Sie sind auf Seite 1von 111

Chapter 6

Vaporizers
P. 122


Most of t he inhal ati onal anesthet ic agents in use today are l i qui ds at atmospheric
pressure and room t emperature and must be convert ed int o vapors before they can
be used. A vapori zer (anesthet i c agent or vapor deli very device) i s a devi ce that
changes a l i qui d anestheti c agent into i ts vapor and adds a control l ed amount of
t hat vapor t o the f resh gas f low or the breathi ng system. Up to t hree vapori zers are
commonl y att ached to an anesthesia machine.
Physics
Vapor Pressure
Fi gure 6.1A shows a vol at i le l i quid i nsi de a contai ner that i s closed t o atmosphere.
Mol ecul es of l i quid break away f rom the surf ace and enter the space above, formi ng
a vapor. If t he contai ner is kept at a constant temperature, a dynami c equi l ibri um i s
f ormed between the l i qui d and vapor phases so t hat the number of molecul es i n t he
vapor phase remai ns constant. These molecul es bombard the wal ls of the
contai ner, creati ng a pressure. Thi s i s call ed the sat urated vapor pressure and i s
represented by t he densi ty of dots above the l iquid.
I f heat is suppl ied to the cont ai ner (Fi g. 6. 1B), the equi l ibri um wi l l be shi f ted so
t hat more mol ecul es enter t he vapor phase and the vapor pressure wi l l ri se. If heat
i s taken away f rom the system (Fig. 6.1C), more mol ecul es wi l l enter t he l i qui d
stat e, and the vapor pressure wi l l be l ower. It i s meaningless, t heref ore, t o tal k
about vapor pressure wi t hout specif yi ng the temperat ure. Vapor pressures of some
anesthet ic agents at 20C are shown i n Tabl e 6.1. Vapor pressure depends onl y on
t he l i qui d and the temperature. I t i s not aff ected by ambi ent pressure wi thi n the
range of barometri c pressures encountered i n anesthesia.
Boiling Point
A l i qui d' s boi l ing point i s the temperature at which i ts vapor pressure i s equal to the
at mospheric pressure. The boil ing poi nt wi l l be l ower wi th l ower at mospheric
pressure. Anestheti c agents wi t h l ow boi l ing poi nts are more suscepti bl e to
vari ati ons in baromet ri c pressure t han agent s wi t h higher boi l i ng poi nts. The boil i ng
poi nts for some anest het ic agents are shown i n Tabl e 6.1.
P. 123



View Figure

Figure 6.1 Vapor pressure changes with varying
temperature. A: The liquid and vapor are in equilibrium. B:
The application of heat causes the equilibrium to shift so
that more molecules enter the vapor phase, as illustrated by
the increased density of dots above the liquid. C: Lowering
the temperature causes a shift toward the liquid phase and a
decrease in vapor pressure. D: Passing a carrier gas over the
liquid shifts the equilibrium toward the vapor phase. The
heat of vaporization is supplied from the remaining liquid.
This causes a drop in temperature.

Gas Concentration
Two met hods are commonl y used t o express the concent rati on of a gas or vapor:
Parti al pressure and volumes percent (vol %).
Parti al Pressure
A mixture of gases i n a closed contai ner wi l l exert a pressure on the wal l s of t he
contai ner. The part of the total pressure due t o any one gas in the mixture is cal l ed
t he parti al pressure of that gas. The tot al pressure of the mi xt ure i s the sum of the
part ial pressures of the const i tuent gases. The parti al pressure exerted by the
vapor of a l i qui d agent depends onl y on the temperature of that agent and i s
unaff ect ed by t he total pressure above the l i qui d. The highest part i al pressure t hat
can be exerted by a gas at a gi ven t emperat ure i s i ts vapor pressure.
TABLE 6.1 Properties of Common Anesthetic Agents
Heat of
Vaporization
Specific Heat
of Liquid
Agent
Trade
Name
Boiling
Point
(C,
760
mm
Hg)
Vapor
Pressu
re
(torr,
20C)
Density
of Liquid
(g/mL) cal/g cal/mL cal/mL cal/g
MACa
in O
2

(%)
Haloth
ane
Fluot
hane
5
0.
2
2
4
3
1.8
6
(20
C)
35
(20
C)
65
(20
C)
0.
3
5
0.
1
9
0.
7
5
Enflur
ane
Ethra
ne
5
6.
5
1
7
5
1.5
17
(25
C)
42
(25
C)
63
(25
C)
1.
6
8
Isoflur
ane
Fora
ne
4
8.
5
2
3
8
1.4
96
(25
C)
41
(25
C)
62
(25
C)
1.
1
5
Desflu
rane
Supr
ane
2
2.
8
6
6
9
1.4
5
(20
C)
6.
4
Sevofl
urane
Ultan
e
5
8.
6
1
5
7
2.
0
a
Minimum anesthetic concentration.
Adapted with permission from Quasha AL, Eger EL, Tinker JH. Determinaion and
applications of MAC. Anesthesiology 1980;53:315334.

Volumes Percent
The concentrat ion of a gas i n a mi xt ure can al so be expressed as i ts percentage of
t he tot al vol ume. Vol umes percent i s the number of uni ts of vol ume of a gas in
rel ati on to a t otal of 100 uni ts of vol ume for the tot al gas mi xture. I n a mi xt ure of
gases, each const i tuent gas exerts t he same proport i on of the t otal pressure as i ts
volume i s of the total vol ume. Vol umes percent expresses the rel at ive rat io of gas
mol ecul es i n a mixture, whereas parti al pressure expresses an absol ute value.
Parti al Pressure/ Total pressure = Vol umes percent
Al though gas and vapor concentrati ons del ivered by a vapori zer are usual l y
expressed i n vol umes percent , pat ient uptake and anestheti c depth are di rectl y
rel ated t o
P. 124

part ial pressure but onl y i ndi rectl y t o vol umes percent . Whi l e a gi ven part ial
pressure represents t he same anesthet ic potency under vari ous barometric
pressures, thi s i s not the case wi th volumes percent (1).
Heat of Vaporization
I t takes energy f or t he mol ecul es i n a l i qui d to break away and ent er t he gaseous
phase. A l iqui d's heat of vapori zat i on is t he number of cal ori es necessary t o
convert 1 g of l iquid i nto a vapor. Heat of vapori zati on can also be expressed as
t he number of cal ori es necessary to convert 1 mL of l i qui d i nto a vapor. The heats
of vapori zati on of some anesthet ic agents are shown i n Tabl e 6.1.
Li qui d temperature decreases as vapori zat ion proceeds. As the t emperature fal l s, a
gradi ent is creat ed so t hat heat f lows f rom the surroundings int o the l i qui d. The
l ower t he l iquid t emperat ure, the greater the gradi ent and t he greater the f l ow of
heat f rom the surroundi ngs. Eventual l y, equi l i bri um i s establ ished so that the heat
l ost to vapori zati on is matched by the heat suppl i ed f rom t he surroundings. At thi s
poi nt , the temperature ceases to drop.
I n Figure 6.1D, a f low of gas (carri er gas) is passed through t he contai ner and
carri es away mol ecul es of vapor. This causes t he equil i bri um to shi f t so that more
mol ecul es enter the vapor phase. Unl ess some means of suppl yi ng heat i s
avai l able, the l i qui d wi l l cool . As the t emperat ure drops, so does the vapor pressure
of t he l iquid, and f ewer mol ecul es wi l l be picked up by t he carri er gas so that there
i s a decrease i n concent rati on i n the gas f l owi ng out of the cont ai ner.
Specific Heat
A substance' s speci fi c heat is the quanti t y of heat requi red t o rai se the temperature
of 1 g of the substance by 1C. The higher the speci fi c heat , t he more heat that i s
requi red t o raise t he t emperat ure of a given quanti ty of that substance. A sl i ght l y
di ff erent def i ni t ion of specif i c heat i s the amount of heat requi red t o rai se t he
t emperat ure of 1 mL of the substance by 1C. Wat er i s the standard wi t h a specif i c
heat of 1 cal /g/ C or 1 cal / mL/C.
Speci f i c heat is i mportant when consi deri ng the amount of heat that must be
suppl ied to a l i qui d anestheti c to maintai n a stabl e temperature when heat is l ost
duri ng vapori zat i on. Speci f i c heats f or some anesthet i c agents are given in Tabl e
6. 1.
Speci f i c heat is al so i mportant for choosi ng the materi al t o const ruct a vapori zer.
Temperature changes more gradual l y for materi als wi t h a hi gh speci fi c heat than f or
t hose wi th a l ow specif i c heat .
Thermal Conductivity
Another consi derati on i n choosing materi al f rom whi ch t o const ruct a vapori zer i s
t hermal conducti vi ty. Thi s is a measure of the speed wi th whi ch heat f lows through
a substance. The hi gher the t hermal conducti vi t y, t he bet ter the substance
conducts heat.
Thermostabil i zat ion i s achi eved by const ruct i ng a vapori zer of a metal wi t h high
t hermal conducti vi ty (copper, bronze) t o minimi ze t emperat ure changes when the
vapori zer is i n use. In a vapori zer contai ni ng a wi ck, i t i s import ant t hat t he wi ck be
i n cont act wi t h a metal part so that heat l ost as a resul t of vapori zat i on can be
quickly repl aced.
Vaporizer Design
Concentration Calibration
Nearl y al l the vapori zers i n use today i n the Uni ted States are cal i brated by agent
concentrat ion as expressed in percentage of vapor output. They are known as
concentrated-cal i brat ed vapori zers.
They are al so cal l ed di rect -readi ng, dial -control led, automat i c plenum, percentage-
t ype, and tec-type vapori zers. Vapori zer output i s control led by a single knob or
di al that is cal i brated in volumes percent .
Concent rati on-cal i brated vapori zers are desi gned to be l ocated bet ween t he
f lowmeters and t he common gas outl et on the anest hesia machi ne. They are not
designed t o be used between t he common gas out l et and the breat hi ng system or i n
t he breathi ng system, because they are not cal i brated f or t he hi gh gas f lows t hat
occur wi t h t he oxygen f lush i n these l ocati ons and off er t oo much resi stance.
Vari abl e Bypass Vaporizers
The vapor pressures of most anesthet ic agents at room t emperature are much
great er t han t he parti al pressure requi red t o produce anesthesi a. To produce
cl i nical ly usef ul concentrati ons, a vapori zer di lutes saturated vapor. Thi s can be
accompl i shed by spl i t ti ng t he gas f l ow t hat passes through the vapori zer (Fi g. 6.2).
Some of the gas f l ows t hrough the vapori zi ng chamber (t he part cont aini ng t he
l i quid anesthet i c agent ), and the remai nder goes through a bypass to the vapori zer
outl et . Bot h gas fl ows j oi n downstream of t he vapori zi ng chamber, where gas exi ts
t he vapori zer at the desi red concent rat i on.
The rat io of bypass gas to gas goi ng to t he vapori zi ng chamber i s cal l ed the
spli tt i ng rat i o and depends on t he rati o of resi st ances i n the two pathways (2,3).
Thi s i n turn depends on t he vari able (adj ustabl e) ori fi ce. Thi s ori f ice may be in t he
i nl et to the vapori zi ng chamber but i s in
P. 125

t he out let i n most modern vapori zers. The spl i tt ing rat io may al so depend on t he
t otal fl ow t o t he vapori zer.

View Figure

Figure 6.2 Concentration-calibrated vaporizer. A: In the
OFF position, all of the inflowing gas is directed through
the bypass. B: In the ON position, gas flow is divided
between the bypass and the vaporizing chamber. In the
MAX position, all of the gas flow allowed by the vaporizer
goes to the vaporizing chamber.

Electronic Vaporizers
I n an electroni c vapori zer, t he vol ume of carri er gas necessary to produce the
desi red agent concentrat ion may be determi ned by a computer t hat calcul ates the
carri er gas f l ow t hat needs to pass through t he vapori zi ng chamber i n order to
produce the desi red anesthet i c agent concent rati on.
Another type of el ectroni c vapori zer wi t hdraws a cal cul ated amount of l i qui d agent
f rom the agent bot tl e and i nj ects t hat li qui d i nto t he breathi ng system or f resh gas
f low. The amount of l i qui d that is i nj ected i s adj usted to achi eve t he desi red
anesthet ic agent concent rat ion.
Vaporization Methods
Flow-over
I n a f low-over vapori zer, a stream of carri er gas passes over t he surface of the
l i quid. Increasi ng the area of the carri er gas-l i qui d i nt erface can enhance t he
ef fi ci ency of vapori zati on. Thi s can be done by usi ng baf f l es or spi ral tracks to
l engthen t he gas pathway over the l i qui d. Another method is t o empl oy wi cks t hat
have thei r bases i n the l i qui d. The l i qui d moves up the wi ck by capil l ary acti on.
Most of t he vapori zers used i n anesthesi a empl oy this vapori zati on method.
Inj ecti on
Certai n vapori zers cont rol the vapor concent rat i on by i nj ecti ng a known amount of
l i quid anesthet i c i nto a known volume of gas.
Temperature Compensation
As a l i quid i s vapori zed, energy i n the f orm of heat i s lost . As the l i qui d temperature
decreases, so does the vapor pressure. Two methods have been empl oyed t o
mai ntai n a constant vapor output wi t h f l uctuat ions i n l i qui d anest heti c temperature.
Mechani cal Thermocompensation
Most concent rati on-cal i brated vaporizers compensat e for changes in vapor pressure
wi th t emperature changes by al teri ng the spl i t ti ng rati o so that the percent age of
carri er gas that i s di rected t hrough t he vapori zi ng chamber i s increased or
decreased. As the vapori zer cool s, the thermal el ement rest ri cts the bypass f l ow,
causi ng more carri er gas t o pass t hrough t he vapori zi ng chamber. The opposi te can
occur i f the vapori zer becomes too warm.
Supplied Heat
An el ect ri c heater can be used to suppl y heat t o a vapori zer and mai ntain i t at a
const ant t emperat ure.
Computerized Thermocompensati on
Thermocompensat ion may be accompl i shed by computer cont rol . Two methods have
been used. The amount of agent inj ected i nt o the breathi ng system or f resh gas
f low may be al tered. I f the vapori zer wi thdraws an amount of l iqui d f rom a bot t le
and i nj ects i t , t he heat l oss due t o vapori zati on may not be i mportant. The second
method i s computeri zed control of the amount of carri er gas that f l ows t hrough the
vapori zi ng chamber.
Effects of Altered Barometric Pressure
Most vapori zers are cal ibrated at sea l evel (4). Because they are somet imes used
i n hyperbari c chambers or at hi gh al ti tudes where at mospheri c pressure i s low, i t i s
i mportant to have some knowl edge of how t hey
P. 126

wi l l perform when the barometric pressure is changed. The Ameri can Society of
Testi ng and Materi als (ASTM) anesthesia workstat ion standard (5) requi res that t he
ef fects of changes i n ambi ent pressure on vapori zer perf ormance be stated i n the
accompanyi ng documents.
Effects of Intermittent Back Pressure
When assi sted or control led vent i l at ion i s used, t he posi t i ve pressure generated
duri ng inspi rati on is t ransmi tt ed f rom the breathi ng system back to t he machine and
t he vapori zers. Back pressure al so occurs when t he oxygen f l ush i s act i vat ed. Back
pressure may ei ther i ncrease (pumpi ng ef f ect ) or decrease (pressuri zi ng ef fect) t he
vapori zer out put .
The ASTM anesthesia workstat i on standard (5) l i mi ts the changes i n concentrati on
f rom intermi tt ent back pressure. Manuf acturers are requi red to state i n operat ors'
manual s t he extent to whi ch back pressure af f ects a vapori zer' s perf ormance.
Pumping Effect
Factors
St udi es have shown t hat concent rat i ons del i vered by some vapori zers duri ng
control led or assisted vent il ati on are hi gher than when the vapori zer was used wi th
f ree f low t o atmosphere (6). This change i s most pronounced when there is l ess
agent i n the vapori zing chamber, when carri er gas fl ow i s l ow, when the pressure
f luctuati ons are hi gh and f requent, and when the dial set t i ng i s low.

View Figure

Figure 6.3 The pumping effect in a concentration-calibrated
vaporizer. (See text for details.) (From
Hill DW. The design and calibration of vaporizers for
volatile anesthetic agents. Br J Anaesth 1968;40:656
.)

Mechani sms
A proposed mechanism f or t he pumpi ng ef fect i n the concentrati on-cal ibrated
vari abl e-bypass vapori zers i s shown i n Figure 6. 3AC. Fi gure 6.3A shows t he
vapori zer duri ng exhal at i on. The rel at ive resistances of t he outl ets f rom t he bypass
and vapori zi ng chamber determine t he f l ows to each (i t ems 3 and 4 i n the f igure).
Fi gure 6.3B shows i nspi rat ion. Posi t ive pressure at poi nt C prevents gas and vapor
outf l ow. Pressure is t ransmi tt ed to points A and B. This resul ts i n gas bei ng
compressed i n the vapori zing chamber and bypass. Because t he bypass has a
smal l er volume than the vapori zi ng chamber, more gas ent ers t he vapori zi ng
chamber so t hat the normal rat i o between the f l ow to t he vapori zi ng chamber and
t hat through the bypass i s disturbed. The resul t i s an increased f l ow t o the
vapori zi ng chamber, whi ch then pi cks up addi ti onal anesthet ic vapor.
Fi gure 6.3C shows the si tuati on j ust af ter t he begi nning of exhalati on. The pressure
at poi nt C fal l s rapi dl y, and gas f lows f rom the vaporizi ng chamber and the bypass
t o t he outl et . Because t he bypass has l ess resi stance than t he vapori zing chamber
outl et , the pressure i n the bypass fal l s more quickl y than that in the vapori zi ng
chamber, and gas contai ni ng vapor f l ows f rom the vapori zi ng chamber i nto t he
bypass. Because t he gas i n the bypass (whi ch di l utes the gas f rom t he vapori zi ng
chamber) now carri es vapor and the gas fl owi ng f rom
P. 127

t he vapori zi ng chamber i s st i l l saturated, the concentrati on i n the vapori zer output
i s i ncreased.
Modifications to Minimize the Pumpi ng Effect
Alterations to the Vaporizer
Because the i ncreased output i s rel ated to t he relati ve si zes of the space above the
l i quid i n the vapori zi ng chamber and the space in t he bypass, keepi ng the
vapori zi ng chamber smal l or i ncreasi ng the si ze of t he bypass wi l l decrease the
ef fects of back pressure (2). Another method i s to empl oy a l ong, spi ral or l arge-
di ameter t ube to l ead t o the vapori zi ng chamber (Fi g. 6.3DF). The extra gas
f orced into this tube and subsequentl y returned to the bypass does not reach the
vapori zi ng chamber. Another method i s to excl ude wi cks f rom the area where the
i nl et tube joins the vapori zi ng chamber. Fi nal l y, an overal l increase i n resi st ance to
gas f l ow t hrough t he vapori zer may be used.
Alterations to the Anesthesia Machine
These devices (pressuri zing valve, unidi recti onal val ve, and pressure rel i ef devi ce)
were di scussed i n Chapt er 5. A check valve near t he machine outl et but upst ream
of t he j unct i on wi t h the oxygen f l ush of f ers l ess prot ect i on f rom t he pumping eff ect
t han a check val ve at t he outl et of a vapori zer (7).
Pressurizing Effect
Factors
The output of some vapori zers used i n conjunction wi t h automati c venti l ators has
been f ound to be l ower t han duri ng f ree f low t o atmosphere (8). The eff ect is
great er wi th hi gh f lows, l arge pressure fl uctuati ons, and l ow vapori zer sett i ngs.
Mechani sms
The expl anat i on for the pressuri zi ng ef f ect i s shown i n Fi gure 6.4. Fi gure 6.4A
shows a vapori zer f l owi ng f ree to at mosphere. The pressure i n the vapori zi ng
chamber and the bypass i s P. As gas f l ows t o t he outl et , the pressure is reduced to
R. The number of mol ecul es of anestheti c agent pi cked up by each mi l l i l i ter of
carri er gas depends on t he densi ty of t he anesthet ic vapor mol ecul es i n the
vapori zi ng chamber. Thi s, in turn, depends on the agent' s vapor pressure. The
vapor pressure depends sol el y on the temperature and is not af f ected by al t erati ons
i n the at mospheric pressure.
Fi gure 6.4B shows t he si tuati on when an i ncreased pressure i s appl i ed to t he
vapori zer out l et and t ransmi tted to the vapori zi ng chamber. The i ncreased pressure
wi l l compress the carri er gas so that t here wi l l be more mol ecul es per mi l l i l i t er. The
number of anest het i c vapor mol ecul es i n the vapori zing chamber wi l l not be
i ncreased, however, because thi s depends on the saturated vapor pressure of t he
anesthet ic and not on t he pressure i n t he container. The net resul t i s a decrease i n
t he concent rati on of anest het i c i n the vapori zi ng chamber and the vapori zer out let.

