The Ideal Breathing

System
Simple and safe to use
Delivers the right gas mixture
Allows all methods of ventilation in all
age groups
Efficient
Pressure relief
Sturdy, small and light
Allows easy removal of waste gases
Easy to maintain with low running costs

Breathing System
Components
Fresh Gas connection
Patient connection
Adjustable Pressure Limiting (APL)
Valve
Reservoir (Bag or bellows)
Tubing
Waste gas connection

Open, semi open, semi

closed?
Open is the old fashioned method of
dropping ether or chloroform over a
gauze or lint. Later modernised by the
likes of the Schimmelbusch mask.
Semi-open I classify as systems used
today such as the Mapleson systems.
Semi-closed and Closed systems use a
CO2 absorbent so that the gases are recirculated, the classification is defined by
the amount of fresh gas flow.

Semi-open Systems
In the early 1950s, Prof. WW
Mapleson from University of Wales,
Cardiff, classified the several
breathing systems around
depending on what components
they contained and what position
they took in the system.
It is known today as
The Mapleson Alphabet

The
Mapleson
Alphabet

The F was added later

to the alphabet

Semi-open Circuit
Anaesthesia
This is typically used for induction of the
patient. It is usually a single limb
system that uses an APL valve to control
the pressure of the gas, and allows for
waste gas to leave the system.
High fresh gas flows (more than patients
minute volume) are required with these
systems to stop rebreathing of expired
CO2.

Types of Semi-open Circuit

Systems
Mapleson
Mapleson
Mapleson
Mapleson
System
Mapleson
Mapleson

D or Bain System
A or Magill System
A or Lack System
F or Ayres T Piece
F with APL Valve
C Bagging System

What FGFs are needed?

Mapleso Systems
n

Magill
Lack

Uses
Spontaneous
Gen
Anaesthesia

Very
uncommon,
not in use
today

Resuscitation
Bagging

Bain

Spontaneous
IPPV, Gen.
Anaes

Ayres T Piece

Very
uncommon,
not in use
today

FGF SV
70-100
ml/kg/min

FGF IPPV
Min 3 x MV

Min 15 lpm
150-200
ml/kg/min

70-100
ml/kg/min

Mapleson A (Magill)
System
1950s

The Mapleson A or Magill system is good for

spontaneous breathing patients, so the fresh
gas flow can be lower. However as the APL
valve is close to the patient, it is regarded by
many as difficult to use.

Mapleson A (Lack) System

1976

The Mapleson A or Lack system is a modification

of the Magill where the valve is moved to the
machine end of the system using another length
of tubing. This adds volume to the system and
makes it rather heavy at the patient end.

Mapleson D (Bain)
1972

The Mapleson D or Bain System is a co-axial

system where the fresh gas is delivered directly to
the patient. It requires very high fresh gas flows to
prevent rebreathing of CO2. It is very convenient
to use, thus is very popular especially for
induction, in the UK!

Mapleson F (Jackson Rees

Modification)
Ayres1937
JR1950

The Mapleson F or
Jackson Rees
modification of the Ayres
T Piece is a basic system
for use with very small
patients. It is a big
disadvantage that you
cannot remove waste
gases safely.
Because this has a bag
with an open tail, it is
technically a JacksonRees Modification system

Mapleson F with APL Valve

1998

Intersurgical decided
to modify the
Jackson-Rees by
using a closed tail
bag and a specially
modified APL valve.
Now the waste gases
can be removed
safely from the
system via the APL
valves 30mm outlet.

Mapleson C Bagging
System
The Mapleson C is
more than an
anaesthesia system. It
can be found all over
the hospital for use as
an emergency bagging
system for
resuscitation or
manual ventilation
using oxygen, as well
as being a standard
induction system in
some countries.

Semi Closed Circuit

Anaesthesia
This type of General Anaesthesia is used
mainly for maintenance of anaesthesia
following induction. It can be used for
induction of anaesthesia, but this is a slower
process.
It requires an absorber system containing a
CO2 Absorbent to remove CO2 from the expired
patient gases, and a high degree level of
patient monitoring, especially respiratory gas
monitoring to measure levels of inspired and
expired CO2 and the volatile agent.

Semi Closed Anaesthesia

Explained
Semi Closed Anaesthesia is where the
expired gases from the patient pass
through a canister in the breathing system
which contains a CO2 absorbent. This
absorbent by an exothermic chemical
reaction removes the CO2, so the patients
expired gases can be rebreathed. Because
of this exothermic chemical reaction, some
warmth and humidity is added to the
inspired gases.

Semi Closed Anaesthesia

Explained
Because the patients expired gases are re
circulated (where the circle comes from), this
means that we do not have to add so much
fresh gas to the system like an open system. So
the fresh gas flow rate can be reduced to low
flow, i.e., 1 litre per minute. If the flows were as
low as a few hundred ccs of gas, equivalent to
the patients metabolic uptake of gases, this
would be closed circuit anaesthesia, or
metabolic (basal) flow, or minimal flow.
Circle systems were first used back in 1930 by
Brian Sword in the USA

Types of Semi Closed

Circuit System
Standard Parallel Y System
Extendible Parallel Y System
Complete Semi Closed Circuit
Systems
Co-Axial Semi Closed Circuit
Systems

Tight Connections
Remember, it is
important with
conical connectors
such as those used
on breathing
systems, always
connect with a firm
push and twist.
This will ensure a
leak tight
connection.

Conclusion
The silver ion based anti-microbial
additive reduced the potential risk of
cross contamination from the outside of
the breathing system

This means that the anti-microbial

additive in Breathing Systems not only
inhibits bacterial growth but will reduce
colonisation on the circuit, and
therefore can reduce cross infection in
the ITU and the operating theatre

Well thats it!

I hope you now have a clearer
understanding of Breathing
Systems and Filtration. It really
only leaves me one thing to say:

TIGHTCONNECTIONS