AA Raka Karsana

GAS MEDIS
– Oxygen
– Carbon Dioxide
– Helium
– Nitrogen
– Nitrous Oxide
– Specialty Gas Mixtures
Emergency Oxygen on Nursing Floor

3 Copyright ECRI 2007

Nitrous Oxide = OEA
4 Copyright ECRI 2007
 Sejarah Anestetik Umum
• Jaman pre-anesthetic, orang menggunakan sedikit alkohol dan
atau opium untuk mengurangi ketidaknyamanan selama
pembedahan (ada juga menggunakan daun koka, akar mandrake
dll)
• Yang menarik, orang-orang Mesir menggunakan opium poppy
(morfin) & hyoscyamus (hyosyamin & skopolamin) yg hingga saat
ini masih digunakan u/ premedikasi
 18th Century Surgery

Original in the Royal College of Surgeons of England, London.

 Sejarah Anestetik Umum
• 1800 - Sir Humphrey Davy – menemukan Nitrous Oxide
(N2O). Dikenal sbg ‘laughing gas” - menyebabkan
euphoria, analgesia & unconsciousness.
 HISTORY OF ANESTHESIA
INHALATION AGENTS

• Nitrous Oxide • Modern Agents

• 1799 Davy • Halothane 1956
• 1824 Hickman • Enflurane 1972
• 1844 Wells • Isoflurane 1981
• Ether • Sevoflurane and
• 1842 Long Desflurane
• 1847 Snow
1800 - Sir Humphrey Davy – menemukan Nitrous Oxide
(N2O). Dikenal sbg ‘laughing gas” - menyebabkan
euphoria, analgesia & unconsciousness.
Sir Humphrey Davy at the Royal Institution
 Nitrous Oxide Inhalational
Sedation May Represent the
Most Ideal Sedation
Technique
FARMAKOLOGI
NITROUS OXIDE
[ Dinitrogen oxide ]
 Pembuatan Nitrous Oxide
Kristal ammonium nitrate dipanaskan hingga
240 der celsius

Terurai menjadi nitrous oxide dan air

heat
NH4NO3 =======> N2O + 2 H2O
240 deg.C
 Pembuatan Nitrous Oxide
N2O secara kimia mempunyai kemurnian 99.5%

Disimpan dalam bentuk terkompresi dalam tabung

logam/metal
30% berupa liquid dalam tabung penuh

Nitric oxide (NO) merupakan pencemar paling

berbahaya (gunakanlah hanya medical grade
N2O)
 Sifat Fisik
N2O adalah gas yang tidak mengiritasi, sweet-
smelling, tidak berwarna

Zat anorganik selain CO2 yg mempunyai efek

CNS depressant

Satu-satunya gas anorganik yg digunakan untuk

anesthesia pada manusia
 Sifat Fisik
N2O liquid memerlukan panas untuk vaporisasi
menjadi wujud gas

Relatif tdk larut dalam darah; Koefisien kelarutan

dalam darah-gas adalah 0.47 pada 37 der. C
 Potensi Nitrous Oxide
Gas anestetik yang paling lemah (least potent)

35 kali lebih larut dibandingkan N2 dalam plasma

100 kali lebih larut dalam plasma dibandingkan O2

N2O + O2 dapat menimbulkan depresi SSP

 Potensi Nitrous Oxide
N2O pada dosis subanestetik dapat menghasilkan
analgesia

N2O + O2 dengan perbandingan 20%/80%

memiliki efek analgesik setara dengan 10 hingga
15 mg morphine (morfin)

Konsentrasi optimalnya adalah 35%

 Farmakologi Nitrous Oxide
N2O diabsorbsi dengan cepat menuju sistem CV,
disebabkan oleh adanya gradien konsentrasi
N2O yang besar antara alveolar sacs dan darah

N2O dengan cepat mengisi ruang-ruang dlm tubuh

(body cavities) yang terisi udara
 Farmakologi Nitrous Oxide
Karena uptake yang cepat, terlihat ada dua
fenomena
Efek konsentrasi – makin tinggi konsentrasi
menyebabkan uptake N2O makin cepat