View Figure

Figure 6.4 The pressurizing effect. An increase in pressure
(p) causes an increase in pressure (p) inside the vaporizer.
The vapor pressure of the volatile anesthetic is unaffected
by changes in the total pressure of the gas mixture above it.
As a result, the concentration is reduced.

Interplay between Pressurizing and Pumping Effects
The changes i n vapori zer output caused by t he pumpi ng ef fect usual l y are greater
t han those associ ated wi th t he pressuri zi ng ef fect. The pressuri zi ng eff ect is seen
wi th hi gh gas f l ows and t he pumpi ng ef f ect at low f l ows.
Effects of Rebreathing
The vapori zer di al set ti ng refl ects the concent rat i on of i nhal ati onal agent del ivered
t o t he breathi ng system. When the f resh gas f low i s hi gh, there may be li t tl e, i f any,
exhal ed gas rebreathed, and the i nspi red concentrat ion shoul d be cl ose to the
vapori zer set t ing. As the f resh gas f low i s lowered, exhal ed gases contri bute a
more signi f i cant porti on of the i nspi red gases. Rebreathing causes a dif f erence
bet ween t he vapori zer set t ing and the i nspi red concent rati on. Also, i f minute
volume i s
P. 128

i ncreased, t here wi l l be more rebreathi ng and a great er eff ect . Wi t h si gni f icant
rebreat hi ng, onl y an agent anal yzer can provi de an accurate val ue for t he i nspi red
agent concentrat ion.
Vaporizers and Standards
An i nternati onal st andard covers vapori zers (9). The ASTM anest hesi a workstat i on
standard (5) contains t he f ol lowi ng provi si ons regardi ng vaporizers:
The eff ects of vari at ions in ambi ent temperature and pressure, ti l ti ng, back
pressure, and i nput f l ow rat e and gas mi xt ure composi ti on on vapori zer
perf ormance must be stated i n the accompanyi ng documents.
The average del i vered concent rati on f rom the vapori zer shal l not devi at e
f rom the set val ue by more than 20% or 5% of the maxi mum sett ing,
whi chever i s greater, wi t hout back pressure.
The average del i vered concent rati on f rom the vapori zer shal l not devi at e
f rom the set val ue by more than +30% or -20% or by more than +7.5% or -5%
of t he maxi mum set ti ng, whi chever i s greater, wi t h pressure f l uctuat i ons at
t he common gas out l et of 2 kPa wi th a total gas f l ow of 2 L/mi nut e or 5 kPa
wi th a total gas f low of 8 L/mi nute.
A system that prevents gas f rom passing t hrough the vapori zi ng chamber or
reservoi r of one vapori zer and then through that of anot her must be provi ded.
The output of t he vapori zer shal l be l ess than 0.05% i n the OFF or zero
posi t i on if t he zero posi t i on is al so the OFF posi t ion.
Al l vapori zer control knobs must open countercl ockwi se.
Ei ther the maxi mum and mi ni mum fi l li ng l evel s or t he actual usable volume
and capaci t y shal l be displ ayed.
The vapori zer must be desi gned so that i t cannot be overf i l l ed when in t he
normal operati ng posi ti on.
Vapori zers unsui tabl e f or use i n the breathing syst em must have
noninterchangeabl e propri etary or 23-mm f i tti ngs. Coni cal f i t ti ngs of 15 mm
and 22 mm cannot be used. When 23-mm f i tti ngs are used, t he inlet of the
vapori zer must be mal e and the outl et f emal e. The di recti on of gas f l ow must
be marked.
Vapori zers sui tabl e f or use i n the breathi ng system must have standard 22-
mm f i tt ings or screw-t hreaded, wei ght -beari ng f i t ti ngs wi t h the i nl et f emal e
and the out l et mal e. The di recti on of gas f l ow must be i ndi cated by arrows
and the vapori zer marked f or use in t he breathing system.
Concentration-calibrated Vaporizers
Tec 5
Tec 5 vapori zers are designed f or use wi th hal othane, enfl urane, isof l urane, and
sevof lurane.
Construction
Tec 5 vapori zers are shown i n Fi gure 6.5. The control dial is at the top. A rel ease
but ton located at the rear of the di al must be pushed i n bef ore the vapori zer can be
t urned ON. At the rear is a l ocking l ever that i s connected to the control di al so that
t he vapori zer cannot be t urned ON unti l i t i s l ocked on the mani fold. At the bottom
ri ght f ront i s a si ght glass that shows the l i qui d agent l evel i n the vapori zi ng
chamber.
Tec 5 vapori zers are avai l abl e wi th ei ther of t wo f i l l i ng devices. One i s a keyed
system (Fi g. 6.5). The fi l li ng/drai ni ng port is at the f ront of t he vapori zer on t he lef t
near the bot tom. A l ocking l ever to secure the f i l l er bl ock i s l ocat ed on the l ef t side
of t he vapori zer. A smal l l ever at t he base al l ows l i qui d t o be added to or drai ned
f rom the vapori zer. The other f i l l i ng devi ce i s a f unnel f i l l that has a drain pl ug t hat
can be l oosened t o drain t he vapori zer.
A schemat ic di agram of a Tec 5 vapori zer is shown i n Figure 6.6. The i nternal
baff l e syst em i s designed to keep l i quid f rom reachi ng the out l et i f the vapori zer i s
t i pped or i nverted.
When t he concent rati on di al i s in the zero posi t ion, al l of the gas f rom t he
f lowmeters bypasses the vapori zer t hrough t he Sel ect -a-t ec bar (Fi g. 6.74). When
t he di al i s t urned past zero, inf l owi ng gas i s spl i t i nto two st reams by the rotary
valve. One st ream i s di rected t o the vapori zi ng chamber, the other through the
bypass.
Gas f lowi ng t hrough t he bypass f l ows down one si de of the vapori zer and past the
t hermostat, whi ch is a bi metal l i c st ri p i n the base. As the temperature in t he
vapori zer decreases, the thermostat permi ts l ess gas f l ow through the bypass so
t hat more gas passes t hrough the vapori zi ng chamber. From t he t hermostat, gas
f lows up t he ot her side of the vapori zer and near t he outl et j oi ns the gas that has
passed through the vapori zi ng chamber.
The gas f l owi ng to t he vapori zi ng chamber f i rst passes through the cent ral part of
t he rotary val ve, af ter which i t i s di rected through a hel i cal channel then past a
spi ral wi ck t hat i s in cont act wi t h t he wi ck ski rt, whi ch dips i nt o the l i qui d agent .
Gas wi th vapor l eaves the vapori zi ng chamber vi a a channel i n the concent rat i on
di al rotary val ve and f l ows t o the outl et .
Evaluation
The manufacturer' s performance curves are shown i n Fi gure 6.7. Greatest accuracy
i s at a f resh gas f l ow of
P. 129


P. 130


P. 131


P. 132

l ess than 5 L/ minute and dial set ti ngs l ess than 3%. At hi gher f l ows and hi gher di al
sett ings, there is a decrease i n output (10).

View Figure

Figure 6.5 Tec 5 vaporizers. The locking lever for the
filling device is on the lower left side of each vaporizer. The
lever for filling-draining is at the base, below the sight
glass. To fill, the bottle adaptor is inserted into the port and
clamped in place by pulling the locking lever down. The
bottle is then lifted up, and the filling-draining lever is
pulled forward. When filling is completed, the filling-
draining lever is returned to the closed position, the bottle is
lowered, the clamping lever is pushed upward, and the
bottle is removed. Draining of the vaporizer is
accomplished by using the same levers but by lowering the
bottle rather than lifting it. Behind each control dial is a
locking lever in the locked position. (Courtesy of Ohmeda,
a division of BOC Health Care, Inc.)


View Figure

Figure 6.6 Diagram of Tec 5 vaporizer in the ON position.
(See text for details.) (Redrawn from a drawing furnished
by Ohmeda, a division of the BOC Health Care, Inc.)


View Figure

Figure 6.7 Performances of four Tec 5 vaporizers.
(Redrawn from drawings furnished by Ohmeda, a division
of the BOC Health Care, Inc.)

The greatest accuracy is between 15C and 35C. The t hermostat does not respond
t o t emperatures bel ow 15C, and the out put wi l l be l ess t han i ndi cat ed on the di al .
I f the t emperat ure i s above 35C, the out put wi l l be unpredictabl y hi gh.
The Tec 5 i s prone to i ncreases i n output f rom the pumpi ng ef fect (11). Carri er gas
composi ti on af f ects the output of t he Tec 5 vapori zers. At l ow f l ows, t he output is
l ess when ai r or ni trous oxide i s used than when oxygen i s the carri er gas. At hi gh
f lows, a smal l i ncrease i n output wi l l occur.
Hazards
I f the l ocki ng lever i s parti al l y l oose or the f i l l i ng port open, there wi l l be a gas l eak
(12,13,14, 15). Li qui d agent may be l ost i f the vapori zer i s f ai rl y ful l .
These vapori zers can be overf i l led i f the bot tl e adaptor is l oose and the cont rol di al
i s i n the ON posi ti on (16,17, 18). Ti l t ing t he vapori zer can resul t i n overf il l ing (19).
Thi s wi l l cause the vapor output to be elevat ed. Reversed f l ow t hrough the
vapori zer resul ts i n increased output (20).
Maintenance
The exteri or of t he vapori zer may be wi ped wi th a damp cl ot h. No ot her cl eani ng or
di si nf ect ion should be at tempted.
The manufacturer recommends t hat if the agent cont ains addi t ives or stabi l izing
agents, t he vapori zer should be drai ned every 2 weeks or when t he l evel is l ow. I f
t here are no addi t i ves or stabi l i zi ng agents, the vapori zer can be drained at l ess
f requent i nt erval s. The vapori zer shoul d be returned to a servi ce cent er every 3
years. There may be some f lexi bi l i ty i n the recommended service f requency when
agent anal ysi s is used.
Tec 6
The Tec 6 vapori zer i s designed f or use onl y wi th desf l urane (21,22, 23).
Construction
The Tec 6 vapori zer i s shown i n Fi gure 6.8. It i s somewhat l arger t han the Tec 5
vapori zers. The concentrati on di al at the top i s cal i brated f rom 1% to 18% i n
gradati ons of 1% up t o 10% and 2% bet ween 10% and 18%. A dial rel ease at t he
back of the di al must be depressed to t urn the di al f rom t he standby posi t ion or to
di al concent rat ions over 12%. This rel ease cannot be depressed unl ess t he
operati onal li ght -emi t ti ng di ode (LED) i s i l l umi nated.
The f i l l er port i s at the f ront on the l ef t. I t i s desi gned so that onl y a desf l urane-
speci f i c bot tl e can be i nsert ed i nto i t. The power cord att achment and bat tery case
are on the bott om. The bat tery provi des power f or the al arms and l iqui d crystal
l evel indicator duri ng mains power f ai lures. The power cord exi ts at the si de. The
vapori zer casi ng i s warm t o the touch when i t is connected t o the el ectri cal suppl y,
whi ch wi l l cause sli ght heat i ng of adjacent equi pment (24). The drai n pl ug i s
l ocated at t he base. A speci al ki t i s requi red t o drain the vapori zer.

View Figure

Figure 6.8 Tec 6 vaporizer. The filler port is at the bottom
left. At the bottom right are the liquid level indicator and the
visual signals for monitors of vaporizer function. A bottle of
desflurane with the protection cap in place is to the left of the
vaporizer. The locking lever behind the control dial is in the
unlocked position. (Courtesy of Ohmeda, a division of BOC
Health Care, Inc.)

On the f ront l ower ri ght of the vapori zer i s the di spl ay panel , whi ch has vi sual
i ndi cators for vapori zer f uncti ons (Fi g. 6.8). Wi th t he except i on of the ti l t condi ti on,
t here i s a 10-second del ay between detect ing a mal f unct i on and al arm activati on.
An audi tory alarm is mounted behi nd the upper part of the di spl ay panel . An audi o
OFF (mute) but ton i s l ocated above the display panel .
The amber warm-up LED i ndi cates an i ni ti al warm-up period af ter t he vapori zer is
f i rst connected to the mains power. Once warm-up i s compl ete, the green
operati onal LED is i l l umi nated, i ndicati ng t hat t he vapori zer has reached i ts
operati ng temperature and t he concent rati on di al can be turned ON. A short tone
sounds at the t ransi ti on f rom warm-up to operat ional .
The red no output LED f l ashes and an audi t ory al arm of repet i ti ve tones sounds i f
t he vapori zer i s not abl e to del i ver vapor. Thi s can be caused by an agent l evel less
t han 20 mL, t i l t ing t he vapori zer more than 10 degrees, power f ai l ure, or an i nternal
mal f unct ion. Turni ng the concent rat i on di al t o standby wi l l mute t hi s al arm and
i l l umi nate the red l i ght.
P. 133


The amber l ow agent LED accompani ed by an audi bl e alarm i s i ll umi nat ed if there
i s l ess than 50 mL of agent i n the vapori zer. This al arm can be audio paused
(muted) for 120 seconds. I f l ess than 20 mL remai n i n the vapori zer, t he no output
al arm i s act ivated.
The amber al arm batt ery l ow LED i l l umi nates to i ndi cat e that a new bat t ery i s
requi red. There i s no audi t ory si gnal f or t his condi t i on.
The l i qui d l evel i ndi cat or has a l i qui d cryst al di splay (LCD) t hat indicates the
amount of l i qui d in t he vapori zer bet ween 50 and 425 mL. The LCDs are vi si bl e
whenever the vapori zer i s powered. There are 20 bars. A si ngle bar corresponds to
a vol ume of approxi matel y 20 mL. An arrow on the side i ndicates the 250 mL refi l l
mark. If the l evel i s bel ow thi s mark, t he vapori zer wi l l accept a f ul l bott le (240 mL)
of desf lurane.

View Figure

Figure 6.9 Diagram of Tec 6 vaporizer. (1) agent, (2) level
sensor, (3) sump heaters, (4) electrical mains, (5) shut-off
valve, (6) agent pressure-regulating valve, (7) battery for
alarms, (8) LCD level display, (9) alarm electronics, (10)
heater electronics, (11) control electronics, (12) alarm
battery low LED, (13) warm-up LED, (14) low agent LED,
(15) no output LED, (16) pressure transducer, (17) pressure
monitor, (18) heater in vapor manifold, (19) heater in valve
plate, (20) solenoid interlock, (21) variable resistor
(controlled by rotary valve), (22) fixed restrictor, (23) tilt
switch, (24) operational LED. (See text for details.)
(Redrawn from a diagram furnished by Ohmeda, a division
of BOC Health Care, Inc.)

When t he uni t i s plugged i n, the el ect roni cs go through a sel f -test. For 2 seconds,
t he al arm sounds, and each LED and LCD i l l uminates. This sel f -test can be
repeated at any ti me by pressing t he mute but ton f or 4 seconds or more. Once the
vapori zer is plugged i n, the power i s al ways ON, and the sump heaters are
operati onal . I ni ti al l y, the vapori zer wi l l take 5 to 10 mi nut es to reach operati ng
t emperat ure.
The i nt ernal const ructi on i s shown i n Fi g. 6.9. Desf l urane i s heat ed to 39C
(102F), whi ch is wel l above i ts boi l i ng poi nt , by two heat ers i n the base. An
external heat source i s needed, because t he potency of desf lurane requi res that
l arge amounts be vapori zed. In addi ti on, the desf lurane boil i ng poi nt i s near room
t emperat ure and dependi ng on ambi ent t emperat ure woul d make the output
unpredictable. These factors make
P. 134

t hermocompensati on usi ng t he usual mechani cal devi ces i mpossi bl e. A transformer
and al ternat ing current (AC) t o di rect current (DC) converter provide DC power for
t he vapori zer.
The sump assembl y holds the agent and incl udes t he f i l l i ng port , drain, heat ers,
and agent l evel sensor. I t has a capaci t y of 425 mL. The temperature is moni tored,
and the associ ated el ect roni cs act as a t hermostat . Two heaters i n the upper part of
t he vapori zer prevent agent condensati on where the warm vapor meets the col d gas
f rom the common mani f old.
The l i qui d agent l evel i s sensed by a probe and sheath in t he sump assembl y.
These measure t he capaci tance by usi ng the agent as a di el ect ri c. The di spl ay i s
on the f ront of the vapori zer.
When t he proper t emperat ure i s reached, t he green operat i onal LED i l l uminates. A
si gnal f rom the cont rol el ect ronics operates the sol enoi d i nterl ock, al l owi ng t he di al
and rotary valve to be turned. When the di al and rotary valve are turned, the shut -
of f valve opens.
Fresh gas f l ow ent ers t he vapori zer and encounters a f i xed resi stor t hat creates
back pressure. The hi gher t he f resh gas fl ow, the greater t he back pressure
generated. El ect romechanical devi ces mai nt ai n t he agent vapor pressure at the
vari abl e resistor i n t he rotary val ve at t he same l evel as t he f resh gas pressure at
t he f i xed rest ri ctor. Thi s pressure bal ance bet ween the desf l urane and the di luent
f low compensates for changes i n temperature, vapor pressure, or di l uent f l ow rat e.
The pressures are sensed by a t ransducer that sends a si gnal to the cont rol
el ect roni cs, which i n turn al ters the agent pressure at t he vari abl e resistor by
openi ng or cl osing t he agent pressure-regul at ing valve to balance t he pressures.
Wi th this balance of pressures mai ntai ned, t he concent rati on del i vered by t he
vapori zer depends only on t he rati o of f resh gas fl ow t hrough the f i xed rest ri ct or
and agent vapor fl ow through the vari abl e resistor, whi ch depends on the
concentrati on di al set ti ng. When the concentrat i on di al is turned to a hi gher val ue,
resi st ance to desf l urane fl ow decreases and t he f l ow of desf lurane i ncreases. Wi t h
an i ncrease i n di luent f l ow, the elect ronics wi l l i ncrease the fl ow i n t he desfl urane
l i mb t o maint ai n the pressure bal ance. The vapor mi xes wi t h f resh gas j ust bef ore
t he l atter exi ts the vapori zer.
The f i l l ing syst em is di scussed later i n the chapter under Desf lurane Fi l li ng System
(see Fi g. 6. 73). The vapori zer can be f i l l ed whi l e i n use, but the f resh gas f l ow
shoul d be less than 8 L/mi nute, t he concentrati on di al set at no more t han 8%, and
t he vapori zer should not be subj ected to hi gh back pressure. The vapori zer can be
f il l ed whi l e i t is i n i ts warm-up cycl e.
Evaluation
The manufacturer' s dat a are shown i n Fi gure 6.10. The vapori zer i s cal i brated f or
f lows f rom 0. 2 to 10 L/mi nute. The output i s almost l inear at the 3%, 7%, and 12%
sett ings, wi t h sl i ght l y lower outputs at f lows l ess than 5 L/mi nut e and sl ightl y
great er outputs at higher f l ows. The vapori zer i s designed to be used at ambient
t emperat ures between 18C and 30C. Studi es have shown t hat the out put is wi thin
15% of the di al set ti ng. Ti l ti ng does not render t he vapori zer i noperati ve or
dangerous t o operate (25). Ni trous oxide i n the carri er gas decreases the output
sl i ght ly.

