit, permitting positive circuit
pressures during reservoir bag compressions.
 Reservoir Bag (Breathing Bag)

Reservoir bags function as a reservoir of anesthetic gas and a method of

generating positive-pressure ventilation.
They are designed to increase in compliance as their volume increases.
 Fresh Gas Supply

The O2/N2O mixture from the dosing unit is added to the anesthetic agent
vaporizer.
After passing through the vaporizer, the gas mixture consisting of O2, N2O,
and the anesthetic agent is also called fresh gas.
This gas mixture is delivered to the inspiration side of the breathing
system.
 Ventilator Circuit Design
Traditionally ventilators on anesthesia machines have a double-circuit
system design and are pneumatically powered and electronically controlled.

Newer machines also incorporate microprocessor control that relies on

pressure and flow sensors.

Some anesthesia machines have ventilators that use a single-circuit piston

design.
 Double-Circuit System Ventilators
Pressurized oxygen or air from the ventilator power outlet is routed to the
space between the inside wall of the plastic enclosure and the outside wall of
the bellows.
Pressurization of the plastic enclosure compresses the pleated bellows inside,
forcing the gas inside into the breathing circuit and patient.
In contrast, during exhalation, the bellows ascend as pressure inside the
plastic enclosure drops and the bellows fill up with the exhaled gas.
 Piston Ventilators

The major advantage of a piston ventilator is its ability to deliver accurate tidal
volumes to patients with very poor lung compliance and to very small patients.
The piston fills with gas from the breathing circuit.
 Waste-gas scavenging systems

An anesthesia scavenging system collects the waste anesthetic gases from the
breathing circuit and discards them.
A properly designed and assembled system will not affect the dynamics of the
breathing circuit, nor will it affect ventilation and oxygenation of the patient.
Scavenging systems are classified as either active or passive.
Active scavenging system, a substantial negative pressure (hospital
vacuum) is applied to the disposal line connected to the interface, and waste
gas is literally sucked away from the interface.
Passive scavenging system, waste gases flow under their own pressure
via a wide-bore tube to ventilation exhaust grille.
 Monitoring in Anesthesia

Generally, anesthesia devices are equipped with nine sensors.

Five device monitoring sensors for drug dosing and ventilation:
Oxygen
Pressure
Volume
Carbon dioxide (CO2)
Anesthetic agent
Four patient monitoring sensors for monitoring patient health during
uncomplicated operations:
Electrocardiogram (ECG)
Noninvasive blood pressure (NIBP)
Oxygen saturation (SpO2)
Body temperature
 Oxygen Sensor: Fuel Cell
This membrane prevents the alkaline electrolytes from escaping from the
housing but allows oxygen molecules to diffuse through.
The alkaline electrolytic solution contains a lead anode and a gold cathode.
After the oxygen molecules of the gas to be measured have passed through the
membrane, the following electrode reactions take place:
On the gold cathode, oxygen releases electrons from the cathode material,
forming OH− ions and positively charging the cathode.
On the anode, lead reacts with the OH− ions to form lead oxide and water
(the anode is negatively charged).
If the cathode and anode are
connected with each other, an
electrical current proportional to
the oxygen concentration is
produced.
 Oxygen Sensor: Paramagnetic
Oxygen is paramagnetic while other gases are diamagnetic.
Magnetic field causes oxygen molecules to be attracted and agitated.
Streams of sample and reference gas have different oxygen partial pressures.
A sensitive pressure transducer is used to convert pressure to an electrical
signal.
 Pressure Sensor: Piezoresistive Sensor

An electrical pressure signal can be produced from a mechanical–electrical

(piezoresistive) converter.
Pressure cell is sealed with a movable membrane.
Membrane is attached to a solid-state device, whose electrical resistance
depends on the elongation of the membrane.
The stretching of the membrane causes the solid-state device to bend,
leading to a variation in resistance.
 Volume Measurement: Hot-Wire Principle
Resistive wire (thin platinum wire) is placed in flow path and heated using
electrical current.
Flow cools down wire and changes its resistance.
The greater the volume per time flowing past the wire, the more the wire is
cooled.
The volume is obtained by integrating current over time electronically.
 CO2, N2O, and Anesthetic Agent Sensors
Infrared absorption spectroscopy.
Based on physical principle that polyatomic gases absorb infrared
radiation at characteristic frequencies.
Level of absorption depends on concentration of molecules.
For measurement, the molecules are channeled into a cuvette with a
defined length and illuminated with an infrared light source.
Detection element detects the remaining residual radiation after absorption.
 Recommended References
John Butterworth, David C. Mackey, John Wasnick - Morgan and Mikhail's
Clinical Anesthesiology (Chapter 3 & 4).
Rüdiger Kramme, Heike Kramme (auth.), Rüdiger Kramme, Klaus-Peter
Hoffmann, Robert S. Pozos (eds.) - Springer Handbook of Medical Technology)
(Chapter 30).