Efek gas kedua - gas anestetik kedua juga akan

terambil lebih cepat dari biasanya bila diberikan
bersama (ditambahkan) N2O
 Efek konsentrasi
Tampak hanya jika menggunakan gas dengan
konsentrasi tinggi
Makin tinggi konsentrasi gas yang diinhalasi,
makin cepat terjadi peningkatan arterial tension
dari gas
Gradien difusi dari paru-paru ke darah
menghasilkan uptake gas yang lebih besar
menuju paru-paru
 Efek Konsentrasi
• Terjadi saat nitrous oxide diberikan pd kons.
tinggi selama induksi. Terambil dg cepat dan lbh
banyak gas segera masuk mengisi tempatnya,
ventilasi alveolus meningkat dg efektif
 Second Gas Effect/
Efek Gas Kedua
Terjadi ketika anestetik inhalasi digunakan
bersama N2O
Uptake N2O yang cepat menghasilkan vacuum
dalam alveoli
Gas kedua juga mengalami uptake cepat
bersama-sama N2O
 Efek Gas Kedua
• Bila gas anestetik diberikan bersama nitrous
oxide, gas anestetik akan diangkut/dibawa dalam
jml lebih besar ke alveolus krn gas anestetik
segera mengganti nitrous oxide yg diabsorbsi
oleh darah di paru. Peningkatan konsentrasi zat-
zat anestatik abar (volatile) akan mempercepat
induksi anestesi.
• Kebalikannya, bila pemberian N2O dihentikan,
terjadi eliminasi N2O, mengencerkan gas yg ada
di alveoli dapat menyebabkan hipoksia jika tidak
diberikan O2 tambahan
 Efek gas kedua
• Dlm keadaan normal, hanya O2 diambil paru
• Bila ada gas kedua yg diabsorpsi dengan cepat,
seperti N2O yg masuk ke paru-paru, ambilan
gas ini oleh darah (menuju sirkulasi) berefek
mengkonsentrasikan gas-gas yg berada dalam
alveoli. Efeknya terutama pada anestetik
abar/volatil akan mempercepat induksi anestesi
• Sebaliknya bila pemberian N2O dihentikan,
eliminasi gas ini akan mengencerkan gas-gas
dalam alveoli dan akan menyebabkan
hipoksemia
 Absorpsi
Saturasi SSP terjadi dengan jalan
dipindahkannya/digesernya N2 oleh N2O,
biasanya dalam 3-5 menit

Jaringan dengan aliran darah lebih besar (brain,

heart, liver, kidney) menerima lebih banyak N2O
 Absorpsi
Jaringan dengan sedikit suplai darah (fat, muscle,
connective tissue) mengabsorbsi sedikit N2O

Terjadi absorpsi lambat ketika terjadi

kejenuhan/primary saturation komplit
 Biotransformasi
N2O tidak mengalami biotransformasi di dalam
tubuh

Sebagian besar N2O dikeluarkan melalui

pernafasan dlm bentuk tdk berubah dalam 3
hingga 5 menit setelah pemberiannya dihentikan

1% dieliminasi melalui kulit dan paru-paru dalam

24 jam
 Difusi Hypoxia
Dapat terjadi pada penghentian pemberian N2O
jika pasien bernafas hanya dengan udara
biasa/ruangan (tanpa pemberian tambahan O2)

Terjadi “Hangover” effect

(headache,nausea,lethargy)

Dapat dicegah dengan memberikan 100% O2

selama minimum 3 sampai 5 menit (ref lain 5-10
mnt)
 Difusi Hypoxia
Difusi cepat N2O dari darah ke paru-paru
menghasilkan penurunan tekanan arterial CO2
disertai penurunan stimulus respirasi