View Figure

Figure 6.10 Performance of Tec 6 vaporizer, with oxygen
as the carrier gas. (From a graph furnished by Ohmeda, a
division of BOC Health Care, Inc.)

Fl uctuat i ng back pressure does not si gni f i cantl y af fect t he Tec 6 vapori zer out put .
Carri er gas composi ti on af fects vaporizer output (25,26,27,28). The output i s
decreased wi th ai r or ni t rous oxi de as the carri er gas.
El ect ri ci t y consumpt ion by the vapori zer i s l ow (29). The bat tery must be replaced
annual l y.
Hazards
Vapor can l eak i nt o the f resh gas wi th t he vapori zer turned OFF.
When f i l l ing the vapori zer, t he bot t le must be gri pped ti ght l y when i t is rotated
downward. I f not gri pped t ight l y, the bott l e may be dropped when i t i s rel eased
under pressure at the l ower posi ti on.
A case has been report ed where a val ve pi ston i n the attachment stuck i n the
depressed posi ti on, causing a l arge l eak of f resh gas (30). Ot her vapori zers
mounted on the machine coul d not be turned ON.
I f the Tec 6 i s used on an anesthesi a machi ne that t urns OFF the f resh gas f l ow
duri ng inspi rati on (f resh gas decoupli ng; Chapter 12), t he i ntermi ttent fl ow wi l l
t ri gger an al arm i f the sof t ware t o avoid t hi s problem i s not i n pl ace (31,32,33).
Cases of sparks and smoke around the connection between the mains power cord
and the socket have been
P. 135

reported (34). Thi s was bel i eved to be the resul t of a l oose pl ug.
The Tec 6 shoul d be mounted on the f ar ri ght -hand si de on the back bar of the
anesthesi a machine (35). I n other posi t i ons, t he power cord may i nterf ere wi th t he
vapori zer i nterl ock mechani sm for the other vapori zers (36,37).
Leaks have been reported wi t h thi s vapori zer (38).
Two cases of cardiac arrest secondary to a massive overdose caused by a
defective control valve have been reported (39).
Maintenance
Thi s vapori zer requi res servicing every year at an authori zed center. The ext ernal
surf ace may be wi ped by using a cl oth sl i ght l y dampened wi t h a cl eani ng agent. No
ot her cleani ng or di si nf ect i on should be at t empted.
Tec 7
There are Tec 7 vapori zers f or hal othane, enf l urane, i sof l urane, and sevofl urane.
Construction
A Tec 7 vapori zer is shown i n Fi gure 6. 11. On t op is the concentrati on cont rol dial .
At t he rear of t he di al i s a rel ease but ton that must be pushed i n bef ore t he
vapori zer can be turned ON. At the rear i s a l ocki ng lever that i s connect ed to t he
control dial so that t he vapori zer cannot be t urned ON unti l i t i s l ocked on t he
mani f ol d. At t he bot tom right f ront of each vapori zer i s a si ght glass that i ndi cates
t he l i qui d l evel i n the vapori zi ng chamber.

View Figure

Figure 6.11 Tec 7 vaporizer with Easy-Fil system. Note the
locking lever behind the control dial. The interlock device
can be seen near the back on the right of the vaporizer.
(Courtesy of Datex-Ohmeda, a division of General
Electric.)


View Figure

Figure 6.12 Back of Tec 7 vaporizer. The rectangle at the
lower right is the identification label. At the top is the
locking lever. Note the interlock connectors at either side.

The back of t he vapori zer is shown i n Figure 6.12. A vapori zer i dent i f i cati on label i s
af fi xed to the back. An anesthesi a system fi t ted wi th a vapori zer i dent if i cat ion uni t
uses this l abel to i denti fy t he vapori zer.
Al though t here are a number of i mprovements i n this vapori zer compared wi t h t he
Tec 5, the schemati c di agram of the Tec 7 vapori zer i s essent iall y the same as f or
t he Tec 5 (Fi g. 6.6). Tec 7 vapori zers are avail able wi th t hree f i l l i ng devi ces: a
f unnel f i l ler, t he Qui k-Fil , or t he Easy-Fi l system (Fi g. 6.11).
Approximatel y 300 mL of l i qui d i s needed t o f i ll a vaporizer wi th dry wi cks.
Approximatel y 75 mL is retained i n the wi cks when t he vapori zer is drai ned.
P. 136


Evaluation
The manufacturer' s performance curves are si mi l ar t o those of t he Tec 5 (Fi g. 6.7).
Greatest accuracy i s at a f resh gas fl ow of 5 L/mi nut e and di al sett ings less than
3%. At higher f lows and hi gher dial sett ings, t here is a decrease i n output bel ow t he
set val ue.
The greatest accuracy is between 15C and 35C. The t hermostat does not respond
t o t emperatures bel ow 15C, and the out put wi l l be l ess t han i ndi cat ed on the di al .
I f the t emperat ure i s above 35C, the out put wi l l be unpredictabl y hi gh.
Changes i n baromet ri c changes are compensat ed f or automati cal l y. Fl uct uat i ng
back pressure can aff ect the vapori zer and i ncrease t he del i vered concentrati on.
When ai r or ni t rous oxi de i s part of the carri er gas, t he output i s l owered compared
wi th t he output when oxygen i s the carri er gas. The ef fect i s greatest duri ng low
f low rates and low di al set ti ngs. The ef f ect i s great est (up to 20% of set ti ng) at l ow
f lows when ni trous oxide i s used.
I f the anesthesia machi ne and vapori zer are out of service for a peri od of t i me
wi thout gas f l owi ng, l ow concent rati ons of the agent may be detect ed at t he
machi ne outl et immedi atel y af ter t he gas f l ow i s t urned ON. When the vapori zer i s
t urned ON af ter a period of nonuse, a high concentrat ion of agent may be deli vered
f or approxi matel y 10 seconds.
Hazards
The Tec 7 vapori zers are i nt ended to be operated i n the upri ght posi ti on. If a
vapori zer is i nverted, i t shoul d be connected t o a scavengi ng system, the dial set to
5%, and the vapori zer purged wi t h carri er gas at 5 L/mi nut e for 5 mi nutes.

View Figure

Figure 6.13 Aladin cassette vaporizer in place. The cassette
fits into a recess on the front of the anesthesia machine. It
can be removed by squeezing the handle. The concentration
dial is to the left of the cassette. The wheel on the left of the
cassette is used to lock the keyed filler in place and open the
inlet to the vaporizer. The liquid level indicator is at the
bottom near the center of the cassette. To its left is the
keyed filling receptacle.

The vapori zer coul d be overf i l led i f i t is not f il led i n the upri ght posi t ion. The di al
must not be t urned ON duri ng f i l l ing to prevent overf il l ing.
Maintenance
The halothane vapori zer shoul d be drai ned every 2 weeks when the level i s l ow and
t he l i qui d di scarded i f there are addi ti ves or stabi l i zi ng agents. Other vapori zers
shoul d be drained once a year. Three years f rom t he date of purchase and every 6
months t hereaf ter, t he vapori zers shoul d undergo a saf et y i nspecti on and t he
output checked.
The external surfaces can be cl eaned wi t h a moi st cl oth and neut ral det ergent . The
cl eaning agent must not be al lowed to accumul ate in t he f i l ler, t he gas i nl et, or
outl et port s or around the control di al .
Aladin Vaporizer
The Al adi n vapori zer is desi gned f or desf lurane, isof lurane, sevof lurane, hal othane,
and enfl urane.
Construction
The vapori zer consi sts of t wo parts. The el ect ronic cont rol mechanism i s i n the
anesthesi a machine. The agent i s in a port abl e casset te that i s i nserted i nto a sl ot
i n the anesthesia machine.
The concentrat ion dial is on the anest hesi a machi ne next to where t he cassett e is
pl aced (Fi g. 6. 13). A magneti c sensor i denti f i es the casset te. A green LED on the
f ront panel besi de t he agent wheel i s used to indicat e that the vapori zer i s turned
ON. On t he di spl ay screen (Fi g. 6.14), t he agent is i denti f i ed by name and col or
code and the set ti ng i n numbers and on a tri angul ar graph.
P. 137



View Figure

Figure 6.14 Display screen showing the agent and setting at
the bottom in the center. The agent is identified in text and
color code. The setting is in numerals and a triangular
graph.

The cassett e is shown i n Fi gures 6.15 and 6.16. It is color coded f or t he agent t hat
i t is desi gned to contai n and i s magneti cal l y coded so t hat the machi ne can
automati cal l y i denti f y whi ch cassett e has been i nserted. A handl e on t he f ront i s
used to carry t he cassett e and to i nsert i t i nt o and remove i t f rom t he machine.
There i s a rel ease on t he i nsi de of t he handl e that when squeezed rel eases the
casset t e f rom the machi ne. It can be t ransported and st ored i n any posi ti on.
The cassett es f or hal ot hane, enf l urane, and i sof l urane have keyed f i l l ers or t he
Easy-fi l system. Sevofl urane casset tes may be equi pped wi t h ei ther a keyed f i l l er or
t he Qui k-Fi l system. A l ock-and-f i l l wheel on t he lef t l ocks the keyed f i l l er i n pl ace
and opens the ai r vent and l i quid f il l ing channel . The desfl urane casset t e has a
f il l i ng system si mi l ar to t he one on the Tec 6 vapori zer (Fi g. 6.17). The l i qui d l evel
i ndi cator and the f il l ing port are l ocated on t he f ront . The cassette hol ds up t o 250
mL when f ul l . When t he ball i n the sight t ube i s at the bot tom, the casset te contai ns
80 mL or l ess. The l iquid l evel may al so be di spl ayed on the machi ne. When onl y
10% of l i qui d remai ns i n the cassett e, an alarm message appears.
The i nt ernal const ructi on i s shown i n Fi gure 6.18. Fresh gas enters the vapori zer
and i s spl i t bet ween t he bypass f l ow t hat i s i n the machi ne and the vapori zing
chamber. Sensors i n the vapori zi ng chamber out l et and bypass moni tor the f low
t hrough each. Wi cks i n the vapori zing chamber increase the surface area. A check
valve i n the i nl et to the vapori zing chamber protects agai nst agent backf l ow i nto the
bypass. The f low at the outl et of the vapori zi ng chamber is cont rol l ed by the cent ral
processi ng uni t (CPU) i n t he anesthesi a machine. Thi s recei ves i nf ormati on,
i ncl udi ng t he f resh gas composi t i on, anesthet i c agent , di al set ti ng, t emperat ure i n
t he rear of the casset te, and f l ow. Thi s inf ormati on i s used t o determi ne t he rati o of
gas f l ow t hrough t he bypass and the vaporizi ng chamber. A mixing chamber
stabi l izes the output and reduces t he ef f ects of back pressure f l uctuat ions.
I nsi de the vapori zi ng chamber, metal pl ates i ncrease heat capaci ty, heat
conductivi ty, and vapori zing surf ace, al l of whi ch i mprove t emperat ure stabil i t y and
vapori zati on. When casset te t emperature decreases t o l ess than 18C, a fan below
i t is acti vated t o facil i tat e heat transfer to the vapori zer.
When t he casset te i s removed, two spri ng-l oaded valves automat ical l y cl ose t he
channels to and f rom the vapori zer. When the cassette is i nsert ed into the machi ne,
t hese valves open to make t he connect i ons wi th t he inf l ow and outf l ow channels. In
error si tuati ons, the
P. 138

valves operate to cut off anestheti c agent del ivery. A pressure rel i ef val ve opens to
t he scavenging l i ne i f a hi gh pressure i s detect ed i n the cassette or the l i qui d level
measuri ng devi ce detects overf il l ing.

View Figure

Figure 6.15 Aladin cassette vaporizer. The handle is used to
transport the vaporizer, which can be held in any position.
Inside the handle is a release that when squeezed will
release the cassette from the machine. The cassette is color
coded for the agent contained.

I f the cassett e pressure i s hi gher t han the pressure di stal to t he casset t e outf l ow,
t he vapori zer starts to work as an injector.
A locki ng mechani sm hol ds the cassette i n the sl ot on t he machine. The connecti on
i s aut omat ic when t he cassett e i s pushed i nt o posi ti on. The casset te i s unl ocked by
squeezi ng t he handl e.
The cont rol di al (Fi g. 6.13) i s turned to set the concent rati on. The set t i ng i s
di spl ayed on the anesthesia machi ne screen (Fi g. 6.14).
During f i l l i ng, t he casset te must be on a level surface or in i ts slot wi t hout bei ng
l ocked. The keyed f i l l er i s screwed f i rml y onto t he bot tl e and t hen i nsert ed i nto the
f il l i ng port . The f i l l er i s l ocked i n pl ace by turni ng t he lock-and-f il l wheel on the l ef t
f ul l y cl ockwi se (Fi g. 6.15). There wi l l be a sl i ght resi stance when the f i l l i ng port i s
opened. The bot tl e i s turned upsi de down. Li qui d shoul d then f l ow i nto t he casset te.
When t he vapori zer is f i l l ed, t he bot tl e i s rotat ed downward and t he keyed fi l ler
rel eased by turni ng the l ock-and-fi l l wheel countercl ockwise. The f i ll er i s then
removed f rom t he f i l l i ng port .

View Figure

Figure 6.16 Back of Aladin cassette vaporizer. A magnetic
identification system is used by the anesthesia machine to
determine which cassette is in place.


View Figure

Figure 6.17 Aladin cassette vaporizer for desflurane.

Evaluation
The manufacturer i ndicates that the accuracy for all agents i s 10% of t he set ti ng
or 3% of the maximum di al set ti ng (whichever is greater) wi th f resh gas fl ows f rom
200 mL/mi nut e to 8 L/ mi nute. Figure 6.19 shows vari ati ons i n output wi t h changes
i n f resh gas composi t ion. One st udy f ound that the output remai ned wi thi n 10% of
t he di al concentrati on wi th most commonly used f resh gas fl ows (40). Desf l urane
vapori zer accuracy was sl i ght l y l ess and accuracy wi t h al l anesthetics decreased at
t he ext remes of f resh gas fl ow. The ef f ects of sudden changes i n f resh gas f low or
carri er gas composi ti on, back pressure, and t i ppi ng were mi ni mal . If the
t emperat ure f al ls bel ow 20C or t he f resh gas f l ow i s over 8 L/ mi nute, the vapori zer
may be unabl e to produce high concent rat i ons and t he messages i nsuff i ci ent agent
and decreased f l ow wi l l appear on t he machi ne.
The deli vered concentrat ion wi l l i ncrease wi th a decrease i n ambi ent pressure.
I naccurate output may occur bri efl y if the temperature of the l i qui d agent added t o
t he casset te i s considerabl y l ower than the normal operati ng temperature.
Hazards
The cassett e is f i t t ed wi t h an overf i l l protecti on mechanism. If ai r i s al lowed i nto the
agent bott le, this mechani sm is deact i vated. This may resul t i n overf i l l ing and
anesthet ic overdose.
Turni ng the vapori zer ON whi l e f i l l ing may pressuri ze the cassett e and cause l iquid
t o l eak at the f i l l i ng port.
P. 139



View Figure

Figure 6.18 Diagram of Aladin cassette vaporizer. (See text
for details.)

When t he f resh gas fl ow i s l owered, t he one-way val ve that prevents backf l ow of
saturat ed vapor f rom the cassette toward t he bypass channel may fail t o cl ose,
resul ti ng i n hi gh del ivered concent rat i ons (41). Thi s probl em may be more
si gni f icant when desf l urane is used.
Maintenance
The cassett e surface can be cl eaned wi th a cl oth moi stened in a mi l d soap sol uti on.
The cassett e shoul d be empti ed bef ore sending i t t o a service cent er.
Vapor 19.1, 19.3
The Vapor 19.1 vapori zors are designed for hal othane, isof l urane, sevofl urane, and
enfl urane.
Construction
The Vapor 19.1 i s shown i n Fi gure 6.20. The 0 must be depressed bef ore t he
concentrati on di al can be t urned. A fi l li ng spout , si ght gl ass, and drai n are located
at t he bottom.
The Vapor 19.1 i s shown schemati cal l y i n Fi gure 6.21. I n the OFF posi t i on, the
vapori zi ng chamber i nl et and out let are i nt erconnect ed and vented to the outsi de.
Thi s prevents anesthet i c agent f rom l eaking i nto the f resh gas. Fresh gas passes
di rectl y t hrough the inl et port and ON-OFF swi t ch t o the outl et port wi t hout enteri ng
t he i nteri or of the vapori zer (42).
I n t he ON posi t ion, at dial set ti ngs above 0.2%, i ncoming gas is di verted past the
bypass cone to the l ower vapori zi ng sect ion. Part of the f resh gas f l ows t hrough a
pressure compensat or that i s desi gned to prevent
P. 140

pressure f luctuati ons upst ream or downstream of t he vapori zer f rom aff ecti ng the
output. Part of the f resh gas then f lows t o the vapori zi ng chamber, where i t
becomes saturated. The gas t hat passes through t he vapori zi ng chamber exi ts past
a control cone that i s cont roll ed by t he concent rati on di al . As the concent rati on is
i ncreased or decreased, the space between the cone and i ts housi ng i ncreases or
decreases, al l owi ng more or l ess gas-contai ni ng agent to l eave the vaporizing
chamber. The gas not f lowi ng to the vapori zi ng chamber is routed past the bypass
cone, where i t mixes wi th gas f rom the vapori zi ng chamber and f l ows t o t he
vapori zer out put . The brass shel l around t he bypass cone contracts and expands
wi th changes i n temperat ure. If the vaporizi ng chamber cool s, the shell wi l l cont ract
and the bypass cone wi l l move upward, reduci ng the f low t hrough t he bypass and
i ncreasi ng the f l ow t hrough the vapori zi ng chamber (42A, 43).

View Figure

Figure 6.19 Output of Aladin cassette vaporizer with
changes in fresh gas composition. The electronic control
unit in the machine makes adjustments for changes in fresh
gas composition to maintain a steady output.


View Figure

Figure 6.20 Vapor 19.1 vaporizer. (Courtesy of North
American Drager.)

The 19.3 versi on of thi s vapori zer is simi l ar to t he 19.1 but has a mount ing adapter
t hat wi l l at tach to a pl ug-i n syst em. Thi s is a quick rel ease devi ce si mi l ar t o, but not
i nterchangeabl e wi t h, t he Sel ect-a-tec mounti ng system.
Evaluation
The manufacturer' s dat a for t he Vapor 19.1 are shown i n Figure 6.22. Output i s
i ndependent of f resh gas f l ow i n the range of 0.3 t o 15 L/minute wi th l ower dial
sett ings, but
P. 141

wi th hi gh gas f l ows output f al l s. An accuracy of 10% can be expected bet ween
10C and 40C. At temperatures outsi de this range, the vapori zer wi l l be l ess
accurate. Investi gat ions of Vapor 19.1 vapori zers f or i sof l urane, enf l urane,
sevof lurane, and halothane wi t h hi gh and l ow f l ows f ound t hat t hey perf orm
accuratel y (44, 45).

