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2012/11/06

Anesthesia Units

Rob Dickinson
South Africa

An Anesthesia Gas Machine Example


• Layout similar to that of an Ohmeda Modulus II

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2012/11/06

Facilities & Services Requirements


• Piped & Cylinder Back-up Medical Grade Gases

Facilities & Services Requirements


• Piped & Cylinder Back-up Medical Grade Gases
• Oxygen pipeline connected to the central supply
via a non-interchangeable safety-indexed gas
probe and receptacle

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2012/11/06

Facilities & Services Requirements


• Piped & Cylinder Back-up Medical Grade Gases
• Oxygen pipeline pressure gauge

Facilities & Services Requirements


• Piped & Cylinder Back-up Medical Grade Gases
• Oxygen pipeline non-return valve

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Facilities & Services Requirements


• Piped & Cylinder Back-up Medical Grade Gases
• High pressure (back-up) Oxygen cylinder mounted
on a non-interchangeable safety-indexed gas yoke
(Some anesthesia machines have 2 x Oxygen yokes)

Facilities & Services Requirements


• Piped & Cylinder Back-up Medical Grade Gases
• High pressure Oxygen cylinder non-return valve

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2012/11/06

Facilities & Services Requirements


• Piped & Cylinder Back-up Medical Grade Gases
• High pressure Oxygen cylinder contents gauge

Facilities & Services Requirements


• Piped & Cylinder Back-up Medical Grade Gases
• High pressure Oxygen regulator

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Facilities & Services Requirements


• Piped & Cylinder Back-up Medical Grade Gases
• Machine Oxygen supply pressure

Facilities & Services Requirements


• Piped & Cylinder Back-up Medical Grade Gases
• Nitrous Oxide pipeline connected to the central
supply via a non-interchangeable safety-indexed
gas probe and receptacle

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Facilities & Services Requirements


• Piped & Cylinder Back-up Medical Grade Gases
• Medical Air pipeline connected to the central
supply via a non-interchangeable safety-indexed
gas probe and receptacle

Facilities & Services Requirements


• Piped & Cylinder Back-up Medical Grade Gases
• Cylinder yokes

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Facilities & Services Requirements


• Piped & Cylinder Back-up Medical Grade Gases
• Cylinder and pipeline pressure gauges

Internal ‘Machine’ Operation


• Main ON/OFF switch and gas cut-off block

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Internal ‘Machine’ Operation


• Main ON/OFF switch and gas cut-off block
• The single ON/OFF switch cuts off both the
electrical system and machine gas flows

Switched gas supplies out

To Ventilator
To emergency O2
Flush and external
flowmeter
Machine Gas Supplies in

Internal ‘Machine’ Operation


• Main ON/OFF switch and gas cut-off block
• On de-activation Oxygen is cut-off and pressure
distal to the ON/OFF valve begins dropping

Switched gas supplies out

To Ventilator
To emergency O2
Flush and external
flowmeter
Machine Gas Supplies in

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2012/11/06

Internal ‘Machine’ Operation


• Main ON/OFF switch and gas cut-off block
• Once the Oxygen pressure distal to the ON/OFF
valve drops to around half the supply pressure, the
gas cut-off block prevents other gases flowing
Switched gas supplies out

To Ventilator
To emergency O2
Flush and external
flowmeter
Machine Gas Supplies in

Internal ‘Machine’ Operation


• Main ON/OFF switch and gas cut-off block
• On many machines the de-activation of this switch
(or an interruption of Oxygen supply pressure) only
cuts off Nitrous Oxide, not Medical Air
Switched gas supplies out

X
To Ventilator
To emergency O2
Flush and external
flowmeter
Machine Gas Supplies in

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2012/11/06

Internal ‘Machine’ Operation


• Low Oxygen supply whistle/alarm (not shown)
• On all machines an interruption of Oxygen supply
pressure cuts off Nitrous Oxide, and triggers an
audible pneumatic or electronic alarm
Switched gas supplies out

To Ventilator
To emergency O2
Flush and external
flowmeter
Machine Gas Supplies in