Difusi cepat N2O kembali memasuki paru-paru

mengencerkan kadar O2 di alveolus dengan
akibat terjadi hypoxia
 Farmakologi Nitrous Oxide
N2O = non-allergenic
Zat inhalasi yg paling tidak toksik
Guna : analgesik inhalasi, anestesia
Dosis : titrasi hingga mencapai efek
analgesia, induksi & maintenance anastesi
Eliminasi : paru, ginjal, GIT
Kemasan : silinder berwarna biru
Penyimpanan : suhu kamar, 15 – 30 C
 Mekanisme kerja
1. Meningkatkan efek GABA pada reseptor GABAA
– Inhaled anesthetics - Etomidate
– Barbiturates - Propofol
– Benzodiazepines
2. Menyekat (Block) reseptor subtipe nikotinik (analgesia)
– Moderate to high conc’s of inhaled anesthetics
3. Mengaktifakan K channels (hyperpolarize Vm)
– Nitrous oxide, ketamine, xenon
4. Inhibisi reseptor NMDA (glutamate)
– Nitrous oxide, ketamine, xenon, high dose barbiturates
5. Inhibisi synaptic proteins (NT release)(amnesia)
6. Meningkatkan efek glycine pd reseptor glycines
(immobility)
 Inhalasi Sedatsi
• Nitrous oxide/oxygen (N²O/O²) mrpkan
kombinasi gas yg diinhalasi pasien untuk
membantu mengeliminasi rasa takut dan untuk
membantu pasien relax.
• History
– Dates pd 1844
– Dr. Horace Wells pertama kali menggunakan pada
pasien
• Efek
– Nonaddictive
– Easy onset, efek samping minimal, recovery cepat
– Menghasilkan stage I anesthesia
– Dulls the perception of pain
 Keuntungan N²O/O²
• Penggunaannya simple dan
pengaturan mudah/easily managed
• Services of anesthetist or other special
personnel not necessary
• Excellent safety record (aman)
• Minimal side effects
• Patient awake
• Recovery cepat
• Used with all age of patients (segala usia)
 Kontraindikasi N²O/O²
• Kehamilan : Trimester I
• Hidung mampet : Masalah inhalasi
melalui hidung
• Emphysema: Increased O²
• Multiple Sclerosis: Kesulitan bernafas
• Emotional Stability: Altered perception

of reality
 Inhalation Sedation Equipment
• Cylinders: Gas dlm tabung baja/steel cylinders,
berwarna hijau untuk O² dan biru untuk N²O.
• N²O machines: Portable or part of the unit/dental
unit.
– Control valves: Mengedalikan flow tiap gas.
– Flowmeter: menunjukkan kec flow gas.
– Reservoir bag: Kedua gas bercampur di
kantong ini dan pasien menghirupnya.
(Cont’d…)
Inhalation Sedation Equipment
(…Cont’d)

• Gas hose
– Membawa gas dari reservoir bag menuju
mask atau nosepiece.
• Masks: Untuk dewasa & anak
– Melalui nosepiece ini pasien menghirup gas.
• Scavenger system
– Proteksi dr resiko kerja/occupational risks
dari N²O.
Fig. 37-10 Portable Nitrous Oxide System Unit
 Paparan Nitrous Oxide
• Gunakan hanya untuk tujuan terapi pasien.
• Jangan pernah menggunakannya untuk
recreational purposes.
• Bgmn mengurangi paparan N²O thd petugas
– Gunakan scavenger system.
– Gunakan masker yang menutup dg baik/pas/fit well.
– Jaga jangan sampai pasien bicara talking.
– Alirkan gas keluar gedung.
– Periksa peralatan dan hose secara rutin thd kebocoran.
– Gunakan N²O monitoring badge system.
 Patient Preparation for
Inhalation Sedation
• Review health history.
• Obtain baseline vital signs.
• Describe the procedure of
administering the gases.
• Describe the use of the mask and
the importance of nasal breathing.
• Describe the sensations that the
patient will experience.
• Reassure the patient.
Assisting in the Administration
of Inhalation Sedation
• Start with pure oxygen while establishing the
patient’s tidal volume.
• Slowly titrate the nitrous oxide until the
desired results are achieved.
• Patients should refrain from talking or
mouth breathing.
• The N²O/O² analgesia should end with the
administration of 100% O² for 3 to 5 minutes.
• Obtain postoperative vital signs and compare
them to the preoperative recordings.
 Exposure limits
• UK Guidelines from 1996 (COSHH –
Control of Substances Hazardous to
Health)
• N2O: 100ppm
• Isoflurane: 50ppm

• Lower limits in the US and other EU

countries
 Efek Nitrous Oxide
pada Organ Systems
 Central Nervous System

Mekanisme sebenarnya blm diketahui

Vasodilatasi serebral dan meningkatkan aliran darah otak

Meningkatkan tek intrakranial akibat meningkatnya
volume darah otak
Depresi SSP ringan (cerebral cortex) dlm hubungannya
dg kadar fisiologis O2 (> 20%)
Penekanan/depresi sensasi (sight, hearing, touch, pain)
 Sistem Kardiovaskular