View Figure

Figure 6.21 Vapor 19.1 vaporizer in the ON position. (See
text for details.) (Redrawn from a drawing furnished by
North American Drager.)

The Vapor 19.1 i s cal ibrat ed by using ai r as the carri er gas. Wi t h 100% oxygen, t he
del i vered concent rati on i s 4% t o 10% hi gher t han the set concent rati on (44,46).
When operated wi t h 30% oxygen and 70% ni t rous oxi de, the del ivered
concentrati on i s 5% to 10% lower. Changing f rom 66% ni trous oxi de in oxygen to
100% oxygen resul ts in an i ncrease in output foll owed by a decrease (47). If hel ium
i s i n the carri er gas, the out put does not vary by more than 10% (48, 49).
When t he vapori zer was exposed t o pressures up to 4 atm, the out put decreased
wi th i ncreasing pressure but remai ned wi thi n 20% of setti ng (50).
Mounti ng the vapori zer on a moving t roll ey or reversed f l ow through i t has no ef f ect
on output (20,51).
The Vapor 19.1 wi th a keyed f i l ler wi l l not overf i l l , even when the vapori zer i s in t he
ON posi t ion and the bottl e adaptor i s l oosened (52).
Hazards
I f a f i l l ed Vapor 19.1 i s t i l t ed, l i qui d agent may spi l l into t he control devi ce whether
t he vapori zer i s turned ON or OFF. Thi s can resul t i n ei ther an i ncrease or
decrease i n del ivered concentrat ion. I f the vapori zer i s ti pped more than 45, i t
shoul d be fl ushed wi t h a fl ow of 10 L/minute wi t h t he concentrat ion di al at the
hi ghest sett ing f or at least 20 mi nutes.
A case has been report ed where a rubber f ragment obstructed the l i quid l evel
i ndi cator (53). Thi s gave t he appearance of a l i qui d level al t hough the vapori zer
was empty.
When t hi s vapori zer i s equipped wi t h a keyed fi l l i ng devi ce, a metal pl ug is used to
seal t he f i l l i ng port (Fi g. 6.62). There is al so a vent on the top of the f il l er bl ock. If
t he vent is not cl osed or the plug i s not securel y pl aced i n the key f i l ler, t here wi l l
be a si gni f icant gas l eak when the vapori zer i s turned ON. Unl ike some other
vapori zers t hat f i l l bel ow t he l iquid l evel , t here wi l l not be an escape of l i qui d
anesthet ic.
Maintenance
The outer part of the vapori zer can be cl eaned wi t h a damp cl oth soaked wi t h
detergent. The manuf acturer recommends that the hal othane vapori zer be ri nsed
wi th f resh hal othane when t he l i quid i n the sight gl ass shows di scolorat i on or
part icl es.
The vapori zer shoul d be inspected by t rai ned personnel every 6 months. The
vapori zi ng chamber shoul d be cl eaned and t he wi cks changed every 2 years.
Vapor 2000
The Vapor 2000 is desi gned f or i sof l urane, sevof lurane, halot hane, and enf l urane.
Construction
Vapor 2000 vapori zers are shown i n Fi gures 6. 23 and 6.24. The 0 but ton on the
handwheel (cont rol di al ) must be depressed to t urn the vapori zer ON. To the right
of t he
P. 142

OFF posi ti on is the T (t ransport ) posi ti on. Thi s is used when t he vapori zer is t o be
removed f rom t he anesthesi a machi ne. When the handwheel i s turned to this
posi t i on, t he but t on locks i n place.

View Figure

Figure 6.22 Output of Vapor 19.1 vaporizers at an ambient
temperature of 22C. (Redrawn from graphs furnished by
North American Drager.)

An adapter at t he back of the vapori zer has hol es t hat match pi ns on t he anesthesi a
machi ne. The vapori zer i s secured/rel eased by turni ng the l ocki ng l ever at the top.
A pi n on t he l ocki ng l ever must engage a groove i n the top of the handwheel to
rel ease t he vapori zer. This can be done onl y when t he handwheel i s at the T
sett ing.
There are two i nterl ock systems to prevent more than one vapori zer bei ng turned
ON at t he same ti me. For systems in whi ch t he vapori zer i s easi l y removabl e, there
i s a sli de l ever that causes a shaf t to engage a hol e i n t he
P. 143

unused vapori zer handwheel that t hen cannot be used (Figs. 6. 23, 6.24). For
permanentl y mounted vapori zers, there i s a rocker-styl e l ever that engages a
groove i n the back of the handwheel . If one end i s i n this groove, t he handwheel
cannot be rotated and the vapori zer cannot be used (see Figs. 6. 77, 6.78).

View Figure

Figure 6.23 Vapor 2000 vaporizers. The left vaporizer has a
funnel filler. The right vaporizer has a keyed filling system.
Note the locking levers at the top. An interlock mechanism
is between the two vaporizers at the top. The lever is turned
toward the vaporizer in use.


View Figure

Figure 6.24 View of Vapor 2000 vaporizers from the top.
The 0 button on the handwheel (control dial) must be
depressed to turn the vaporizer ON or to put it into the
transport position. To the right of this is the T (transport)
mark. When the handwheel is turned to this position (left
vaporizer), the lever at the back of the vaporizer fits into the
groove on the top of the dial so that the dial cannot be
moved. The vaporizer can then be removed.

Three di ff erent f i l l i ng systems are avai l abl e. A si mpl e funnel i s avai l abl e (Fig. 6.23,
l ef t vapori zer). There is al so a keyed fi l li ng device simi l ar t o that avai l abl e on other
vapori zers (Fi g. 6. 23, ri ght vapori zer). Sevof l urane vapori zers may have a Qui k-Fi l
system. A drai n i s l ocated under the vapori zer. The Qui k-Fi l system has a drai n
under t he fi l ler. The drai n val ve i s opened by i nserti ng a 2.5-mm Al len key and
t urning i t count erclockwi se. The Qui k-Fi l system is discussed l ater i n this chapt er
(see Fi gs. 6.66,6.68,6. 69)
The i nt ernal vapori zer const ructi on i s shown i n Figures 6.25, 6.26, and 6.27. When
t he vapori zer i s turned OFF (Fi g. 6.25), t he i nf l owi ng gas passes through t wo
bypasses. Part of the gas fl ows around t he f low cont rol cone. Two i sol ati on valves
(A and B) separate the vapori zi ng chamber f rom the bypass gas st ream. The
vapori zi ng chamber i s vented to the outsi de through i solat i on val ve A to prevent
pressure bui l dup, thus preventi ng a vapor surge when the vapori zer is turned ON.
When t he handwheel is turned to t he transport posi t i on (Fi g. 6.26), i solat i on val ves
A and B seal the vent channel as wel l as bot h channel s t o the vapori zi ng chamber.
Another i sol ati on valve (C) seal s the bypass channel around the concentrati on
cone.
When t he handwheel is turned ON and set to a concent rati on great er t han 0.2%
(Fi g. 6.27), i sol ati on valve C cl oses one bypass and i solati on val ves A and B are
opened, al l owi ng a st ream of gas to pass through the vapori zi ng chamber. The vent
i s closed. The st ream of gas that passes t hrough t he vapori zi ng chamber bypass
passes t he temperature-compensati on mechani sm. As the vapori zer cool s, the
bypass channel i s narrowed and more gas passes through the vapori zing chamber.
The remai nder of t he gas passes t hrough t he vapori zi ng chamber. An el ongated
channel to t he vapori zi ng chamber
P. 144

reduces the pumpi ng ef f ect. The vapor-saturated carri er gas then passes t hrough
t he isol ati on valve and past the f low cont rol cone, where i t j oi ns the bypass gas and
f lows t o the vapori zer outl et .

View Figure

Figure 6.25 Vapor 2000 vaporizer in OFF position.
(Redrawn from graphs furnished by Drager Medical.)

Evaluation
The perf ormance data suppl ied by the manufacturer are i ll ustrated in Fi gures 6. 28
t o 6.31. Some vari ati on i n vapori zer output occurs, mostl y at hi gher set t ings, hi gher
f lows, and temperature ext remes. Whi le t he vapori zer can compensate f or cool i ng
t hat occurs as the vapori zer i s used, af ter a certai n runni ng ti me, t he vapori zer
stabi l izes at a sl i ght l y l ower t emperature and del i vers concent rati ons that devi ate
sl i ght ly f rom the set val ue. Al ti t ude changes between 700 and 1100 mbar wi l l cause
onl y mi nor devi ati ons i n output .
The Vapor 2000 is cali brat ed by usi ng ai r. One hundred percent oxygen wi l l cause
an i ncrease i n the out put by a maximum of 10% but no more t han 0.4 vol % (Fi g.
6. 32). A 30:70 rat i o of oxygen and ni t rous oxi de wi l l l ower the output by the same
amount.
Hazards
The vapori zer must be upright and secured whi l e bei ng fi l l ed. Overf i l l i ng can occur
i f the vapori zer i s ti l ted duri ng f i l li ng. If t hi s happens, the vapori zer may del i ver
concentrati ons that are t oo hi gh or t oo low. If the vapori zer i s ti l ted more than 30,
anesthet ic agent may escape into the f resh gas, causi ng a high concent rat i on to be
del i vered.
The output i s not def i ned i n the area bet ween 0% and 0.2%. The handwheel should
not be set i n this area.
The vapori zer shoul d not be l ef t i n t he ON posi t ion wi t h no gas f l ow through i t ,
because agent may accumul ate i n the anesthesia machine.
Leakage i n the keyed f i ll i ng syst em has been report ed (54, 55). Thi s was thought to
be the resul t of using oversi zed f i l l ing adaptors that damaged the seal i ng
component or excessive pressure on t he f i ll i ng device l ever that brought the lever
mechani sm out of al i gnment . When this probl em occurs, t here i s a st rong smell of
agent near t he vapori zer and reduced or no output f rom the vapori zer. This probl em
may be corrected on more recent versi ons of the vapori zer.
P. 145



View Figure

Figure 6.26 Vapor 2000 vaporizer in transport position.
(Redrawn courtesy of Drager Medical.)


View Figure

Figure 6.27 Vapor 2000 vaporizer in ON position.
(Redrawn courtesy of Drager Medical.)

P. 146



View Figure

Figure 6.28 Performance of halothane Vapor 2000
vaporizer. (Redrawn from graphs furnished by Drager
Medical.)

P. 147



View Figure
Figure 6.29 Performance of enflurane Vapor 2000
vaporizer. (Redrawn from graphs furnished by Drager
Medical.)

I f the connect ion between the f i l l ing adapter and the agent bott l e i s not leak ti ght ,
t he vapori zer can be overf i l l ed and anestheti c agent vapor can escape.
I f f l ow through the vapori zer i s reversed, t he deli vered concentrati on wi l l be
i ncorrect and of ten too hi gh.
Maintenance
The external parts of the vapori zer can be wi ped wi t h a disposabl e cloth soaked
wi th cl eaning sol uti on. Hal ogen-rel easi ng compounds, strong organi c aci ds, and
oxygen-releasi ng compounds are not sui t abl e.
P. 148



View Figure

Figure 6.30 Performance of isoflurane Vapor 2000
vaporizer. (Redrawn from graphs furnished by Drager
Medical.)
P. 149



View Figure

Figure 6.31 Performance of sevoflurane Vapor 2000
vaporizer. (Redrawn from graphs furnished by Drager
Medical.)
The vapori zer shoul d be inspected every 6 months by trained servi ce personnel .
The cal i brat ion shoul d be checked weekl y if the concentrati on i s not cont i nuousl y
moni tored.
Drager D-Vapor
The Drager D-Vapor i s onl y for desf l urane.
Construction
The D-Vapor i s shown i n Fi gure 6. 33. The power cabl e is connected to the
vapori zer at t he rear. The control di al on the t op is used to swi t ch t he vapori zer ON
or OFF, put i t i n the t ransport posi ti on, and adj ust the del ivered agent
concentrati on. Pushing t he 0 but ton on the f ront of t he di al al l ows t he di al t o be
rotated. The control dial l ocks i n the zero (0) and t ransport (T ) posi t i ons.
The concentrat ion range is 2% to 18%. Concent rat ions hi gher than 12% are shown
i n i nverted order. The 0 but ton on the control di al must be depressed to all ow
access to this hi gh concentrati on range.
When t he vapori zer must be removed f rom t he anest hesi a machi ne, the 0 butt on
i s depressed, and the concentrat ion dial is moved to the T posi t ion. Thi s al lows
t he vapori zer t o be transported i n any posi ti on. A l ocki ng l ever at t he rear of t he
vapori zer is used to disengage the vapori zer f rom i ts mounti ng.
The D-Vapor f i l l i ng system (Saf -T-Fi l System) (Fi g. 6.33) i s l ocated on t he f ront of
t he vapori zer. A seal i ng pl ug cl oses the f i l l ing syst em when the vapori zer i s not
P. 150

bei ng f il l ed. To f i l l t he vapori zer, t he but t on on the ri ght si de of the vapori zer i s
depressed to al l ow t he seal i ng pl ug to be removed. The desf lurane bott l e i s
i nsert ed int o the f i l l i ng mechani sm. When i t i s l ocked in place, an audi ble cli ck i s
heard. Pressi ng the bot tl e downward wi l l al l ow the agent to f i l l the vapori zer. When
t he vapori zer i s f ul l , the bot tl e retracts, stoppi ng the agent f l ow. Af ter wai ti ng 2 to 3
seconds to al low al l of the agent t o ent er t he vapori zer, t he but ton is depressed to
rel ease t he bot tl e f rom the f i l l ing devi ce. The seal i ng cap i s pressed i nt o the f i l l er
unti l i t locks i n place, as determi ned by an audi bl e cl i ck.

View Figure

Figure 6.32 Effect of carrier gas composition on output of
the halothane Vapor 2000 vaporizer. (Redrawn from graphs
furnished by Drager Medical.)

The agent -l evel i ndi cator i s at t he f ront on the right si de. There are t hree hori zontal
l i nes. The t op l i ne i ndicates that the vapori zer i s ful l . The second l i ne, whi ch i s
near the bot tom, i ndicates when one complete bott l e of desf l urane (240 mL) wi l l be
needed to f i ll t he vapori zer. The bot tom l i ne i ndicates t hat there are onl y 30 mL of
agent remai ni ng in t he vapori zer. The vapori zer has a capaci ty of 300 mL.
The D-Vapor can be f i l l ed when t he device i s swi tched OFF (no power t o the
vapori zer), duri ng the heat ing phase, or duri ng operat ion. I f f i l led duri ng operat i on,
t he f i l l i ng process wi l l be sl ower.
The display and al arm i ndi cators are l ocated on the f ront of the vapori zer t o the
l ef t . For a hi gh pri ori t y al arm, t here is a red f l ashing LED accompani ed by two
groups of f i ve t ones, each emi t ted f or 10 seconds. For a medi um pri ori t y al arm,
t here i s an amber f l ashing LED and one group of t hree tones emi tt ed every 25
seconds. The i ndi cati on al arm i s a cont inuousl y gl owi ng amber LED wi t h a si ngl e
t one every 1 to 2 seconds.
There i s a button and LED at the top and f ive LEDs bel ow. Pushi ng t he but ton audi o
pauses (si lences) the alarms for 2 mi nutes and causes the amber LED t o i l luminate.
The second LED i s green and i ndi cates that the vapori zer i s operat i onal . The thi rd
LED i s red and i ndicates no output. The f ourth LED i s amber and i ndicates warm
up. The f i f th LED is amber and i ndi cates that t he vapori zer needs to be ref i l led
(Fi l l UP). The bottom LED is amber and i ndi cates Bat tery. In t he event of a
mai ns power f ail ure, i t wi l l bl i nk. If i t gl ows conti nuall y, the battery should be
changed. If there i s an apparatus f aul t, al l of the LEDs bl ink. The reader i s ref erred
t o t he user manual f or furt her detail s.
I f no power i s suppl ied to the vapori zer, t here wi l l be no i l l umi nated LEDs. When
power i s suppl i ed to the vapori zer, a self -t est is automati cal l y perf ormed. Al l six
LEDs shoul d l i ght, and an audi bl e al arm si gnal sounds. Duri ng the 5-mi nut e heati ng
phase, t he green operat ion LED f l ashes. When the heat ing phase i s compl ete, t hi s
LED gl ows conti nuousl y, and an audibl e si gnal is emi t ted.
P. 151

The vapori zer i s then ready for use. The vapori zer must be set to 0 at l east every
24 hours f or a total of 5 seconds. Thi s wi l l i ni t iate a sel f -test .

View Figure

Figure 6.33 Drager D-Vapor. (Courtesy of Drager
Medical.)

The D-Vapor has i ts own batt ery backup. If t he bat tery i s not suff ici entl y charged,
t he amber LED glows. The backup batt ery wi l l l ast onl y 5 mi nut es. Af ter 5 mi nut es,
t he vapori zer i s swi t ched OFF, and an al arm sounds. If power i s rest ored i n l ess
t han 5 minutes, t here wi l l be no i nt errupt ion i n output.
The i nt ernal const ructi on i s shown i n Fi gure 6.34. The reservoi r containing the
l i quid desf lurane i s heated t o 40C and i s at a constant pressure of 2 bar. Thi s
al l ows the desf l urane t hat leaves t he reservoi r to be a f ul l y saturat ed vapor. A
shutoff val ve prevents the reservoi r f rom del iveri ng vapor when t he control dial is at
t he zero set ti ng, duri ng the heati ng phase, or i n the event of vapori zer f ai lure.
Fresh gas f rom the fl owmeters is conducted through t he bypass and on to the
machi ne outl et . There i s a f l ow resist ance in t he bypass that i ncreases the pressure
i n the l i ne and causes pressure t o be appl i ed to a di aphragm i n the regul at ing
sensor. Thi s sensor causes the proport ioni ng val ve t o del i ver as much saturated
desfl urane vapor as i s necessary t o bal ance t he pressures between the f resh gas
f low and the desf l urane f l ow. The del ivered desfl urane concentrati on i s det ermi ned
by t he relat i onship between the bypass resi stances and t he f l ow control cone,
whi ch i s determi ned by t he control dial set ti ng.
Evaluation
Carri er gas composi ti on wi l l aff ect vapori zer output. Wi t h ai r or ni t rous oxide, the
del i vered concent rati on i s reduced i n compari son to that del i vered when t he carri er
gas i s oxygen. For ai r, the output i s reduced approxi matel y 10%. Wi th a ni t rous
oxide:oxygen i n a 70: 30 rati o as the carri er gas, the output i s reduced approxi -
matel y 20%.
Vapori zer performance i s not substanti al l y i nf l uenced by ambi ent temperat ure
f luctuati ons wi t hi n t he range of 18C t o 30C.
The D-Vapor i s cal i brat ed in volume percent . Si nce this cal ibrat ion i s i ndependent
of ambient pressure, the cont rol di al sett ings need t o be adj usted hi gher at hi gher
al ti tudes to achi eve the same concent rat i on.
The output accuracy i s rel ated to t he vol ume of gas that passes through the
vapori zer (Fi g. 6.35). The desfl urane concent rati on i s accurat e for di al
concentrati on and f l ows i n the shaded areas of the graph. In the unshaded areas,
t he out put i s lower t han t he set ti ng.
Hazards
Cel l ular phones shoul d not be used wi t hi n 10 m of the vapori zer.
The D-Vapor i s not designed to be used at an angl e of more than 10 degrees. At
great er angl es, an uncontrol led concentration of vapor may resul t, connect ions to
t he vapori zer may leak, and t he l evel in the si ght gl ass wi l l not be correct . Thi s
could l ead t o overfi l li ng.
Maintenance
Conti nuous agent moni tori ng is recommended. In t he absence of this, a weekl y
check of vapor output i s recommended. The manuf acturer requi res t hat the
vapori zer be i nspected and servi ced by ski l l ed personnel at yearl y i nterval s.
Detergents must not be al l owed to get under t he control di al or into the i nl et for gas
f low or t he f i l l i ng system. Hal ogen-rel easing compounds, strong organic acids, or
oxygen-releasi ng compounds should not be used to cl ean the vapori zer.
Penlon Sigma PPV
The Penl on Si gma PPV vapori zer i s desi gned to di spense hal ot hane, enf l urane,
i sof lurane, and sevof l urane.
Construction
The Penl on Si gma PPV vapori zer i s shown i n Figure 6.36. The upper part of the
vapori zer and concentrat ion dial are color coded. To set a concent rati on, t he di al i s
pushed i n and rotated. The f i l l i ng devi ce can be ei ther a funnel f i l l , Quik-Fi l , or
keyed f i l ler. The l i qui d level
P. 152

i ndi cator has l i nes f or t he mi ni mum and maximum l evel s. The di recti on of gas f l ow
i s marked on the top.