Internal ‘Machine’ Operation


• Main ON/OFF switch and gas cut-off block
• Main ON/OFF switch

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2012/11/06

Internal ‘Machine’ Operation


• Secondary gas regulators

Internal ‘Machine’ Operation


• Secondary gas regulators
• It is essential that flowmeter gas supplies remain
stable as other occasional anesthesia machine and
cyclical ventilator gas requirements are drawn

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2012/11/06

Internal ‘Machine’ Operation


• Secondary gas regulators
• Secondary Oxygen regulator

Internal ‘Machine’ Operation


• Secondary gas regulators
• Secondary Nitrous Oxide regulator

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2012/11/06

Internal ‘Machine’ Operation


• Secondary gas regulators
• Secondary Medical Air regulator

Internal ‘Machine’ Operation


• Gas flowmeter banks (Rotameters)

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2012/11/06

Internal ‘Machine’ Operation


• Gas flowmeters and mixers
• All Anesthesia Gas Machines have user interface
controls to facilitate the accurate proportioning and
mixing of individual medical gases

Gas mixture out

Medical gas supplies in


from the secondary gas
regulators

Internal ‘Machine’ Operation


• Gas flowmeters and mixers
• Individual gas flows may be adjusted mechanically
(as in this example) or by software selection in the
case of machines employing electronic mixers

Gas mixture out

Medical gas supplies in


from the secondary gas
regulators

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2012/11/06

Internal ‘Machine’ Operation


• Gas flowmeters and mixers
• Each medical gas has its own ‘control knob’ and
flows are adjusted by turning needle valves that
these knobs are attached to

Gas mixture out

Medical gas supplies in


from the secondary gas
regulators

Internal ‘Machine’ Operation


• Gas flowmeters and mixers
• As each gas flow is adjusted, the user observes and
lines up a ‘float’ with one of several graduated lines
marked on a glass rotameter tube

Gas mixture out

Medical gas supplies in


from the secondary gas
regulators

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2012/11/06

Internal ‘Machine’ Operation


• Gas flowmeters and mixers
• An Oxygen needle valve and rotameter tube

Internal ‘Machine’ Operation


• Gas flowmeters and mixers
• Needle valves and rotameters

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Internal ‘Machine’ Operation


• Gas flowmeters and mixers
• Mechanical flowmeter controls must be interlocked
by way of an ‘Anti-Hypoxic Device’ such that it is
‘impossible’ for the user to flow hypoxic gas
mixtures (Insufficient Oxygen)
Gas mixture out

Medical gas supplies in


from the secondary gas
regulators

Internal ‘Machine’ Operation


• Gas flowmeters and mixers
• Link-25 AHD system on an Ohmeda Modulus II

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2012/11/06

Internal ‘Machine’ Operation


• Gas flowmeters and mixers
• An example of a failed ‘Anti-Hypoxic Device’

Internal ‘Machine’ Operation


• Gas flowmeters and mixers
• Examples of no ‘Anti-Hypoxic Device’ fitted

X X

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2012/11/06

Internal ‘Machine’ Operation


• Gas flowmeters and mixers
• An example of electronically measured flow

Internal ‘Machine’ Operation


• Gas flowmeters and mixers
• An example of software selected gas flow

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2012/11/06

Internal ‘Machine’ Operation


• Vaporizers and Vaporizer Backbars

Internal ‘Machine’ Operation


• Vaporizers
• Anesthesia Gas Machines have Vaporizers fitted to
them in order to introduce accurate concentrations
of inhalational anesthesia drugs to the (carrier) gas
delivered by the flowmeters / gas mixer
Gas mixture Carrier gas
in from the mixture +
flowmeters / additional
mixer unit vapor out
(Now called (Now called
carrier gas) fresh gas)

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2012/11/06

Internal ‘Machine’ Operation


• Vaporizers
• Users turn a dial control to select the Vol % of the
anesthesia vapor they wish to introduce into the
carrier gas mixture from the flowmeters / gas mixer

Halothane Enflurane Isoflurane Sevoflurane Desflurane

Internal ‘Machine’ Operation


• Vaporizers
• All modern Vaporizers are anesthesia agent specific
• Anesthesia agent Saturated Vapor Pressure (SVP)
affects Vaporizer design and calibration