Tidak ada perubahan kecepatan denyut jantung

(heart rate) atau cardiac output

TD cendrung stabil dg sedikit penurunan TD & CO

bila digunakan sendiri

Cutaneous vasodilation

Depresi miokard langsung (pd kons >40%)

 Respiratory System
N2O = non-irritating pada
pulmonary epithelium

Perubahan (drop) dalam

kecepatan dan
kedalaman respirasi lebih
disebabkan oleh efek
anxiolytic

Sedikit peningkatan/elevasi
volume menit respirasi
istirahat pada 50%/50%
 GI System
Tidak ada efek yang signifikan
secara klinis, kecuali terjadi
sumbatan (ada ruang
tertutup/close space)

N/V jarang terjadi kecuali terjadi

hypoxia

Dapat digunakan pada hepatic

dysfunction
 Hematopoietic System
Paparan jangka lama (lebih dari 24 jam)
dapat menimbulkan depresi sumsum
tulang

Sistem Muskuloskeletal
Tidak terjadi relaksasi langsung dari otot
skeletal

Efek ansiolitik membantu relaksasi

 Sistem Reproduksi
Tdk ada hambatan kontraksi uterus

Kontraindikasi relatif pd kehamilan (hindari

trimester pertama)
 Eliminasi
• Efek Anesthesia diakhiri dg teredistribusinya obat
dari otak ke darah & keluar melalui paru-paru.
• Kecepatan recovery dr anesthesia bagi anestetik umum
dg Koef.Partisi darah:gas rendah lebih cepat dibanding
kan gas dg kelarutan dlm darah tinggi.
- Time is $$ in the O.R. & recovery room
 Sifat-sifat anestetik inhalasi
Nitrous Oxide
– MAC > 100% : Incomplete anesthetic
– Good analgesia
– Tidak dimetabolisme
– Rapid onset & recovery
– Digunakan bersama anestetik lain; induksi &
recovery cepat

* fewer side effects also seen in children

 Toksisitas
• Nitrous oxide
– Megoblastic anemia may occur after prolonged
exposure due to decreases in methionine synthase
activity (Vit B12 deficiency).
OKSIGEN
 Surgical
Boom
Fires

Oxygen
leak

53 Copyright ECRI 2007

 Fire blow out

Oxygen regulator fire

54 Copyright ECRI 2007
Fire During Defibrillation

Oxygen
and
electricity

55 Copyright ECRI 2007

Surgical fires are very different
56 Copyright ECRI 2007
Most frequent ignition source is
electrosurgery.

57 Copyright ECRI 2007

Oxygen Cylinder Safety
• Transport and store safely
• Jangan menggunakan oli atau lubricants
• Gunakan hanya oxygen-rated devices
• Patikan valve tertutup sblm menyambung
device
• Sambungkan devices ketika tdk ada aliran
• Ajari petugas

58 Copyright ECRI 2001

 Oxygen Safety Training
Standard Patient Care Orientation

• Oxygen = essential for life.

• Oxygen can also be dangerous during a
fire emergency. Your knowledge of the
interruption of piped-in oxygen and what to
do with flowing oxygen in the event of a
fire is crucial to saving lives.
 Safe Oxygen Handling
and Storage
• Oxygen gas diisikan dalam tabung berwarna
Hijau, 30 lb. /steel tanks or cylinders.
• Krn oxygen = kimia berpotensi bahaya, tiap
tangki/tabung hrs ada label. Semua gas untuk
keperluan medis diisikan dalam tangki/tabung
dengan kode warna.
• ALWAYS READ THE LABEL and confirm
that the tank you are going to use does contain
oxygen.
– Carbon Dioxide – Helium - Nitrogen
– Nitrous Oxide - Specialty Gas Mixtures
 Safe Oxygen Handling
and Storage
• Oxygen tanks should be stored in a rack or carrier in an upright
position. If no rack or carrier is available, the oxygen tanks may
be secured to the wall in an upright position by a chain or strap.
• Oxygen tanks should never be stored lying down.
• If a tank is stored with the regulator and/or flow meter attached,
make sure both the regulator and flow meter are turned OFF.

OXYGEN TANK MUST BE STORED WITH

THE VALVE CLOSED.