View Figure

Figure 6.34 Internal construction of Drager D-Vapor.
(Redrawn courtesy of Drager Medical.)

I nternal vapori zer construct i on is shown i n Fi gure 6. 37. Gas enters the vapori zer
and i s spl i t into t wo streams, one passi ng through the bypass and t he other t hrough
t he vapori zi ng chamber. In t he zero lock posi ti on, the bypass remai ns open, but the
vapori zi ng chamber i s i sol at ed. I f the zero lock port is open, gas passes t hrough a
spi ral t ube i nt o the vapori zi ng chamber, whi ch contains a stai nl ess-steel wi ck. Gas
saturat ed wi t h vapor exi ts the vapori zing chamber through the vapor cont rol ori f ice.
The si ze of this orif i ce is cont rol l ed by the concent rat i on di al setti ng. Gas saturated
wi th vapor t hen j oi ns the bypass gas and f lows to t he out let.
Temperature compensati on is provided by a l i qui d-fi l l ed expansion bel l ows
control li ng a vari abl e resistance val ve i n the bypass. As the vapori zi ng chamber
cools, the ori fi ce becomes smal l er so that a greater proporti on of gas passes
t hrough the vapori zi ng chamber.
Evaluation
The perf ormance characteri st ics suppl i ed by t he manuf acturer are i l l ust rated i n
Fi gure 6.38. The vapori zer i s accurate at t emperatures f rom 15C to 35C. At
hi gher temperatures, out put i s i ncreased. I f ni trous oxide i s in t he carri er gas, t he
output wi l l be sl i ghtl y hi gher. Ai r or hel i um i n the carri er st ream causes the output
t o drop sli ght ly. I ntermi ttent back pressure may resul t i n a smal l i ncrease i n output .
Reversed gas f l ow resul ts in i ncreased output (20).
Hazards
I f the vapori zer i s transported whi l e f i l l ed, the cont rol must be i n the zero posi ti on,
and at least 2 mi nutes shoul d elapse wi th the vapori zer i n a secure upri ght posi ti on
before use. If the vapori zer has been transported wi th t he control i n the open
posi t i on, i t shoul d be f l ushed wi t h gas at 4 L/mi nute for 2 mi nutes.
The concentrat ion dial must be i n the zero posi ti on duri ng f i l l i ng or drai ni ng. The
vapori zer must be upright to avoi d overfi l li ng. A vaporizer t hat has been overf i l l ed
shoul d be wi t hdrawn f rom use.
Overf i l l i ng can occur if the vapori zer i s turned ON and t he bot tl e adaptor l oosened
(56). A high output wi l l then occur when t he vapori zer i s used.
P. 153



View Figure

Figure 6.35 The desflurane concentration is accurate for
dial settings and flows in the shaded areas of the graph. In
the unshaded areas, the output is lower than the setting.
(Redrawn from a graph furnished by Drager Medical.)

The key fi l ler port is cl osed wi t h a block that i s shaped l i ke the end of the keyed
f il l er. I f t he bl ock i s not repl aced or the screw not t i ghtened, t here wi l l be a gas
l eak when the vapori zer i s turned ON. This wi l l resul t in l oss of the gas that passes
t hrough the vapori zi ng chamber, and l i t tl e or no vapor wi l l reach the breathing
system (57, 58). Li qui d agent wi l l not be l ost t hrough a l oose f i ll er bl ock.
Maintenance
The vapori zer shoul d be cal ibrated every 3 t o 6 months, wi th a maj or overhaul
every 5 years. The exteri or shoul d be cleaned wi th a dry cl oth. No li qui ds, incl udi ng
wat er, shoul d be appl ied t o the surf ace. The halothane vapori zer shoul d be drai ned
peri odi cal l y and the l i qui d di scarded t o prevent thymol buil dup.
Penlon Sigma Delta
The Si gma Del ta vapori zer i s used t o di spense hal othane, enf lurane, i sof l urane,
and sevof l urane.
Construction
The Si gma Del ta vapori zer i s shown i n Fi gure 6.39. The f ront has a color-coded
control dial that l ocks i n the 0 posi ti on. To use the vapori zer, the dial is pushed
i nward and rotated count erclockwi se t o the desi red concentrat ion. When the cont rol
di al i s turned
P. 154

OFF, i t wi l l automat ical l y spri ng out ward to t he l ocked posi ti on.

View Figure

Figure 6.36 PPV Sigma vaporizer with screw cap filler and
back entry connections. (Courtesy of Penlon, Ltd.)

At t he bot tom i s the l i qui d level i ndi cator, wi th maximum and mi ni mum l evel marks.
Three di f f erent f i l l i ng devi ces are avai l able: f unnel f i ll , keyed f i l l , and Qui k-Fi l . The
keyed f i l ler ut il i zes a pl ug that i s hel d i n pl ace by usi ng a screw on t he si de.
At t he base of the f i ll i ng mechani sm i s a means of drainage. If a keyed fi l ler is
used, the same bott le adaptor t hat i s used to fi l l the vapori zer i s used t o drain i t.
For the Qui k-Fi l and f unnel -f i l l mechani sms, a screw at the base of t he f i l ler bl ock
opens the drai n. The fi l ler cap must be removed f rom the vapori zer t o drain i t. The
l i quid can drai n di rect l y i nto t he bot t le f or t he funnel f i l l . For t he Qui k-Fi l , a
receptacle i s sl i d over the base of the f i l l er mechani sm and i s used to catch the
l i quid (see Fi gs. 6.68, 6. 69).

View Figure

Figure 6.37 Diagram of PPV Sigma vaporizer. (See text for
details.) (Redrawn from a drawing furnished by Penlon,
Ltd.)

The vapori zer has a l i qui d capaci t y of 250 mL. At t he MIN mark, t he vol ume wi l l be
35 mL. Approxi matel y 60 mL of l i qui d wi l l remai n i n the wi ck af ter t he vapori zer is
drai ned.
The i nt ernal const ructi on i s shown i n Fi gure 6.40. The vapori zing chamber cont ai ns
a wi ck. Temperature compensati on i s by means of a t hermost at i n the bypass. I n
t he zero posi t ion, the bypass remains open, but the vapori zi ng chamber i s isol ated
f rom the gas f l ow.
Evaluation
The operati ng t emperature range i s 15C to 35C. The t emperat ure-compensati ng
mechani sm reacts slowl y t o room t emperature changes and may need a mi ni mum of
1 to 2 hours to compensate f or a change in room t emperature. The vapori zer i s
designed t o operate between f resh gas f l ows of 0.2 and 15 L/mi nute. Graphs of
P. 155


P. 156


P. 157

vapori zer out put in relati on to f resh gas f l ow and temperature are gi ven i n Fi gures
6. 41 to 6.44.

View Figure

Figure 6.38 Performances of PPV Sigma vaporizers with
oxygen as the carrier gas. (Redrawn from graphs furnished
by Penlon, Ltd.)


View Figure

Figure 6.39 Sigma Delta vaporizers. Left: With keyed
filler. Right: With Quick-Fil. (Photo courtesy of Penlon
Company UK.)

Baromet ri c pressure ef fects are not usual l y cl inical ly i mportant. A steady back
pressure of 10 to 15 kPa (100 t o 150 cm H
2
O) wi l l reduce the vapori zer output .
I ntermi tt ent back pressure may resul t i n some changes in output. The ef f ect is
great est at l ow vapori zer sett i ngs and l ow f l ow rates.
The vapori zer i s cal ibrat ed wi th 100% oxygen. Ni trous oxide i n the carri er gas wi l l
produce a decrease i n output . Ai r wi l l reduce the vapori zer output by a maxi mum of
5%. Hel i um in t he f resh gas wi l l resul t i n low concentrat ions.
Hazards
The Penl on Si gma Del ta may malf uncti on i f exposed t o excessi vel y hi gh
t emperat ures. Thi s may af fect t he cal i brati on. The vapori zer shoul d be stored
bet ween -20C and 50C.
The vapori zer control dial shoul d be at zero, and t he vapori zer shoul d be upri ght
duri ng fi l li ng. If i t i s not upri ght , there i s a possibil i ty of overfi l li ng. An agent bot tl e
t hat i s cracked or a f i l l er t hat is not ti ghtl y att ached to the bot tl e or i s broken shoul d
not be used because overf i l l ing may occur or contami nat ed agent may enter the
vapori zer. An overf i ll ed vapori zer must be taken out of servi ce and t he
manuf acturer consul ted.
I f the vapori zer i s transported whi l e f i l l ed, the cont rol di al shoul d be in t he 0
posi t i on. The dial must remai n i n t he 0 posi ti on f or at least 10 mi nut es af ter the
vapori zer is attached to t he anesthesi a machi ne. Anest het i c agent overdose can
occur i f not enough ti me for any l i quid t o drai n i nto the normal posi ti on has
el apsed. If a vapori zer has been transported wi th t he control di al i n an open
posi t i on, i t must be f l ushed wi th a 5 L/mi nut e fl ow of gas f or at l east 10 mi nutes
before use. If a vapori zer has been ti pped or i nverted during t ransport , the cont rol
di al must be set to maxi mum out put and run at 5 L/mi nute for 10 mi nutes pri or t o
use.
Thi s vapori zer is f l ow-di recti on sensi t ive. If the gas f l ow i s reversed, t he output wi l l
be i naccurate.
Maintenance
Cal i brati on can be perf ormed by usi ng a sui t abl e agent gas anal yzer. If the
cali brati on i s outsi de the perf ormance l imi ts, t he vapori zer must be serviced.
The manufacturer recommends t hat a major overhaul be performed every 10 years.
Hal othane model s shoul d have a maj or overhaul every 5 years. The hal othane
vapori zer shoul d be drai ned peri odi call y and t he l i quid di scarded.
Penlon Sigma Alpha
The Penl on Si gma Al pha vapori zer i s an el ect ri cal l y powered vapori zer designed f or
desfl urane.
P. 158



View Figure

Figure 6.40 Internal construction of Sigma Delta vaporizer.
(Redrawn courtesy of Penlon Company UK.)

Construction
The vapori zer i s shown i n Fi gure 6.45. The f ront has a control di al to set the
concentrati on. The di al i s l ocked at 0 when not in use. To set a concent rat i on, the
di al i s pushed i n and rotat ed to t he desi red set t ing.
Bel ow the cont rol di al i s a displ ay screen. When the vapori zer i s f i rst t urned ON, a
WARM-UP message appears. Af t er warm-up i s complete, a STANDBY message
i s shown. When the cont rol di al i s turned ON, an I N USE message appears. If
mai ns el ect ri ci t y i s l ost , a BATTERY IN USE message appears. Agent level i s
i ndi cated vert ical l y on t he lef t side of the message wi ndow.
To the ri ght of the message wi ndow are t he ON-OFF swi t ch, an i n-use i ndi cator,
and an al arm mut e/des used butt on. When connected to mai ns power, t he amber
power i ndi cator t o t he l ef t of t he i n-use i ndicator wi l l be i l lumi nated. When the
ON-OFF swi tch i s acti vated, t he green i n-use i ndicator at t he ri ght is i l l umi nated
and the power i ndi cator exti nguished. Warm-up t akes approxi matel y 2 mi nutes. No
vapor output is possi bl e duri ng t hat period. Af ter the warm-up peri od, the vapori zer
swi t ches to the standby mode. The ON-OFF but ton i s pressed to swi tch OFF the
vapori zer. I f the vapori zer is st i l l connected to mai ns el ect rici t y, t he amber l i ght wi l l
be i l l umi nated.
Pressi ng the al arm mute/des used cont rol i ni ti ates an audi o OFF state and
acti vates t he agent consumpti on mechanism. Thi s al lows t he user t o quant i f y the
volume of desf l urane used.
The f i l l ing capaci t y at t he maxi mum mark i s 330 mL. When the low agent message
i s displ ayed, the cont ents are 70 mL or l ess. At 50 mL, agent output is turned OFF.
P. 159



View Figure

Figure 6.41 Performances of halothane Sigma Delta
vaporizer. (Redrawn from graphs furnished by Penlon
Company UK.)

P. 160



View Figure

Figure 6.42 Performances of enflurane Sigma Delta
vaporizer. (Redrawn from graphs furnished by Penlon
Company UK.)
P. 161



View Figure

Figure 6.43 Performances of isoflurane Sigma Delta
vaporizer. (Redrawn from graphs furnished by Penlon
Company UK.)
P. 162



View Figure

Figure 6.44 Performances of sevoflurane Sigma Delta
vaporizer. (Redrawn from graphs furnished by Penlon
Company UK.)
The f i l l ing syst em is at the f ront of the vapori zer near the bottom. To f il l t he
vapori zer, t he f i l ter cover i s l i f ted and the bot t le al i gned wi th t he f i l ler receiver. The
bot tl e i s inserted unti l i t i s f ul l y engaged. The f i l l er l ocking ri ng, whi ch i s just bel ow
where the bot tl e is i nsert ed, i s then rot ated cl ockwi se unt i l i t cl i cks i nto posi t ion. It
i s then rotated furt her cl ockwi se unt i l i t agai n cl icks into posi t i on. Li quid wi l l then
f low i nt o t he vapori zer unt i l i t i s f i l l ed to t he l evel desi red on the LCD di spl ay or t he
f low of ai r bubbl es i nto t he bott le has stopped. Af ter t he vapori zer is f i ll ed, the
l ocki ng ring i s rotated count erclockwi se unti l t he bot tl e is rel eased. The vapori zer
may be f i l l ed whi l e gas i s f l owi ng through the vapori zer.
The vapori zer i s powered by mai ns el ect rici t y transf ormed down t o a l ow vol tage. I t
has a backup batt ery. I t has a f ast warm-up ti me and l ow power consumpti on. The
vapori zer can calcul ate t he amount of desf lurane used f or each case.
Fi gure 6.46 shows t he i nternal const ructi on. The fi l l i ng device i s used to add
desfl urane to t he agent reservoi r (cartri dge). A sensor measures the l i qui d level ,
whi ch i s displ ayed on t he f ront of t he vapori zer. The vapori zer may be f i l l ed whi le
mounted or off of the
P. 163

anesthesi a machine. When the bot tl e is removed, the agent reservoi r i s
automati cal l y seal ed and t hen pressuri zed above the vapor pressure of desf l urane.
Thi s causes the desf l urane to remai n in the l i quid stat e. Li qui d desf l urane i s moved
vi a a tube f rom the reservoi r t o the control part of the del ivery devi ce.

View Figure

Figure 6.45 Sigma Alpha vaporizer. (Courtesy of Penlon
Company UK.)

Gas f lows are measured in t he vapori zer i nl et and out let. Sensors can detect
ni trous oxi de i n the f resh gas and cal culate the concent rati ons of oxygen and
ni trous oxi de. Wi th no desf l urane being del i vered, the i nl et and out let f l ow sensors
wi l l provi de si mi l ar f low readi ngs. Onl y wi t h the addi ti on of desf l urane wi l l t here be
a di f f erence. The desf l urane concentrat ion i s determined f rom the di ff erence.
The l i qui d desf lurane f l ow i s measured by a l i qui d-fl ow sensor. The central
processor cal cul ates the f l ow of l i quid desf lurane needed f or t he set concent rat i on
and f resh gas f l ow and adj usts the proport i onal val ve to del i ver the requi red amount
of agent . The l i qui d agent fl ows t hrough a device that mai ntai ns a constant back
pressure. It is then del i vered vi a a shutof f (ON-OFF val ve) into a heat i ng devi ce
where i t is vapori zed. The heat i ng element has a f eedback cont rol that ensures that
t he agent is heated according to the f low rat e and i ts thermal properti es. Thi s
arrangement means that the t emperature and power are conti nual l y moni tored and
adj usted t o minimi ze power consumpt ion. The vapori zed agent t hen passes through
t o t he f resh gas suppl y. The second f l ow sensor moni tors t he increased f l ow
resul ti ng f rom t he added vapor. I n the event of a devi ce f ai lure, t he system wi l l stop
del i very of desfl urane and enter i nto a safe mode. It also generates vi sual and
audibl e al arm signal s.
Evaluation
The manufacturer' s dat a for out put are shown i n Fi gure 6.47. The vapori zer i s
designed t o be used at a t emperat ure between 15C and 30C. The output is
mai ntai ned wi thi n 20% of t he set concent rati on. The f l ow range is 0.5 t o 12
L/ mi nute. The maxi mum fl ow t hrough the vapori zer i s 20 L/ mi nute. Above t hi s fl ow,
t he vapori zer t urns OFF.
The vapori zer i s cal ibrat ed wi th pure oxygen. Addi ng ni trous oxi de to the f resh gas
wi l l decrease t he output by up t o 15%. Ai r as the carri er gas wi l l reduce t he output
bel ow t he set val ue by a maxi mum of 5%.
Hazards
Excessive electroni c noi se caused by a devi ce such as an el ect rosurgery uni t may
adversel y interfere wi th vapori zer funct ion. To avoi d t hi s, the el ect rosurgery devi ce
shoul d not be pl ugged i nto t he same wal l socket or outl et st rip as the vapori zer.
El ect romagneti c interference may occur i f the vapori zer i s used wi t h an ext ensi on
cord.
Movement duri ng t ransport can resul t i n i ncreased vapor out put unless ti me is
al l owed f or the l i qui d to drai n i nto the normal area. I f the vapori zer has been
removed f rom t he anesthesi a machi ne and t ransport ed, i t shoul d be purged at 5
L/ mi nute f or 2 mi nutes bef ore use.
Sudden i nadvertent movement can cause an i ncreased out put unl ess the vapori zer
i s securel y f i xed t o the anesthesi a machi ne and i n an upri ght posi t i on.
Maintenance
The manufacturer recommends a peri odi c servi ce check by a manufacturer-t rai ned
engineer. A t raining course is avai labl e f or t hose who wi sh t o carry out routi ne
mai ntenance.
Blease Datum
Bl ease Datum vapori zers are avai l abl e for hal ot hane, enf lurane, i sof lurane, and
sevof lurane.
Construction
The vapori zer i s shown i n Fi gure 6.48. The agent -speci fi c col ored l abel i s on t he
f ront of the vapori zer bel ow the di al . The concent rati on cont rol di al l ocks
automati cal l y i n the OFF posi ti on. To set a concentrat ion, t he dial i s pushed inward
and rotated countercl ockwi se. The concentrat ion dial shoul d not be set bet ween
zero and the
P. 164

f i rst sett i ng. The f i l l i ng devi ce can be ei t her a f unnel f i l l or a keyed f il l er
mechani sm. The sevofl urane vapori zer does not have a f unnel f i l l but may have the
Qui k-Fi l system (Fig. 6.48).