Halothane Enflurane Isoflurane Sevoflurane Desflurane

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Internal ‘Machine’ Operation


• Vaporizers
• Liquid vaporization & temperature compensation

Internal ‘Machine’ Operation


• Vaporizers
• Desflurane heating and proportioning

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2012/11/06

Internal ‘Machine’ Operation


• Vaporizers
• Datex-Ohmeda Aladin Cassette Vaporizers

Internal ‘Machine’ Operation


• Vaporizers and Vaporizer Back bars
• A Vaporizer on a 3 Station Selectatec Back bar

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2012/11/06

Internal ‘Machine’ Operation


• Vaporizer Backbars
• Backbars serve as Vaporizer mounts, provide them
with secure inlet and outlet gas connections and
facilitate safety interlocks such that only one
Vaporizer may be in use at any time
Gas mixture Carrier gas
in from the mixture +
flowmeters / additional
mixer unit vapor out
(Now called (Now called
carrier gas) fresh gas)

Internal ‘Machine’ Operation


• Vaporizer Backbars
• Cagemount (Non-Interlocking Vaporizers)
• Only ONE Vaporizer should be fitted between the
rotameters and the backbar end block

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2012/11/06

Internal ‘Machine’ Operation


• Vaporizer Backbars
• Original Selectatec (Non-Interlocking Backbars)
• It is recommended that only ONE vaporizer station
should be fitted on the Anesthesia Gas Machine

Internal ‘Machine’ Operation


• Vaporizer Backbars
• Selectatec (‘Switchable’ Backbars)
• It is recommended these backbars be removed from
Anesthesia Gas Machines owing to the possibility
of erroneous or lack of drug delivery

X
LHS or RHS
Vaporizer select

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2012/11/06

Internal ‘Machine’ Operation


• Vaporizer Backbars
• Selectatec Pin-Interlock Back bars
• One to three ‘Pin-Interlock’ compatible Vaporizers
may be fitted on the Anesthesia Gas Machine
Side ‘Interlock’ Pins

Pins Pins Side Pins Side Pins


‘Float’ ‘Float’ ‘Shifted’ ◄ ►

Vaporizer Vaporizer Vaporizer Vaporizer


‘Off’ ‘Off’ ‘Disabled’ ‘On’

Internal ‘Machine’ Operation


• Vaporizer Backbars
• An example of Selectatec Pin-Interlocking

Side ‘Interlock’ Pins

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2012/11/06

Internal ‘Machine’ Operation


• Vaporizer Backbars
• Another example of Selectatec Pin-Interlocking

Side ‘Interlock’ Pins

Internal ‘Machine’ Operation


• Vaporizer Backbars
• 3 Station Selectatec Pin-Interlock Back bars

Interlock continuity without


a centre vaporizer fitted

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2012/11/06

Internal ‘Machine’ Operation


• Vaporizer Backbars
• 3 Station Selectatec Pin-Interlock Back bars
No Interlock continuity without
a centre vaporizer fitted

If only two vaporizers are fitted,


one must occupy this position

Internal ‘Machine’ Operation


• Vaporizer Backbars
• Selectatec Pin-Interlock Back bars
• All ‘Pin-Interlock’ compatible Back bars have
vertical pins to exclude the fitment of non-interlock
compatible or original Selectatec vaporizers

‘Exclusion pin’

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2012/11/06

Internal ‘Machine’ Operation


• Vaporizer Backbars
• An example of a removed ‘exclusion pin’

X ‘Exclusion pin’ removed

Internal ‘Machine’ Operation


• Vaporizer Backbars
• Consequences of a removed ‘exclusion pin’
Overdose ‘cocktail’ possible

Selectatec
Compatible
Pin-Interlock Vaporizer but
Vaporizer NOT a
Pin-Interlock
Vaporizer

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2012/11/06

Internal ‘Machine’ Operation


• Vaporizer Backbars
• Draeger Interlock Back bars
• One to three Vaporizers may be fitted on an
Anesthesia Gas Machine depending upon the model