• Tanks should be stored in such a way to prevent

falls. A falling 30 lb. tank can cause injury. If the valve of an
oxygen tank breaks due to a fall, the oxygen tank can become a
30 lb. missile which can cause grave danger to people, and loss
of and/or expensive repairs to equipment and the structure.
 Safe Oxygen Handling
and Storage
• Oxygen tanks are heavy and should be handled
in a carrier for safety.
• Oxygen tanks that are empty or “not in use” may
be stored in an oxygen storage room. Check
with your supervisor for the location of the floors
or department’s oxygen storage rooms.
• Storage of compressed gas cylinders are
governed by codes of the National Fire
Protection Association (NPFA), along with local
codes.
 Oxygen and Fire Danger
• Intentional oxygen shut - off should only occur in the event of a fire
emergency or leak in the system. While oxygen itself is not flammable or
explosive, it will feed a fire and cause it to burn hotter and faster. If you
discover a fire in a patient room, rescue the patient from the room,
activate the R.A.C.E. protocol, and follow institution specific instructions.
• ABSOLUTELY NO SMOKING IS PERMITTED IN
ANY ROOM WHERE OXYGEN IS IN USE OR ON
STANDBY!!! AN “OXYGEN IN USE” SIGN SHOULD
BE POSTED WHEN O2 IS IN USE.
• Only designated personnel should shut off the floor or zone oxygen after
assessing the consequences. Patients requiring oxygen will need to be
connected to portable oxygen.
• Know the locations of how to obtain and the use of portable oxygen
tanks, regulators, flow meters, “Christmas tree” or multi prong adapters,
as well as the tank key.
 ALWAYS STORE
AND HANDLE
OXYGEN
IN A SAFE
AND
RESPONSIBLE MANNER.
Class A: Compressed
Gas
Characteristics
 Gas inside cylinder is
under pressure
 The cylinder may
explode if heated or
damaged
 Sudden release of high
pressure gas streams
may puncture skin and
cause fatal embolism
Class A: Compressed
Gas
Precautions
Transport and handle
with care
Make sure cylinders are
properly secured
Store away from
sources of heat or fire
Use proper regulator
 INTRODUCTION

Many industrial and laboratory

operations require the use of
compressed gases for a variety
of different operations.

Return to Online Training

 INTRODUCTION

Compressed gases present a unique hazard. Depending on the

particular gas, there is a potential for simultaneous exposure to both
mechanical and chemical hazards. Gases may be:

•Flammable or combustible
•Explosive
•Corrosive
•Poisonous
•Inert
•or a combination of hazards

Return to Online Training

 INTRODUCTION

If the gas is flammable, flash points lower than room

temperature compounded by high rates of diffusion present a
danger of fire or explosion.
Additional hazards of reactivity and toxicity of the gas, as
well as asphyxiation, can be caused by high
concentrations of even "harmless" gases such as
nitrogen.
Since the gases are contained in heavy, highly pressurized
metal containers, the large amount of potential energy
resulting from compression of the gas makes the cylinder a
potential rocket or fragmentation bomb.
Return to Online Training
 INTRODUCTION

Careful procedures are necessary for handling the various

compressed gases, the cylinders containing the compressed
gases, regulators or valves used to control gas flow, and the
piping used to confine gases during flow.

Return to Online Training

 IDENTIFICATION

The contents of any compressed gas cylinder must be clearly

identified. Such identification should be stenciled or stamped
on the cylinder or a label. Commercially available three-part
tag systems may also be used for identification and
inventory.

Return to Online Training

 IDENTIFICATION

Tdk boleh menerima compressed gas cylinder dg identitas

yg tdk jelas. Jika idenitas tdk jelas maka pd silindernya hrs
diberi label “isi tdk diketahui" dan segera kembalikan ke
suplier.

Return to Online Training

 IDENTIFICATION

Jangan pernah berpatokan hanya pd warna silinder/tabung.

Warna tdk reliable karena dapat berbeda tergantung supplier.
Tanda pada tutup/caps hanya sedikit membantu krn caps
sering tertukar/interchangeable.

Always read the label!

Return to Online Training

 IDENTIFICATION

All gas lines leading from a compressed gas supply should

be clearly labeled to identify the gas, the laboratory or area
served, and the relevant emergency telephone numbers.

Return to Online Training

 IDENTIFICATION

The labels should be color coded to distinguish hazardous

gases (such as flammable, toxic, or corrosive substances)
(e.g., a yellow background and black letters).