View Figure

Figure 6.46 Internal construction of Sigma Alpha
vaporizer. (Redrawn from a drawing furnished by Penlon
Company UK.)

The i nt ernal vapori zer const ructi on i s shown i n Figures 6.49 and 6. 50. Gas enters
t he vapori zer and is spli t i nto two st reams, one passing t hrough the bypass and the
ot her t hrough the vapori zi ng chamber. I n t he zero lock posi t i on, the bypass remai ns
open, but the vapori zi ng chamber i s compl et el y separated f rom gas f low by t he
cl osed zero l ock val ve. When the vapori zer i s turned ON, t he zero lock valve opens,
and gas passes through a spi ral tube to mi ni mi ze the ef f ects of intermi t tent posi ti ve
pressure vent i l at ion and then i nto the vapori zi ng chamber t hat cont ai ns a mai n and
a coi l wi ck. Gas sat urated wi t h vapor exi ts the vaporizing chamber through the
vapor control val ve. The concent rati on control di al set ti ng control s t he si ze of the
ori f i ce in t hi s val ve. Gas saturated wi t h vapor t hen j oi ns the bypass gas and fl ows
on to t he outl et .
Temperature compensati on is provided by a mechanism wi th i ts base i n the
vapori zi ng chamber. I t i s connected to a vari abl e bypass valve. As the vaporizing
chamber cool s, t he ori f ice in t he val ve becomes small er so that a greater proport i on
of gas passes t hrough the vapori zi ng chamber.
Evaluation
The concentrat ion dial must be i n the zero posi ti on whi l e draini ng or f i l l i ng the
vapori zer. The eff ect of al t i t ude on the out put i s shown in Fi gure 6.51. Vapori zer
output in rel ati on to di al set ti ng, f l ow, and temperature is shown i n Figures 6.52 t o
6. 55.
Temperature compensati on is i n the range of 15C t o 30C. Temperat ures outsi de
of t hi s range wi l l cause t he output to vary. When the l i qui d l evel i s bel ow
P. 165

t he mini mum marking on the si ght gl ass, the output may f all .

View Figure

Figure 6.47 Output of Sigma Alpha vaporizer. (Redrawn
from graphs furnished by Penlon Company UK.)

P. 166



View Figure

Figure 6.48 Blease Datum vaporizer with Quick-Fil system.
(Photograph courtesy of Blease.)

Baromet ri c pressure changes are normal l y not cl i nical l y si gnif icant . A smal l
i ncrease i n output concent rat i on can be produced by i nt ermi tt ent back pressure,
most not iceabl y at l ow concent rati ons and low f l ow rat es.
The output i s aff ected by the gas composi t ion. The vari at ion i s unl i kel y to be more
t han 10% of t he set concent rat i on. The vapori zer i s cal i brated by usi ng ai r. Oxygen
wi l l produce a sl i ght i ncrease i n output. This ef f ect i s greatest at l ow f lows. Hel i um
has negl igible ef fects on t he sevof lurane out put (49). Reversed f l ow has a
negli gi bl e eff ect on output (59,60).
Hazards
Excessive output may occur i f t he vapori zer i s moved suddenl y duri ng use. The
vapori zer shoul d be drai ned pri or t o t ransport . I f the vapori zer i s transported wi th
l i quid agent , the cont rol di al shoul d be in the OFF posi t ion. The vapori zer must then
be secured in t he upright posi ti on for at l east 1 hour before i t is connected to a
machi ne. I t is t hen f lushed wi th 4 L/minut e of oxygen for 2 minutes before bei ng
used. If the vapori zer has been t ransport ed wi th the cont rol di al i n the ON posi t i on,
t he operat or shoul d contact the manuf act urer for advi ce.
I f the vapori zer i s overf i l l ed, i t shoul d not be used, and the manuf acturer should be
contacted for advi ce.
I f the vapori zer i s subj ected t o ext remes in t emperat ure, the t emperature
compensati on mechani sm may be damaged. The temperature range at whi ch the
vapori zer can be stored i s -20C to 50C.
Changes i n atmospheri c pressure do not usual l y af f ect the output , but al t i tudes
great er t han 1500 m may requi re a correction factor.
Probl ems wi th mounti ng this vapori zer have been reported (61).
Maintenance
Mai ntenance incl udes cl eani ng the exteri or of t he vapori zer wi th a cl ean, damp
cl oth. The hal othane vapori zer should be drai ned at regul ar intervals to prevent
t hymol bui ldup. Si nce some agents t urn yel l ow or brown when exposed to l i ght , thi s
i s not i n i tsel f a reason t o change the agent.
In-system Vaporizers
Al though i n-system vapori zers are not of ten used i n devel oped countri es, thei r l ow
cost, si mple desi gn, and portabil i t y have made them popul ar i n developi ng
count ri es and i n the mi li t ary (62). The avai labi l i ty of anestheti c agent moni tors has
sparked renewed i nterest i n t hei r use.
Characteristics of In-system Vaporizers
Of ten, the vapori zi ng chamber i s a si mpl e reservoi r wi th a gl ass t hat al l ows t he
anesthesi a provi der t o det ermine the amount of l i qui d present . There may or may
not be a means of t emperature compensati on. The output depends on the vapori zer
di al sett i ng, f resh gas f l ow, and t he composi ti on and concentrat ion of the gas
entering the vapori zer, whi ch in t urn depends on the pati ent ' s mi nute volume,
oxygen, and anesthet ic agent uptake and t he breathing system conf i gurat i on
(63,64,65).
Ambi ent ai r is of ten used as the principal carri er gas. Oxygen can be suppl i ed
t hrough a T-piece that incl udes a reservoi r t ube (Fig. 6.56). The i nspi red oxygen
concentrati on depends on oxygen fl ow, reserv oi r vol ume, and vent i latory vol ume.
There are two ways that gas f l ows through a vapori zer: push through and draw over
(Fi g. 6.56) (66). Some vapori zers del i ver higher outputs i n the push-through
confi gurati on.
P. 167



View Figure

Figure 6.49 Internal construction of Blease Datum
vaporizer in the OFF position. (Redrawn from information
supplied by Blease.)

Si gni f i cant wat er contaminati on may occur af t er prol onged cl osed-ci rcle anesthesi a
(67).
Oxford Miniature Vaporizer
There are Oxf ord mi niature vapori zers (OMVs) for hal ot hane, enf l urane, i sof l urane,
and sevof l urane.
Description
The vapori zer i s shown i n Fi gure 6.57. On the top i s a cont rol l ever wi th a
cali brated scal e. There are cal i brated scal es f or each agent , and onl y the agent
marked on t he vapori zer should be used. Each vapori zer can hold up to 50 mL.
There are markings at 10 mL and 50 mL. An arrow i ndicates the correct di recti on of
f low. Ri ght-to-l ef t fl ow vapori zers have 22-mm connectors for at tachment to a
breat hi ng system. Lef t-to-ri ght f l ow vapori zers have 23-mm connectors f or use on
t he anesthesi a machi ne bet ween t he f lowmeters and t he common gas outl et or
at tached t o the f resh gas outl et . The scal e i s onl y accurate i f the marked di recti on
of f l ow i s used.
A seal ed compartment in the base contai ns anti f reeze, whi ch acts as a temperature
buff er. On t he top of t he vapori zer i s a control l ever wi t h a cal ibrated scal e that
i ndi cates t he del ivered concent rat i on. Wi th t he control l ever i n the countercl ockwi se
posi t i on, a sl i di ng valve i sol ates the vapori zi ng chamber i nlet and outl et . As the
l ever is rotated clockwi se, t he valve blocki ng the vapori zi ng chamber i nlet and
outl et i s gradual l y opened to al low gas to enter t hat chamber.
The vapori zer can be f i ll ed or drai ned, even i f gas is passi ng through the vapori zer,
as l ong as the indi cator i s i n the OFF posi t ion. The vapori zer i s f i l l ed by removi ng
t he f i l l er cap and pouri ng the li qui d i nto t he vapori zer. Si nce the top of t he f i l l er
ori f i ce is l ower than the vapori zing chamber, i t i s not possi bl e to overf i l l t he
vapori zer.
P. 168



View Figure

Figure 6.50 Internal construction of Blease Datum
vaporizer in the ON position. (Redrawn from information
supplied by Blease.)

The vapori zer i s drai ned by i nverti ng the cap that has a groove to f i t t he t op of t he
drai n screw. Looseni ng the drai n screw wi l l al low l i qui d t o be drai ned f rom the
vapori zer. All of the l i qui d wi l l drai n out except for the 2 to 4 cc that remain i n t he
wi cks.
Evaluation
The Oxf ord mini ature vapori zer has a resistance to f low of l ess than 1 cm H
2
O at a
f low of 40 L/mi nute. I t i s desi gned to be used in an upri ght posi ti on but can be t i l ted
up to 30 degrees. If i t has been t il t ed more t han this or has been transport ed f ul l of
l i quid, 2 or 3 minutes should be al l owed f or l i quid to drai n back into the vapori zi ng
chamber. The control poi nter should be at zero during t ransport .
The Oxf ord mini ature vapori zer i s cal i brated at a f l ow rat e of 6 L/ mi nute at 20C.
The vapori zer does not have an acti ve thermocompensat i ng mechani sm, so output
i s aff ect ed by ambient temperature changes (68). A pl ast ic card that i s suppl ied
wi th t he vapori zer indicates the output vari ati on wi th t emperat ure and fl ow rat e.
The vapori zer i s desi gned for cont i nuous f l ow rat es bet ween 3 and 8 L/ mi nute or
drawover rates between 4 and 10 L/ minute and ambi ent t emperatures bet ween 18C
and 28C. Pressure f l uctuat i ons f rom control l ed breat hi ng have li tt l e eff ect on
vapori zer out put . The output i s reduced at hi gh mi nute vol umes and wi t h conti nuous
carri er gas f l ow (69). Usi ng a sel f -ref i ll i ng bag (Chapter 10) wi t h the Oxf ord
mi niature vapori zer in t he pushover conf i gurati on may cause a hi gher output than
some mechanical venti l ators (62).
These vapori zers are not recommended f or use wi t hi n a cl osed system. Rapi d
anesthet ic overdose may resul t because of t hei r hi gh ef f i ci ency. Thei r
P. 169

perf ormance wi l l deteri orate wi th t i me because wat er condenses on the wi ck.

View Figure

Figure 6.51 Effect of altitude on output of the Blease
Datum vaporizer. (Redrawn from information supplied by
Blease.)

The sevof l urane vapori zer may not be able t o produce a hi gh enough concentrati on
f or an i nhal at ion i nduct ion (69,70). I t may be possi bl e to use t wo vapori zers in
seri es for i nhal at ion i nducti ons.
Service
Agents such as halot hane that leave a resi due shoul d peri odical l y be drai ned and
di scarded. To cl ean the vapori zer, i t shoul d be empt ied and the i nl et closed wi th a
stopper and turned on i ts si de wi th t he out let upper-most . Ether i s poured i nto t he
outl et , and the cont rol di al i s moved repeatedl y unti l t he movement i s f ree. Af t er
t his i s accompl ished, the cont rol is t urned ful l y countercl ockwi se, and the vapori zer
i s agi tat ed gentl y to wash the wi cks. The cont rol is opened f ul l y, and t he et her i s
poured out of t he out l et. Ether i s t hen poured through t he outl et . The f i l ler cap and
drai n screw are opened, and ether i s al l owed to run out through the drain screw.
The vapori zer i s l ef t wi th t he control l ever ful l y cl ockwi se unti l al l of the ether has
evaporated. Wi th t he control l ever ful l y open, dry gas is passed t hrough t he ci rcui t
unti l no t race of ether vapor can be det ect ed.
Filling Systems
There are a number of di ff erent f i l l ing syst ems avai l abl e at t hi s ti me (Fi g. 6.58).
Funnel f i l l i ng systems are avai l abl e. Others are desi gned to al low a vapori zer to
P. 170


P. 171


P. 172


P. 173

be f i l l ed onl y wi t h a specif ic agent . Some systems are speci f ic t o one vapori zer
manuf acturer or anestheti c agent . Some can be used wi th vapori zers f rom di ff erent
manuf acturers.

View Figure

Figure 6.52 Performances of halothane Blease Datum
vaporizer. (Redrawn from information supplied by Blease.)


View Figure

Figure 6.53 Performances of enflurane Blease Datum
vaporizer. (Redrawn from information supplied by Blease.)

View Figure

Figure 6.54 Performances of isoflurane Blease Datum
vaporizer. (Redrawn from information supplied by Blease.)

View Figure

Figure 6.55 Performances of sevoflurane Blease Datum
vaporizer. (Redrawn from information supplied by Blease.)
The ASTM machi ne standard (5) recommends, but does not requi re, that a
vapori zer designed for a si ngl e agent be fi tt ed wi th a permanentl y at tached, agent-
speci f i c device to prevent accidental f il l i ng wi th t he wrong agent. Some of these
devices are covered by i nternat i onal and U. S. standards (71). I n addi t ion t o
preventi ng a vapori zer f rom bei ng f i l l ed wi t h a wrong agent , these systems may
reduce t he ai r pol l ut ion associ ated wi th f i l l ing and drai ni ng vapori zers.
Funnel Fill System
Vaporizer Components
The vapori zer f il l ing components i nclude a f unnel and cap. When the cap i s
removed, l i quid can be poured into the vapori zi ng chamber t hrough t he f unnel .
When t he ful l l evel i s reached, l i quid wi l l accumul ate i n t he f unnel , and no more
l i quid wi l l ent er t he vapori zer. A funnel -fi l l
P. 174

vapori zer can be converted to an agent -speci f ic keyed f il l i ng system by the addi ti on
of an adapt or t hat screws i nto the vapori zer f i ll er (Fi g. 6.59).

View Figure

Figure 6.56 Systems for using an in-system vaporizer. The
unidirectional valve prevents retrograde flow through the
vaporizer.


View Figure

Figure 6.57 Oxford miniature vaporizer. (Courtesy of
Penlon Company UK.)

Bottl e Component
A col or-coded adaptor i s avai labl e to ai d t he f i l l ing process (Fig. 6.60). At one end
i s a connector wi th a screw thread to match the thread on t he bot tl e (Fi g. 6.61) and
a ski rt that extends beyond the screw t hreads. I t has sl ots that match the
proj ect ions on the bot tl e col lar. The adaptor f or a di f ferent agent than the adaptor
i s i ntended f or wi l l not screw on ei ther because of di ff erent threads or bott l e
openi ng si ze or because the proj ect i ons wi l l not l i ne up wi t h the sl ots on the
adapt or.
Fil li ng Procedure
The f i l l er cap i s removed by turni ng i t countercl ockwise. Agent i s poured i nto t he
f il l i ng port unti l the l evel reaches the ful l mark. The level may fal l sl i ght l y as t he
wi cks absorb the agent . The f i l l er cap i s then securel y repl aced.
Draini ng Procedure
To drai n t he vapori zer, a contai ner i s pl aced under t he drain. Removing the f il l i ng
cap wi l l usual l y speed drai nage. The mechani sm f or opening the drai n vari es wi th
t he vapori zer. Af ter draini ng i s compl ete, t he drai n plug shoul d be repl aced and
t i ghtened to mi ni mi ze l eaks.
P. 175



View Figure

Figure 6.58 Various filling systems for vaporizers. Left to
right: Keyed fill, Quik-Fil, keyed filled, funnel fill, and
keyed filled.

Keyed Filling System
The keyed f il l ing system has been used by many manuf act urers f or a vari et y of
anesthet ic agents (71).
Vaporizer Component
The vapori zer f il l er recept acle (f i ll er socket or bl ock, vapori zer f i l ler uni t, f i ll and
drai n system) permi ts only t he i ntended bott l e adapt or t o be inserted. A vari et y of
methods are used to f ix the adaptor i nto the vapori zer t o prevent leaks whi le t he
vapori zer is bei ng f i ll ed (Figs. 6. 62, 6.63). There must al so be a means to seal the
receptacle when the bott l e adaptor i s not i nsert ed. A met al f i l l er bl ock (pl ug) may
be used (Fi g. 6.62). There may be a single port f or both f i l l i ng and draini ng or t wo
ports, t he upper one f or f i l l i ng and t he l ower one for drai ni ng (Fi gs. 6.62, 6.63). An
ai r vent may be l ocated on the vapori zer. This must be opened pri or to f i l l i ng t o
prevent an ai r l ock.

View Figure

Figure 6.59 Adaptor to convert a funnel fill system to an
agent-specific keyed filling system. (Picture courtesy of
Sharn Inc.)

Bottl e Component
Each bot tl e of l i quid anesthet i c has a col or-coded col l ar at tached securel y at t he
neck (Fi g. 6.61). The col ors are red for hal othane, orange for enf lurane, purpl e f or
i sof lurane, and yel low f or sevof lurane. These col ors are al so used on the bott l e
l abel s. Each coll ar has t wo proj ect ions, one thi cker t han the other, whi ch are
designed t o mate wi th correspondi ng i ndentat i ons on t he bot tl e adaptor.
Bot t l e adaptors (adaptor tubes or assembl i es, tube adapt ors, f i l l er tubes) are shown
i n Fi gures 6.64 and 6.65. They are al so color coded. At one end, the adapt or has a
connector wi t h a screw t hread to match t he t hread
P. 176

on the bot tl e and a ski rt that extends beyond the screw threads and has sl ots that
match the proj ecti ons on the bot t le col l ar. At t he other end i s the mal e connector
t hat f i ts i nto t he vapori zer fi l l er receptacl e. A short l ength of plasti c tubi ng wi t h two
i nner t ubes connects the ends. The tubi ng al l ows t he bot tl e to be hel d higher or
l ower t han t he vapori zer.

View Figure

Figure 6.60 Bottle adaptors for vaporizers with funnel
filling systems. The skirt fits over the bottle ring. The caps
allow the adaptors to remain on the bottles without vapor
being lost.

Fi gure 6.65 shows a mal e connector on t he adaptor (key, probe, tube bl ock, f i l ler
pl ug, male adaptor). I t consi sts of a rectangul ar pi ece of pl ast ic wi t h a groove on
one si de and two hol es on anot her surf ace. The groove i s i n dif ferent l ocati ons,
dependi ng on the agent that i s to be used. This prevents the probe f rom bei ng
i nsert ed int o an i ncorrect vapori zer. The larger hol e is f or t he agent to enter or
l eave t he vapori zer, and the smal l er hole i s for ai r to l eave the vapori zi ng chamber,
preventi ng an ai r l ock f rom devel opi ng. A one-way bal l val ve i n the ai r l i ne occl udes
t he ai r port af ter t he vapori zer i s f i ll ed. Thi s prevents overf i l l i ng and f l oodi ng the ai r
channel wi t h l i qui d anesthet ic.

View Figure

Figure 6.61 Bottle collar. The collar is color coded according
to the bottle contents. It has two projections, one thicker than
the other, which are designed to mate with corresponding
grooves on the bottle adaptor.