Internal ‘Machine’ Operation


• Vaporizer Backbars
• Penlon Vaplok Interlock Back bars
• One to three Vaporizers may be fitted on the
Anesthesia Gas Machine depending upon the model

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2012/11/06

Internal ‘Machine’ Operation


• Vaporizer Fillers
• It is recommended that anesthetic-agent-specific
filling systems are used to prevent incorrect filling
and to reduce vapor pollution during the process
Screw, Pour or
‘Funnel Fill’

Key-Filler QUIK-FIL
Mechanism Mechanism

Internal ‘Machine’ Operation


• Vaporizer Fillers
• Vaporizer Screw, Pour or Funnel Fillers
• Not recommended if more than one anesthesia
agent type is present or intended for use

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2012/11/06

Internal ‘Machine’ Operation


• Vaporizer Fillers
• Anesthetic-agent-specific key-filler bottle adaptors
are color-coded and indexed for both the anesthesia
agent bottle and vaporizer filler mechanism ends

Internal ‘Machine’ Operation


• Vaporizer Fillers
• Anesthetic-agent-specific key-filler bottle adaptors
are color-coded and indexed for both the anesthesia
agent bottle and vaporizer filler mechanism ends

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2012/11/06

Internal ‘Machine’ Operation


• Vaporizer Fillers
• QUIK-FIL agent-specific adaptors are color-coded
and often integral to the anesthesia agent bottle

Internal ‘Machine’ Operation


• Fresh Gas Non-Return Valve
• The ‘Fresh gas’ (carrier gas + drug vapors) passes
through a non-return valve, thus ensuring that any
back pressure doesn’t ‘pump’ the Vaporizer in use

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Internal ‘Machine’ Operation


• Common Gas Outlet (CGO)
• The ‘Fresh Gas’ (from the Vaporizer in use) exits
the Anesthesia Gas Machine frame at the Common
Gas Outlet (CGO)

Internal ‘Machine’ Operation


• Common Gas Outlet (CGO)
• The Common Gas Outlet connector is an ISO
standard taper 22M/15F mm tapered cone to
facilitate the connection of breathing circuits

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Internal ‘Machine’ Operation


• Common Gas Outlet (CGO)
• Fitted to this CGO is a semi-closed breathing circuit

Internal ‘Machine’ Operation


• Emergency Oxygen Flush Valve
• From time to time it is required that the patient
breathing circuit be momentarily ‘flushed’ with
pure Oxygen via the Oxygen Flush Valve

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2012/11/06

Internal ‘Machine’ Operation


• Emergency Oxygen Flush Valve
• The Oxygen Flush Valve must not lock in the ‘ON’
state and must deliver a pure Oxygen flow rate of
>35 Lpm to the Common Gas Outlet

Internal ‘Machine’ Operation


• Emergency Oxygen Flush Valve
• The Oxygen Flush Valve is recessed and sprung

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2012/11/06

Internal ‘Machine’ Operation


• External Oxygen Flowmeter
• Many OR interventions do not require general
anesthesia. Oxygen can be flowed to the patient
facemask via an external flowmeter

Internal ‘Machine’ Operation


• External Oxygen Flowmeter
• Not fitted on all Anesthesia Gas Machines

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Breathing Circuit and Ventilator


• Patient Breathing Circuit

Breathing Circuit and Ventilator


• Waste Anesthesia Gas Disposal System (WAGS)

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Breathing Circuit and Ventilator


• Patient Breathing Circuit
• Semi-closed Carbon Dioxide absorber circuit

Breathing Circuit and Ventilator


• Ventilator

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Breathing Circuit and Ventilator


• Ventilator
• Ventilator with O2 Analyzer and Spirometry

Breathing Circuit and Ventilator


• ‘Fresh Gas’ from the Common Gas Outlet

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Breathing Circuit and Ventilator


• Oxygen Analyzer Sensor

Breathing Circuit and Ventilator


• Inspiratory Valve

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Breathing Circuit and Ventilator


• Patient Airway Pressure Gauge (PAW)