Return to Online Training

 IDENTIFICATION

Signs should be conspicuously posted in areas where

flammable compressed gases are stored, identifying the
substances and appropriate precautions (e.g., HYDROGEN -
FLAMMABLE GAS - NO SMOKING - NO OPEN FLAMES).

Return to Online Training

 HANDLING & USE

Gas cylinders must be secured at all times to prevent tipping.

Return to Online Training

 HANDLING & USE

Cylinders may be attached to a bench top, individually to the

wall, placed in a holding cage, or have a non-tip base
attached. Chains or sturdy straps may be used to secure
them.

Return to Online Training

 HANDLING & USE

If a leaking cylinder is discovered, move it to a safe place (if it

is safe to do so) and inform the Environmental Health &
Safety Department. You should also call the vendor as soon
as possible.

Under no circumstances
should any attempt be made to repair
a cylinder or valve.

Return to Online Training

 HANDLING & USE

Standard cylinder-valve outlet connections have been

devised by the Compressed Gas Association (CGA) to
prevent mixing of incompatible gases.

The outlet threads used vary in diameter; some are

internal, some are external; some are right-handed,
some are left-handed.

In general, right-handed threads are used for non-fuel and

water-pumped gases, while left-handed threads are used for
fuel and oil-pump gases.
Return to Online Training
 HANDLING & USE

To minimize undesirable connections, only CGA standard

combinations of valves and fittings should be used in
compressed gas installations; the assembly of miscellaneous
parts should be avoided.

The threads on cylinder valves, regulators and other

fittings should be examined to ensure they correspond
and are undamaged.

Return to Online Training

 HANDLING & USE

Cylinders should be placed with the valve accessible at all

times. The main cylinder valve should be closed as soon as it
is no longer necessary that it be open (i.e., it should never be
left open when the equipment is unattended or not operating).

This is necessary not only for safety when the cylinder

is under pressure, but also to prevent the corrosion
and contamination resulting from diffusion of air and
moisture into the cylinder after it has been emptied.

Return to Online Training

 HANDLING & USE

Cylinders are equipped with either a hand wheel or stem

valve. For cylinders equipped with a stem valve, the valve
spindle key should remain on the stem while the cylinder is in
service.

Only wrenches or tools provided by the cylinder

supplier should be used to open or close a valve. At no
time should pliers be used to open a cylinder valve.

Some valves may require washers; this should be checked

before the regulator is fitted.

Return to Online Training

 HANDLING & USE

Cylinder valves should be opened slowly. Oxygen cylinder valves

should be opened all the way.
Open up the oxygen cylinder valve stem just a crack.  Once
the needle on the high pressure gauge has stopped, open up
the valve all the way.  This back-seats the valve.
Oxygen cylinders must have the valve opened up all the way
because of the high pressure in the cylinder.  There is a back-
seating valve on the oxygen cylinder.   This prevents the high-
pressure gas from leaking out through the threaded stem.

When opening the valve on a cylinder containing an irritating or

toxic gas, the user should position the cylinder with the valve
pointing away from them and warn those working nearby.
Return to Online Training
 HANDLING & USE

Cylinders containing flammable gases such as hydrogen or

acetylene must not be stored in close proximity to open
flames, areas where electrical sparks are generated, or where
other sources of ignition may be present.

Cylinders containing acetylene shall never be stored on

their side.
Return to Online Training
 HANDLING & USE

An open flame shall never be used to detect leaks of

flammable gases. Hydrogen flame is invisible, so "feel" for
heat.

One common practice is to use a natural bristle broom to

"sweep" the air in front of you.

All cylinders containing flammable

gases should be stored in a well-
ventilated area.

Return to Online Training

 HANDLING & USE

Oxygen cylinders, full or empty, shall not be stored in the

same vicinity as flammable gases.

The proper storage for oxygen cylinders requires that a

minimum of 20 feet be maintained between flammable gas
cylinders and oxygen cylinders or the storage areas be
separated, at a minimum, by a fire wall five feet high with a
fire rating of 0.5 hours.

Greasy and oily materials shall never

be stored around oxygen; nor should
oil or grease be applied to fittings.

Return to Online Training

 HANDLING & USE

Regulators are gas specific and

not necessarily interchangeable!

Always make sure that the

regulator and valve fittings are
compatible.