View Figure

Figure 6.62 Dual-port vaporizer filler receptacle. Note the
plug to prevent leaks, the vent at the top, the drain valve at the
bottom, and the two retaining screws at the right. A separate
vent is not present on all filling receptacles. It must be
loosened to fill the vaporizer. If the plug is not reinserted and
the screw tightened, the vaporizer will leak.

Fil li ng
To f i l l a vapori zer, t he cap f rom t he appropri ate bott l e i s removed, and the bot tl e
adapt or i s screwed to the bot t l e unt i l ti ght. I f t he connect ion is not ti ght , t he
vapori zer may be overf il l ed or a l eak may occur. The vapori zer shoul d be t urned
OFF bef ore proceeding f urther. The plug, i f present, i s removed. The bot t l e
component i s then i nsert ed wi th the groove matchi ng that on the vapori zer
receptacle. Duri ng i nsert i on, t he bot tl e shoul d be below t he i nl et level . Af ter the
f il l er bl ock i s i nserted, the retai ni ng devi ce i s ti ght ened, and the f i l l valve (vent) i s
opened. The bot tl e i s then held hi gher t han the f i l l er receptacl e so that l i quid enters
t he vapori zer (Fi g. 6.63, top). Gentl e up-and-down moti on may hel p to clear ai r
bubbl es and f aci li t ate f i l l ing.
P. 177



View Figure

Figure 6.63 Keyed filling device with one front screw and top
vent. Top: Filling the vaporizer. To fill, the plug is removed,
the filler block is inserted, and the retaining screw is
tightened. The vent is opened, and the bottle is tipped upward.
Bottom: Draining the vaporizer. The filler block is inserted
into the drain receptacle, the retaining screw is tightened, and
the drain is opened. The bottle is held below the vaporizer.

Af ter the desi red l i qui d l evel has been reached, the f i l l val ve i s cl osed, the bot tl e
l owered, and the retaining devi ce l oosened. The bot tl e adaptor is removed, and t he
pl ug i s rei nsert ed and t ightened i n place.
Draini ng
To drai n t he vapori zer, t he bott le adaptor i s att ached to an appropriat e bot tl e. In
t he dual -port f i l l er, t he bot tom socket is used. The f i l l er plug i s removed, the mal e
adapt or i nserted, and the retai ni ng devi ce ti ghtened. The bott l e i s hel d bel ow the
receptacle (Fi g. 6. 63, bottom), and t he drain (spool ) val ve is opened. Fl ui d drai ns
t hrough one t ube i nt o the bot t le, and ai r moves upward f rom the bott le t hrough the
ot her t ube. Af ter t he vapori zer i s drai ned, the drain valve i s cl osed, t he ret ai ni ng
device loosened, and the bott le adaptor removed. The f i l l er pl ug shoul d be
rei nserted and the retaining devi ce t ightened.

View Figure

Figure 6.64 Bottle adaptor. The bottle connector is at the
left, and the male adaptor is at the right.


View Figure

Figure 6.65 Male adaptor. The groove corresponds to a
projection on the vaporizer filler receptacle. The larger hole
is for anesthetic agent, and the smaller hole is for air.

Problems with Keyed Fi lli ng Systems
I f the bott l e col l ar f or enf lurane or hal othane i s upsi de down on the bott l e, the
bot tl e adaptor f or the other agent wi l l fi t (72).
Li qui d can l eak i f t he devi ce t hat hol ds the keyed component i nto t he vapori zer is
not ti ght . Fai l ure to ti ghten the adaptor on the bott l e, a bl ocked fl ui d path i nsi de the
vapori zer, or l eakage i n a val ve or t he adapt er can resul t i n l i quid anest het ic agent
l eaki ng duri ng f i l l i ng (73). Vapor can l eak out if t he f i l l or drai n val ve i s not cl osed
(74).
P. 178


Mi sal ignment of the f i l l i ng channel and the ai r channel between the f i l l er and the
vapori zer wi l l make i t dif f i cul t to fi l l the vapori zer. Other probl ems t hat wi l l make i t
di ff i cul t to f i l l the vapori zer i ncl ude t he adaptor not seal ing at the bott l e end or a
l eak i n t he adapt or (73).
I f the bott l e does not have a keyed col l ar or the f il l er t ube is l ost, f il l ing i s awkward
(75). Wi th some f i l l i ng devices, up t o 27 mL of l iqui d agent may be l ef t i n the bott le
af ter the vapori zer i s fi l led (76, 77,78). The resi dual l iquid can be poured i nto a
bot tl e of t he same agent (79).
Some pract i ti oners turn t he vapori zer ON and l oosen t he bot tl e adaptor to speed
f il l i ng. One of these maneuvers al one wi l l not cause t he vapori zer t o overf i l l , but
both together may al l ow overf i l l i ng to occur (52,56,80). Incorrectl y manuf actured
screw t hreads on t he bot tl e necks may resul t i n l eaks wi t h overf i l li ng (81).
I f the bott l e l acks a keyed col lar, i t i s necessary to devel op a speci al t echnique to
f il l t he vapori zer (75).
Quik-Fil System
The Qui k-Fi l system i s onl y used f or sevof l urane. I t i s seen i n Figures 6.39, 6.48,
6. 58, and 6. 66.
Vaporizer Component
The vapori zer f il l er has a screw-on cap. The f i l l er neck has t hree grooves t hat can
accept onl y a speci al f i ll er devi ce, which comes at tached t o the bott l e (Fi g. 6.66).
Bottl e Component
The bott l e has a permanent l y attached, agent -speci f ic f i l l i ng devi ce t hat has three
ri dges that f i t i nto sl ots i n the f i ll er. A val ve prevents l iqui d f rom drai ni ng when the
bot tl e i s inverted but not i nserted i nto t he vapori zer (Fi g. 6.67).

View Figure

Figure 6.66 Vaporizer filler block for Quik-Fil system.
Note the three indentations, which allow only a bottle with
the correct fitting to the inserted.


View Figure

Figure 6.67 Bottle inserted into the filler block. Note the
projections on the bottle that fit into the indentations on the
filler block.

Fil li ng
To f i l l t he vapori zer, t he fi l ler cap and t he bot tl e cap are removed. The bot t l e i s
i nsert ed so that the projecti ons f i t into the correspondi ng grooves i n t he f i l l er neck
(Fi g. 6.67). The bot t le i s pushed into the vapori zer component as f ar as i t wi l l go
and held f i rml y i n pl ace. Thi s wi l l open a val ve and al l ow l i qui d agent to f l ow i nt o
t he vapori zer. Af ter f i l l i ng, t he bot t le i s removed, and the f i l l er cap and bot tl e cap
are replaced.
P. 179



View Figure

Figure 6.68 Drain attachment fitted to the filler block. The
filler cap should be removed. Note the tool for opening and
closing the drain plug.

Draini ng
To empt y the vapori zer, the fi l l er cap is removed f rom t he vapori zer. The drain
at tachment is f i t t ed to the bot tom of the bl ock (Fi g. 6. 68). The bott l e i s then
i nsert ed int o the drai n at tachment (Fi g. 6.69). The drain pl ug i s unscrewed by usi ng
t he tool at tached to the f i l l er cap. Fl ui d wi l l f low f rom the vapori zer. Af ter drai ni ng,
t he drain pl ug i s ti ghtened, and the f i l ler cap i s replaced and t i ghtened.
Easy-Fil System
The Easy-Fi l system i s used on al l f our Tec 7 vapori zers.
Vaporizer Component
The vapori zer component (block) (Fi g. 6.70) has a cap wi th a tool t hat i s used t o
open and cl ose t he drain on the end that i s i nsert ed int o the vapori zer. Insi de the
f il l er channel are t wo keys (ri dges) t hat f i t grooves on the bott le adapter.
Bottl e Component
The bott l e adapt or (Fi g. 6.71) attaches to the bot tl e by al igni ng the notches wi th t he
proj ect ions on the bot tl e col lar. The adaptor has grooves that must be al i gned wi t h
t he projecti ons on the vapori zer.

View Figure

Figure 6.69 Draining the vaporizer.

Fil li ng
To f i l l t he vapori zer, t he bot tl e adaptor is att ached securel y to t he bot tl e, and the
f il l er cap on t he vapori zer is removed. The bottl e nozzle i s i nsert ed i nt o the f i l ler
bl ock, al igni ng the adaptor grooves wi th proj ect ions in t he f i l ler block. When the
bot tl e i s ful l y inserted, l i qui d wi l l f l ow i nt o the vapori zer. When the vapori zer i s full
or t he bot t le empty, t he bott le i s rel eased and then removed f rom t he vapori zer
f il l er. The fi l l er cap is repl aced, and t he cap i s repl aced on the agent bott le. The
f il l er cap i s ti ghtened to mi ni mi ze l eaks.
Draini ng
To drai n, t he cap i s removed f rom the vapori zer f i l l er. A sui tabl e contai ner i s pl aced
under t he drai n nozzl e. The drai n pl ug i s unscrewed by usi ng the t ool attached to
t he f i l l er cap. Li quid shoul d then f l ow i nto the contai ner. Af ter drai ni ng, the drai n
pl ug i s t i ghtened, and the f i l ler cap i s repl aced and t i ghtened.
P. 180



View Figure

Figure 6.70 Easy-Fil system on a vaporizer. The inside of
the cap fits into the screwlike attachment above the drain
port at the bottom. (Courtesy of Datex-Ohmeda.)

Desflurane Filling Systems
Fi l l i ng systems f or vapori zers used wi th desf l urane are di ff erent f rom ot her f i l l i ng
systems. Al l use t he same bott l e to fi l l the vapori zer. Thi s bot t le has a cri mped-on
adapt or (Fig. 6.72). The bot tl e adaptor has a spri ng-l oaded valve that opens when
t he bot tl e is pushed i nto the f il l ing port on the vaporizer.

View Figure

Figure 6.71 Bottle adaptors for the East-Fil system.
(Courtesy of Datex-Ohmeda.)


View Figure

Figure 6.72 Bottle for desflurane. The protection cap has
been removed and is at the right. (Courtesy of Ohmeda, a
division of BOC Health Care, Inc.)

To f i l l t he Tec 6 vapori zer, t he bot tl e protect i on cap is removed, and the bot t le i s
f i t ted to the f i l l er port and pushed up against t he spri ng. Af ter t he bott le i s full y
engaged i n the port , i t i s rotat ed upward (Fi g. 6.73). The bot tl e is hel d i n thi s
posi t i on whi l e f i l l ing. When the l i qui d l evel gauge i ndi cates that the sump i s f ul l or
when t he
P. 181

bot tl e i s empt y, t he bot tl e is rotated downward and removed f rom t he vapori zer.
The valve on the bott l e cl oses aut omat i cal l y t o prevent agent spi l l . The fi l li ng port
has a spri ng valve to prevent agent f rom escapi ng.

View Figure

Figure 6.73 Filling Tec 6 vaporizer. The bottle is fitted to
the filler port. After it is engaged in the filler port, it is
rotated upward. When it reaches the upper stop, agent will
enter the vaporizer. (Courtesy of Ohmeda, a division of
BOC Health Care, Inc.)

Probl ems wi th these f i l l ing syst ems have been reported. Bot tl es cont aini ng
desfl urane that do not have the cap properly i n place can l eak agent (82,83). I f the
O ri ng on the bot tl e is damaged or mi ssing, agent may l eak duri ng f i l l i ng
(84,85,86).
Vaporizer Mounting Systems
Permanent Mounting
Permanent mounti ng means that tools are requi red to remove or i nstal l a vapori zer
on the anesthesi a machi ne. Advantages of thi s system i ncl ude l ess physi cal
damage to vapori zers and fewer l eaks. Vapori zers are al ways f i l l ed i n the vert ical
posi t i on.
There are probl ems wi t h permanent mount ing. The machi ne may not have enough
mounti ng l ocat i ons to accommodat e al l of the vapori zers that are l i kel y to be
needed. A mal f unct i oni ng vapori zer cannot easi l y be exchanged, especi al l y whi l e
anesthesi a i s bei ng admi ni stered.
Detachable Mounting
Detachabl e mount i ng syst ems are standard on most new anesthesi a machi nes.
They al l ow t he vapori zer t o be mounted and removed wi t hout the use of t ool s. The
Sel ect-a-t ec system and a si mi l ar system f rom Drager Medical are wi del y used.
Vapori zers cannot be exchanged between these t wo syst ems. Some other
anesthesi a machine manuf acturers use these mounti ng systems as wel l . Some
vapori zers f rom ot her manuf acturers are equi pped wi t h mount i ng systems that are
compat ibl e wi th one of these systems.
The Sel ect-a-tec system is shown i n Fi gures 6. 74 and 6.75. It consists of a pai r of
port valves f or each vapori zer posi ti on. Each vapori zer has a speci al mounti ng
bracket containing t wo pl ungers (spi ndl es), whi ch f i ts over the port valves. The
wei ght of the vapori zer and an O-ri ng around each port val ve creat e a seal between
t he mount i ng system and the vapori zer. On t he back of each vapori zer i s a l ocki ng
l ever.
Bef ore mount ing a vapori zer, the cont rol di al must be in t he OFF posi ti on, and any
adj acent vapori zer must be turned OFF. The l ocking l ever on the vapori zer shoul d
be unlocked. The vapori zer is f i t t ed onto the mounti ng system and locked i n
posi t i on.
To remove a vapori zer, t he control di al is t urned OFF, and the l ocking l ever moved
t o t he unlock posi ti on. The vapori zer can then be l i f ted of f the manif ol d.
When t he vapori zer is t urned ON (Fi g. 6. 75, ri ght ), t he t wo pl ungers move
downward, openi ng the val ve ports and connecting the vapori zer into the f resh gas
st ream. When the vapori zer is turned OFF (Fi g. 6.75, lef t ), i t i s isol ated f rom t he
f resh gas fl ow.
The Drager Medi cal mount ing system is shown i n Fi gures 6.24 and 6.76. The Vapor
2000 vapori zer must be i n the T (t ravel ) posi t i on bef ore i t can be unl ocked f rom
t he machi ne. Thi s posi ti on i sol ates t he vapori zi ng chamber and prevents li qui d f rom
passi ng i nto the bypass duri ng the t i me t hat t he vapori zer i s not on the machi ne.
Af ter a vapori zer has been added t o a machi ne, several checks should be made to
ensure proper posi t i oni ng. These i ncl ude sighti ng across the t ops of the vapori zers
t o ensure that they are l evel and at the same hei ght . An at tempt shoul d be made to
l if t each off the manif ol d wi t hout unl ocki ng i t . If t he vapori zer can be removed, i t i s
i mproperl y posi ti oned. It should be possi bl e to t urn ON onl y one vaporizer at a
t i me. Final l y, the anesthesia machine must be checked for leaks wi th each
vapori zer i n both the ON and OFF posi ti on as descri bed i n Chapter 33.
These mount i ng systems have a number of advantages. The anesthesi a machi ne
can have f ewer mounti ng l ocati ons, al lowi ng a more compact machine. Vapori zers
can be easi l y removed and repl aced, even duri ng a case. I f mal ignant hypert hermia
i s a potenti al problem, the vapori zers can be removed. Thi s gi ves better resul ts
t han i f the vaporizers remai n on the machi ne i n t he OFF posi t i on (87).
There are a number of di sadvant ages of these mounti ng systems. Parti al or
compl ete obstructi on to gas f l ow
P. 182


P. 183

f rom probl ems wi t h the mount ing system has been reported (88,89,90, 91). Leaks
may occur (92,93, 94,95,96, 97,98,99,100, 101, 102). A common l eak source is an
absent or damaged O-ri ng (103,104,105,106,107,108). Another cause is l eavi ng the
l ocki ng l ever i n the unl ocked posi t i on (109). If somethi ng i s pushed under t he
vapori zer enough to l i f t i t sl i ght l y of f of the O-ri ng, a l eak may resul t when the
vapori zer is t urned ON. Di ff erences among vapori zers and int erlocks f rom di ff erent
manuf acturers can pose probl ems of compat i bi l i t y (98,100).

View Figure

Figure 6.74 Select-a-tec mounting system. A vaporizer is
mounted on the right. In the center position, the nipples and
O rings are in place, ready to accept a vaporizer. Caps are
over the nipples and O rings on the left, to protect them. The
projections between the sets of nipples are to prevent two
vaporizers from being turned ON at the same time
(vaporizer exclusion or interlock system). The plastic
projections are interconnected so that they move from side
to side. The rod shown on the vaporizer to the right contacts
the right projection. When that vaporizer is turned ON, the
rod moves to the left, causing that projection to move to the
left. The left projection also moves to the left. If there were
vaporizers in those positions, their rods would also be
moved in a way that their dials could not be turned ON. The
inlet and outlet pipes are below the mounting system. They
enter at opposite ends so that they cannot be interchanged.


View Figure

Figure 6.75 Select-a-tec mounting system. The mounting
system has channels for the fresh gas flow from the
flowmeters toward the machine outlet. When a vaporizer is
mounted and turned ON, two plungers push the valves
down so that gas passes through the vaporizer. If the
mounting position is empty or the vaporizer is turned OFF,
the gas passes directly through the mounting system.
(Reproduced from a drawing furnished by Datex-Ohmeda.)


View Figure

Figure 6.76 Drager vaporizer mounting system. Between
the two nipples is the receptacle for the locking mechanism.

Several cases have been reported where there was fai l ure to del i ver anesthet i c
agent associat ed wi th probl ems wi th mounti ng syst ems (110,111, 112). I n anot her
case, a swi t ch mal funct ion caused t he f resh gas fl ow t o be di rect ed to t he wrong
vapori zer (113). Thi s resul ted i n del ivery of f resh gas wi t h no vapor to the breathi ng
system.
Interlock Devices
I nterl ock (vapori zer excl usion) systems prevent more than one vapori zer f rom bei ng
t urned ON at a t i me (114). Checki ng t he interl ock devi ce should be i ncl uded wi t h
t he anesthesi a apparatus checkout procedure. Systems are shown i n Fi gures 6. 24,
6. 74, 6.77, and 6.78. Interl ock system f ai lures have been report ed
(115, 116,117,118, 119).
For Datex-Ohmeda vapori zers, operat ing t he di al rel ease activates t wo ext ensi on
rods that prevent operati on of any other vapori zer instal l ed on t he mani fold. Older
versi ons of the Select -a-tec system that provi de mounti ng posi t i ons f or three
vapori zers requi re t hat if onl y t wo vapori zers are f i tted, then the center posi t ion
must be occupi ed. I f the center posi ti on i s not occupied, the i nt erlock that hel ps t o
ensure t hat onl y one vapori zer at a ti me can be turned ON is i nef fective. Lat er
versi ons i ncorporate an addi t i onal i nterl ock that helps t o ensure t hat only one
vapori zer can be turned ON at a ti me, even i f the center posi t i on is not occupi ed.
Hazards
Incorrect Agent
Most cont emporary concent rati on-cal i brated vapori zers are agent speci f ic. Fi l l i ng a
vapori zer wi th an agent other t han the one f or whi ch i t was desi gned i s st i l l a
hazard but i s less l i kel y i f the vapori zer i s equi pped wi t h an agent-speci fi c f i l l i ng
system (120).
I f an agent of l ow potency or l ow vol ati l i t y is pl aced i n a vapori zer designed f or an
agent of higher potency or vol ati l i t y, t he ef fect wi l l be an output of low potency
(121, 122). Conversel y, i f an agent of hi gh pot ency or vol at il i ty i s used i n a
vapori zer i ntended f or an agent of low potency or volati li t y, a dangerousl y hi gh
concentrati on may be deli vered.
I f an incorrect agent i s pl aced i n a vapori zer, there wi l l l i kel y be a mixture of agents
i n the vapori zer. Thi s wi l l resul t f rom the residual amount of the correct agent as
wel l as t he amount contained in t he wi cks. Some anestheti c agent moni tors
(Chapter 22) wi l l detect agent mi xt ures. Smel l i ng cannot be rel i ed on t o tel l whi ch
agent i s in a vapori zer, because the smel l of a smal l amount of one agent can
compl etel y mask t he odor of a l ess-pungent agent, even i f the second agent is
present i n much hi gher concent rat i on (123). Anesthesia personnel can detect the
presence of a vol ati le agent but are not able t o identi f y an agent by smel l (124).
I f a vapori zer i s f i l led wi t h t he wrong agent , i t must be compl etel y drai ned and al l
l i quid di scarded. Gas should
P. 184

be al l owed to f l ow t hrough i t unti l no agent can be detected i n the outf low. Drai ni ng
cannot be rel i ed on to compl etel y empt y a vapori zer.