Breathing Circuit and Ventilator


• Inspiratory Limb

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Breathing Circuit and Ventilator


• Patient Airway Connector to ETT or LMA

Breathing Circuit and Ventilator


• Expiratory Limb

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Breathing Circuit and Ventilator


• Spirometry Sensor

Breathing Circuit and Ventilator


• Expiratory Valve

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Breathing Circuit and Ventilator


• CO2 Absorber

Breathing Circuit and Ventilator


• CO2 Absorbent

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Breathing Circuit and Ventilator


• Reservoir Bag / Vent Valve (Bag position)

Breathing Circuit and Ventilator


• Reservoir Bag

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Breathing Circuit and Ventilator


• Adjustable Pressure Limit Valve (APL)

Breathing Circuit and Ventilator


• Waste Anesthetic Gas outlet from APL

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Breathing Circuit and Ventilator


• Waste Anesthetic Gas System (WAGS)

Breathing Circuit and Ventilator


• Waste Anesthetic Gas Reservoir Bag

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Breathing Circuit and Ventilator


• Positive / Negative Pressure Relief Valves

Breathing Circuit and Ventilator


• WAGS Suction Control Valve

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Breathing Circuit and Ventilator


• Connector to facility WAGS Evacuator

Breathing Circuit and Ventilator


• CO2 Scrubbed Gas from Absorber

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Breathing Circuit and Ventilator


• Gas from Absorber and CGO Mix

Breathing Circuit and Ventilator


• Reservoir Bag / Vent Valve (Vent position)

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Breathing Circuit and Ventilator


• Ventilator Breathing Circuit Connection

Breathing Circuit and Ventilator


• Ventilator Bellows Rises On ‘Exhalation’

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Breathing Circuit and Ventilator


• Ventilator ‘Bellows Base Valve’ opens

Breathing Circuit and Ventilator


• Excess Waste Anesthesia Gas flow

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Breathing Circuit and Ventilator


• Ventilator Control Unit

Breathing Circuit and Ventilator


• Inspiratory Phase ‘Exhaust Valve’ closes

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Breathing Circuit and Ventilator


• Inspiratory Phase ‘Drive Gas Valve’ opens

Breathing Circuit and Ventilator


• Inspiratory Phase ‘Drive Gas’ Flow

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Breathing Circuit and Ventilator


• Bellows Base Valve Held Closed

Breathing Circuit and Ventilator


• Bellows Compressed by Drive Gas in canister

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Breathing Circuit and Ventilator


• Inspiratory Phase ‘Breathing Circuit’ Gas Flow

Breathing Circuit and Ventilator


• Inspiratory Phase ‘Breathing Circuit’ Gas Flow

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Breathing Circuit and Ventilator


• Expiratory Phase ‘Drive Gas Valve’ closes

Breathing Circuit and Ventilator


• Expiratory Phase ‘Exhaust Valve’ opens

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Breathing Circuit and Ventilator


• Expiratory Phase ‘Drive Gas’ Flow

Breathing Circuit and Ventilator


• Expiratory Phase ‘Drive Gas’ Exhausted

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Breathing Circuit and Ventilator


• Ventilator Bellows Rises On ‘Exhalation’

Various Anesthesia Gas Machines

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References
• http://tr.anest.ufl.edu • http://www.gehealthcare.com
• http://www.virtual-anaesthesia-textbook.com • http://www.sharn.com
• http://www.doctorsdepot.com • http://www.metropolitanmedical.com
• http://www.somatechnology.com • http://216.39.195.236/ostia/index.php?xml
• http://www.newtech-medical.com FilePath=journals/ija/vol3n3/inhal2.xml
• http://www.anesthesia.org/winterlude/ • http://www.spacelabshealthcare.com
wl97/acl1.html • http://www.draegermedical.com
• http://longevityllc.com • http ://www.medicalia.co.uk
• http://en.wikipedia.org
• http://www.udmercy.edu
• http://www.alfanaes.freeserve.co.uk
• http://www.oes-medical.co.uk
• http://www.paragonservice.com
• http://soa.group.shef.ac.uk
• http://www.asevet.com

Thank you!

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