Return to Online Training

 HANDLING & USE

After the regulator is attached, the

cylinder valve should be opened
just enough to indicate pressure
on the regulator gauge (no more
than one full turn) and all the
connections checked with a soap
solution for leaks.

Never use oil or grease on

the regulator of a cylinder
valve.
Return to Online Training
 HANDLING & USE

If there is any question as to

the suitability of a regulator
for a particular gas, check
with the Environmental
Health & Safety Department
or call your vendor for
advice.

Return to Online Training

 HANDLING & USE

The following rules should always be followed in regards to

piping:

 Plastic piping shall not be used for any portion of a

high pressure system.
 Do not use cast iron pipe for chlorine.
 Do not conceal distribution lines where a high
concentration of a leaking hazardous gas can build up
and cause an accident.
 Copper piping shall not be used for acetylene.
Return to Online Training
 HANDLING & USE

The following rules should always be followed in regards to

piping:

 Distribution lines and their outlets should be clearly

labeled as to the type of gas contained.
 Piping systems should be inspected for leaks on a
regular basis.
 Special attention should be given to fittings as well as
possible cracks that may have developed.

Return to Online Training

 HANDLING & USE

A cylinder should never be emptied to a pressure lower than

172 kPa (25 psi/in2) (the residual contents may become
contaminated if the valve is left open).

When work involving a compressed gas is completed, the

cylinder must be turned off, and if possible, the lines bled.

Return to Online Training

 HANDLING & USE
When the cylinder needs to be removed or is empty, all
valves shall be closed, the system bled, and the regulator
removed.

The valve cap shall be replaced, the cylinder clearly

marked as "empty," and returned to a storage area for
pickup by the supplier.

Empty and full cylinders should be stored in separate areas.

Return to Online Training

 HANDLING & USE
Where the possibility of flow reversal exists, the cylinder
discharge lines should be equipped with approved check
valves to prevent inadvertent contamination of cylinders
connected to a closed system.

"Sucking back" is particularly troublesome where gases

are used as reactants in a closed system.

A cylinder in such a system should be shut off and removed

from the system when the pressure remaining in the cylinder
is at least 172 kPa (25 psi/in2).

If there is a possibility that the container has been

contaminated, it should be so labeled and returned to the
supplier.
Return to Online Training
 HANDLING & USE
Liquid bulk cylinders may be used in laboratories where a
high volume of gas is needed.

These cylinders usually have a number of valves on the

top of the cylinder.

All valves should be clearly marked as to their function.

These cylinders will also vent their contents when a preset

internal pressure is reached, therefore, they should be
stored or placed in service where there is adequate
ventilation.

Return to Online Training

 HANDLING & USE

Always use safety glasses (preferably with a face shield)

when handling and using compressed gases, especially
when connecting and disconnecting compressed gas
regulators and lines.

Return to Online Training

 HANDLING & USE

All compressed gas cylinders, including lecture-size

cylinders, must be returned to the supplier when empty or no
longer in use.

Return to Online Training

 TRANSPORTATION OF
CYLINDERS

The cylinders that contain compressed gases are primarily

shipping containers and should not be subjected to rough
handling or abuse.

Such misuse can seriously weaken the cylinder and render

it unfit for further use or transform it into a rocket having
sufficient thrust to drive it through masonry walls.

Return to Online Training

 TRANSPORTATION OF
CYLINDERS
1. To protect the valve during transportation, the cover cap
should be screwed on hand tight and remain on until the
cylinder is in place and ready for use.

2. Cylinders should never be rolled or dragged.

3. When moving large cylinders, they should be strapped to

a properly designed wheeled cart to ensure stability.

4. Only one cylinder should be handled (moved) at a time.

Return to Online Training

 Koefisien partisi
• Menggambarkan afinitas relatif gas terhadap 2
zat berbeda (kelarutan)
• Bila diukur pada equilibrium (kesetimbangan),
tekanan partialnya sama, tapi...
• Jml gas terlarut dalam tiap zat (konsentrasi)
tdk sama.
• Paling sering merujuk pada koefisien partisi
darah:gas
• Makin besar nilainya, makin larut dalam darah
Blood/gas partition coefficients

Anesthetic B/G Part. Coeff.

Desflurane 0.42
Nitrous oxide 0.47
Sevoflurane 0.68
Isoflurane 1.4
Halothane 2.3
Ether 12.1
 Koefisien partisi darah:gas
sangat bermanfaat.
• Anesthesia berhubungan dengan tekanan
parsial gas dlm otak.
• Jika obat larut dlm darah, wujudnya tidak
sebagai gas
• Lebih banyak molekul gas terlarut diperlukan
agar fase cair jenuh sebelum meningkatkan
tekanan parsial
• Kecepatan onset/offset berhub erat dengan
kelarutan
• Makin rendah koefisien partisi darah:gas -
makin cepat onset (mula kerja)
 Uptake dan distribusi
• Anesthesia tergantung pada tekanan parsial
otak
• Tekanan parsial alveolus (PA) = Pbrain
• Makin cepat PA mendekati level yang
ditentukan makin cepat pasien teranestesi
• PA adalah keseimbangan antara delivery
obat ke alveolus dan uptake obat menuju
darah
 Minimum Alveolar Concentration
(MAC)/Konsentrasi Alveoli Minimal
(KAM)
• Konsentrasi anestetik minimal dlm
alveolus pd tek 1 atm yg diperlukan untuk
mencegah gerakan pd 50% pasien yg
dilakukan insisi standar.
• Nitrous Oxide is produced by heating Ammonium Nitrate to a
temperature of approx. 250 deg.C. Ammonium Nitrate is
decomposed in the process to give a mixture of Nitrous Oxide
and super heated steam. Impurities include Ammonium Nitrate
fumes, Nitrogen and other oxides of Nitrogen. The steam and
impurities are removed by scrubbing with water, caustic soda
and sulfuric acid. Nitrogen present in traces is removed by
bleeding from the top of storage vessels, where Nitrous Oxide
in liquid state is stored after compression.
Properties of Nitrous Oxide: Nitrous Oxide is a chemical
compound of Nitrogen and Oxygen. Its chemical name is N2O.
It is a colourless, non flammable, nontoxic gas with slightly
sweetish taste and odour. Well-known method of distributing
Nitrous Oxide is as compressed liquid in cylinders of approved
design. It keeps combustion, therefore organic oils and
greases of petrochemical nature be kept away from Nitrous
Oxide gas.
• The Medical Nitrous Oxide Plant room consists of nitrous oxide
cylinders fitted with manifold, that is connected by flexible
copper pig tail pipe. Thereafter, the Nitrous Oxide from cylinder
is passed on through the manifold to the control panel. The
pressure of the Nitrous Oxide is at 750 psi which is controlled
and regulated by the control panel.
There is alarm signal and automatic change over system is
useful for the passage of Nitrous Oxide from one bank to the
other. The Control Panel regulates the output pressure of the
N2O gas at 60 psi and N2O gas which is further passed on to
the entire pipe line at 60 psi to the outlet points fixed at
Operation Theatre. This Medical N2O gas can be used for
anaesthesia purpose.
• Nitrous Oxide PlantPerfect safeguards are incorporated in design against water and power failures, and also to
keep the reaction temperature well under control.
Features:

• Cylinder Testing Station: A cylinder testing station (optional) can be provided to test cylinders. Similarly, a
vacuum pump can be also provided to evacuate the cylinders received from customers which might be containing
some left over impure nitrous oxide.
• Batch Testing Lab: A small laboratory is a must to maintain complete analysis of batch produced in the plant.
The plant is automatic and required only 2 persons to operate per shift besides a chemist.
• Various Plant Capacities Available: Nitrous Oxide plants supplied are have capacities from 15kg/hr, 25 kg/hr,
50kg/hr and 100kg/hr.
• Complete Back up and Support: Not only we install the plant but also we train your people to become good
operators to run the plant independently. We prove the quality (after getting the gas tested by user) quantity and
fill the cylinders, and then only leave the site.
• Asian Concept in Plant Designing: We take into account prevailing asian preconditions while designing gas
plants. Industrial conditions are a lot different in Asia than European and American subcontinent. Considerations
of floor area, labour cost (skilled and unskilled) are never the same for Asia and it can afford maintenance, repair
and a little more space for installation in place of deploying a fully automized, disposable version of gas plants,
which may not give them the best cost-benefit ratio. We offer the designs which are modular, making the
maintenance easy, and affordable.
• Extra Care to safety in plant layout: We leave ample room in plant layout and floor plan. The extra space gives
enough room to the workers and helps them into moving around freely during plant operation-a must with a gas
like N2O.
•
Request a Quote