View Figure

Figure 6.77 North American Drager interlock system.
When the vaporizer of choice is turned ON, a pin is forced
into a notch on the concentration control knob of each of the
other vaporizers. These vaporizers are then locked in the
OFF position. (Reproduced from a drawing furnished by
North American Drager, Inc, Telford, Pa.)

Tipping
I f some vapori zers are ti pped suf f i ci ent l y, l iqui d f rom the vapori zi ng chamber may
get i nto the bypass or outl et . If thi s occurs, a hi gh concent rati on wi l l be del ivered
when t he vapori zer is f i rst used.
Ti ppi ng can be prevented by mounti ng vapori zers securel y and handl i ng t hem wi t h
care when t hey are not mount ed. Vapori zers shoul d be turned OFF or pl aced i n a
t ravel sett ing i f t hey are bei ng moved. Shoul d t i ppi ng occur, a high f l ow of gas
shoul d be run through the vapori zer wi t h the concentrat ion dial set at a low
concentrati on unti l t he output shows no excessive agent.
Many new vapori zers have a mechani sm that bl ocks t he entrance and exi t f rom the
vapori zi ng chamber. Thi s prevents t he probl ems associ ated wi t h ti pping the
vapori zer when i t i s t ransport ed.
P. 185



View Figure

Figure 6.78 North American Drager interlock system. The
top picture (A) shows the adjustment screw at the back. It is
connected to the pin (B), which interlocks with the
concentration control dial of the vaporizer.

Overfilling
I f a vapori zer i s overf il l ed, l i qui d agent may enter t he f resh gas l i ne, and lethal
concentrati ons may be del ivered. Another resul t of overf i l l i ng may be complete
vapori zer fail ure so that i t produces no output (19).
On most vapori zers, t he fi l li ng port i s si tuated so that overf i l l i ng cannot occur.
Li qui d wi l l pour over the edge of the f unnel before the l evel i nsi de the vapori zer
ri ses to a dangerous l evel .
I f a vapori zer i s ti pped during t he f i l l i ng process, i t i s possi bl e that i t coul d be
overf i l l ed. The vapori zer should be securel y att ached to t he anesthesi a machi ne
and i n a verti cal posi t ion.
Agent-speci fi c f i l l i ng devices prevent overf i l l i ng by connect ing t he ai r i ntake in t he
bot tl e to t he i nsi de of the vapori zer chamber. To facil i tate f i l l i ng when usi ng key
f il l i ng devi ces, many users have f ound that sl i ght ly unscrewi ng the bot tl e adaptor
can speed t he f i l li ng process. Turni ng the concent rati on di al of the vapori zer ON
duri ng fi l li ng wi l l accompl i sh t he same end. Such practi ces shoul d be avoided,
because t hey can resul t in overf i ll i ng (16,17,56,125).
Reversed Flow
Al though t he anesthesi a machi ne standard (5) requi res that the vapori zer i nl et be
mal e and the out let f emale, the di rect ion of gas f l ow be marked, and the i nlet and
outl et l abel ed, i t is possi bl e to connect the f resh gas deli very li ne f rom the
anesthesi a machine t o the outl et and
P. 186

t he del ivery t ube t o the breathi ng syst em t o the i nl et , especi al l y i f the vapori zer i s
used i n a f reestandi ng posi ti on (126). Reversed f l ow t hrough a vapori zer has been
reported af ter i mproper connecti on or repai rs to t he sel ect or val ve (127,128).
I f the f l ow t hrough a vapori zer i s reversed, i n most cases t here wi l l be an i ncreased
output. The consequences of reversed f l ow t o a part i cul ar vapori zer are discussed
wi th i ndivi dual vapori zers earl i er i n this chapt er.
Control Dial in Wrong Position
Af ter previ ous vapori zer use or servicing, the vapori zer cont rol di al may be l ef t ON
(114, 129,130,131). For t hi s reason, the di al shoul d be i nspected as part of t he
preuse checki ng procedure.
The cont rol di al may be changed duri ng a case wi t hout the operator' s knowl edge.
Operat ing room personnel movi ng a machi ne or simpl y passi ng by may grab the dial
and change t he sett ing.
Leaks
The eff ects of a leak on a vapori zer wi l l depend on the si ze and l ocati on of t he l eak
and whether or not t here i s a check val ve at t he vapori zer out l et. I n addi ti on to
af fecti ng f resh gas composi t ion and f l ow, l eaks may pol lute t he operat ing room ai r.
A common cause of l eaks is f ai l ure t o repl ace or adequatel y t i ght en the f i l l er cap. I f
t he f i l l val ve or vent on a keyed f i l l ing syst em i s not cl osed or the pl ug i s not
repl aced and ti ghtened i n pl ace, a l eak wi l l occur when the vapori zer i s turned ON
(Fi g. 6.79) (74,132). I f an i ncorrect cap i s used on the f il l er device, a l eak may
resul t (133).
The f i t t ing between a vapori zer and i ts i nl et or outl et connecti on may become loose
or broken (134,135). A vapori zer may not be mounted properl y
(37,95,96, 97, 105, 108,109,136,137).
Wi th a l eak in a vapori zer or i ts mount, the machi ne wi l l of ten functi on normal l y
unti l the vapori zer i s turned ON. At t hat point, f resh gas f low f rom t he machi ne wi l l
be l ost through the l eak, and the tot al f low wi l l be reduced. The l eak may contai n
l i t tl e or no vapor, especi al ly i f i t i s i n the mount ing mechanism. A l eak shoul d be
suspected i f a vapori zer appears to requi re f il l i ng wi th unusual f requency, i f an odor
can be detected, or i f there is a l oss or reduct ion i n the f resh gas f low i nt o the
breat hi ng system af ter the vapori zer i s turned ON. A l oose or missi ng f i ll er cap may
be detected by l i qui d bei ng forced out under pressure when the vapori zer i s turned
ON (138,139). If the l evel is l ow or below t he fi l ler, l iqui d may not be spl attered
(14). If t he device to hol d the key f i l l er in pl ace i s broken, a leak wi l l occur (54,55).
Spl at teri ng may not be seen wi th t he key f i ll er system on certai n vapori zers.

View Figure

Figure 6.79 Failure to replace the filler plug will result in a
leak when the vaporizer is turned ON.

A leak can be i denti f i ed by usi ng t he sampl i ng tube f rom an anestheti c agent
moni tor t o sni f f around the vapori zer (55).
Personnel who f i l l vapori zers should be i nstructed to al ways close fi l ler caps and
vents t i ght ly. A l eak i n a vapori zer can be det ected when the anest hesi a machi ne i s
t est ed bef ore use if the vapori zer i s turned ON (Chapter 33). Even af ter a proper
preuse check, i f anythi ng i s pushed under the vapori zer and t he vapori zer i s l i f ted
even sl ightl y f rom i ts mount , a l eak may occur.
Vapor Leak into the Fresh Gas Line
Some vapori zers l eak smal l amounts of vapor i nto the bypass when t urned OFF
(87). Int erlock devices or selectors wi l l not prevent thi s problem i f there i s sti l l a
di ff usion pathway vi a the selector val ve (140). The amount of such a l eak depends
on the ambi ent temperature as wel l as the si ze and conf i gurat i on of the i nt ernal
ports. Al though the amounts del i vered are usual l y too smal l to produce a cl i ni cal
ef fect , i t mi ght cause a sensi ti zed i ndividual to react to a hal ogenated agent or
t ri gger an epi sode of mal ignant hyperthermi a. These l eaks can be reduced by not
t urning a vapori zer f rom the OFF t o the 0 sett ing unl ess i t i s to be used.
P. 187



View Figure

Figure 6.80 Corrosion in vaporizer caused by water and
other foreign substances.

Contaminants in the Vaporizing Chamber
I t i s possi bl e f or various substances to be poured i nto a bott le t hat shoul d contai n
anesthet ic agent (141). Cl eani ng agents may col l ect i n the f unnel f i l l er and be
washed i nto the vapori zi ng chamber when i t i s f il led wi t h l i qui d agent. Water and
ot her f orei gn substances can cause corrosion (Fi g. 6. 80). I f f orei gn substances are
known to have ent ered the vapori zer, the manufacturer shoul d be contacted to
determine what measures need to be taken.
Physical Damage
Shock, excessi ve vi brati on, or mi streatment may l ead to mal f unct ion. Damage t o
vapori zers permanent l y mounted on a machi ne is si gnif i cant l y l ess t han wi t h t hose
t hat can be di sconnected and are f requentl y moved (142). A suf f i ci ent number of
vapori zers shoul d be purchased so t hat they do not need to be moved duri ng
rout ine use. If a vapori zer must be removed, care shoul d be taken to prot ect i t f rom
physi cal damage.
No Vapor Output
The most common cause of no vapor out put i s an empty vapori zer.
I ncorrect vapori zer mounti ng can resul t i n l i t tl e or no vapor output (112,143). I n
most cases, thi s can be detected by checking f or l eaks wi t h the vapori zer ON
(Chapter 33). An overf i l l ed vapori zer may del iver no vapor (19). Bl ood enteri ng the
vapori zer can cause vaporizer f ai l ure (144). If an anesthesia machi ne is t urned OFF
and then ON agai n, the vapori zer sett ings may def aul t to zero (145). Fai l ure to
del i ver adequate vapor can be detect ed by an anest het i c gas moni tor (Chapter 22).
Projectile
A case has been report ed in whi ch a port abl e vapori zer carri ed int o the magnet i c
resonance i magi ng (MRI ) sui te was rapidl y at t racted to the magnet (146). The
vapori zer was consi dered MRI saf e but onl y when at tached t o a rack.
Disposing of Liquid Anesthetics
Af ter a vapori zer has been drai ned, the quest i on of what do wi t h the l i qui d agent
arises. Some of these agents wi l l react wi t h plast ic. A simpl e sol uti on is to place
t he agent in a bott le or t ray and set i t outside, where personnel wi l l not be exposed
t o t he vapor. An evaporator has been descri bed (147). I t consists of a glass f l ask
wi th a stopper that has t wo hol es. A glass tubi ng open t o room ai r i s i nserted
t hrough one hol e. The gl ass t ubi ng t hat i s inserted through the other hole i s
connected t o the vacuum system. The l iqui d i s al l owed to evaporat e, and the vapor
i s removed by the vacuum syst em.
References
1. Gorel ov V. Cal i brat ion of vapori sers. Anaest hesi a 2005;60:420.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
2. Jones MJ. Breathing systems and vaporizers. In: Anaest hesi a. Ni mmo WS, Smi th
G, eds. Oxf ord, UK: Blackwel l Scienti f i c, 1989:327341.
3. Lei gh JM. Vari ati ons on a t heme:spl i tt i ng rat i o. Anaesthesi a 1985;40: 7072.
[CrossRef ]
[Medli ne Li nk]
4. Camporesi EM. Anesthesi a at di ff erent envi ronmental pressures. In: Anesthesi a
Equi pment. Pri nci pl es and Appl icati ons. Ehrenwert h J, Ei senkraf t JB, eds. St.
Louis: Mosby, 1993:588598.
5. Ameri can Soci ety f or Testi ng and Materi al s. Standard speci f i cat i on f or parti cul ar
requi rements for anesthesia workstati ons and thei r components (ASTM F-1850-00).
West Conshohocken, PA: Author, 2000.
6. Hi l l DW, Lowe HJ. Compari son of concent rat i on of hal ot hane i n cl osed and
semi cl osed ci rcui ts during cont roll ed venti l ati on. Anesthesi ol ogy 1962;23:291
298.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
7. Keet JE, Val ent ine GW, Ri ccio JS. An arrangement t o prevent pressure ef fect on
t he Verni -Trol vapori zer. Anesthesiology 1963;24:734737.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
8. Heneghan CPH. Vapori zer out put and gas dri ven venti l ators. Br J Anaesth
1986; 58:932.
[CrossRef ]
[Medli ne Li nk]
P. 188


9. I nternat ional Standards Organi zati on. Inhal ati onal anaesthesia systemsPart 4:
Anaesthetic vapour del ivery devi ces. Geneva, Swi t zerl and: Author, 2004.
10. Seropi an MA, Robi ns B. Smal l er-t han-expect ed sevof lurane concent rati ons
using t he Sevotec 5 vapori zer at l ow f i l l st ates and hi gh f resh gas f l ows. Anesth
Anal g 2000;91:834836.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
11. Loeb R, Santos B. Pumpi ng ef f ect i n Ohmeda Tec 5 vapori zers. J Cl in Moni t
1995; 11:348.
[CrossRef ]
[Medli ne Li nk]
12. Vohra SB. Leaki ng vapori zer. Anaesthesia 2000;55:606607.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
13. Kersl ey M. Leaki ng vapori zer. A repl y. Anaesthesi a 2000;55:607608.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
14. Chum NL. A pot ent i al ci rcui t leak wi th Tec 5 vapori zers. Anesthesi ol ogy
1997; 87:1599.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
15. Garstang JS. Gas l eak f rom Tec 5 i sof l urane vapori zer. Anaesthesi a
2000; 55:915.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
16. Ll oyd J, Koshowski EM. Fi l l i ng Tec 5 vapori zers. Repl y. Can J Anaest h
1995; 42:839.
[Medli ne Li nk]
17. Dani el s D. Overf i l l i ng of vapori zers. Anaesthesia 2002; 57:288.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
18. Dumphy JA, O' Grady D, Regan J. Fi l l ing Tec 5 vapori zers. Can J Anaesth
1995; 42:839.
[Medli ne Li nk]
19. Fernando PM, Peck DJ. An uncommon cause of vapori zer fai l ure. Anaesthesi a
2001; 56:10091010.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
20. Eisenkraf t JB, Bradf ord C, Si lverstei n JH. Eff ect of reversed gas f l ow through a
f reestandi ng i sof lurane concent rat i on-cal ibrat ed (Tec 3) vapori zer. Anesth Anal g
1993; 76:S92.
21. Andrews JJ, Johnst on RV. The new Tec 6 desf l urane vapori zer. Anesth Anal g
1993; 76:13381341.
[Medli ne Li nk]
22. Anonymous. Desf l urane (Suprane). Consi derat i ons f or introducing the new
i nhal at i on anestheti c agent i nto cl i ni cal practi ce. Heal th Devices 1994;23:131
142.
[Medli ne Li nk]
23. Graham SG. The desf l urane Tec 6 vapori zer. Br J Anaesth 1994; 72:470473.
[CrossRef ]
[Medli ne Li nk]
24. Chandler J, Poul ton B. Tec 6 vapori zer rai ses the temperature. Anaesthesia
2000; 55:10311032.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
25. Weiskopf RB, Sampson D, Moore MA. The desf lurane (Tec 6) vapori zer: design,
design considerati ons and perf ormance eval uat ion. Br J Anaest h 1994;72:474
479.
[CrossRef ]
[Medli ne Li nk]
26. Johnst on RV, Andrews J, Deyo DJ, et al . The eff ects of carri er gas composi ti on
on the performance of t he Tec 6 desfl urane vapori zer. Anest h Anal g 1994;79:548
552.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
27. Goul d DB. Dual causes of vapori zer aberrance l uci dl y separated. Anest h Anal g
1995; 80:8.
28. Johnst on RV Jr, Andrews JJ. Dual causes of vapori zer aberrance l uci dl y
separated. I n response. Anesth Analg 1995;80:1068.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
29. Goodman EJ, Cotman FL, Hudson I M, et al . Desf l urane vapori zer uses mini mal
el ect rici t y. Anesth Anal g 1997;84:S38.
30. Abdi S, Acquadro MA. Techni cal f ai lure of desf lurane vapori zer Tec-6.
Anesthesi ol ogy 1995; 83:226227.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
31. Kimati an SJ. Wi th t echnol ogy comes responsi bi l i ty: int raoperat i ve fai l ure of an
anesthet ic vapori zer. Anesthesi ology 2002;96:15331534.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
32. Fel dman JM. Wi th technol ogy comes responsibi l i ty: i nt raoperat ive f ai l ure of an
anesthet ic vapori zer. In repl y. Anesthesi ol ogy 2002; 96:1534.
[Full text Li nk]
[CrossRef ]
33. Mi t ton M. Wi th technol ogy comes responsi bil i ty: intraoperat ive fai l ure of an
anesthet ic vapori zer. In repl y. Anesthesi ol ogy 2002; 96:15341535.
[Full text Li nk]
[CrossRef ]
34. Farmer GM, Zel man V. Tec 6 power cord probl em. Anesthesiol ogy
1995; 82:1300.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
35. Connor DJ. Tec 6 vapori zer. Anaesthesi a 2001;56:184185.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
36. Lockey D, Purcel l -Jones G. A probl em wi t h a desf l urane vapori zer. Anaesthesia
1995; 50:574.
[CrossRef ]
[Medli ne Li nk]
37. Anonymous. Anesthesi a uni t vapori zers. Technol Anesth 1996;17(6):6.
38. Anonymous. Gas leaks i n vapori zers. Bi omed Safe St and 1998;28: 124.
39. Geff roy J-C, Genti l i ME, Le Pol l es R, et al . Massive i nhalati on of desf lurane due
t o vapori zer dysf uncti on. Anesthesiol ogy 2005;103:10961098.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
40. Hendri ckx JFA, De Cooman S, Deloof TM, et al . The ADU vapori zi ng uni t : a new
vapori zer. Anest h Anal g 2001;93:391395.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
41. Hendri ckx JFA, Carett e RM, Del oof T, et al . Severe ADU desf l urane vapori zing
uni t mal f unct i on. Anesthesiol ogy 2003; 99:14591460.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
42. Cicman JH, Skibo VE, Yoder JM. Anesthesi a systems. Part II : Operat i ng
pri nci pl es of f undament al components. J Cli n Moni t 1992;8:295307.
[CrossRef ]
[Medli ne Li nk]
42a. Loeb RG. Anesthesi a systems. J Cl i n Moni t 1994;10:6870.
[CrossRef ]
[Medli ne Li nk]
43. Cicman JH, Skibo VF, Yoder JM. Anesthesi a systems. Repl y. J Cl i n Moni t
1994; 10:6970.
44. Li n C. Assessment of vapori zer performance i n l ow-f l ow and cl osed-ci rcui t
anesthesi a. Anesth Anal g 1980;59:359366.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
45. Gi l l y H, Fi t zal S, St ei nberei thner K. Low f l ow accuracy of vapori zers: a
l aborat ory comparison bet ween TEC and VAPOR systems. Eur J Anaesthesi ol
1987; 4: 7374.
46. Pet ty WC. New anesthet ic requi res new vapori zers for saf et y. J Cl in Moni t
1996; 12:483.
[CrossRef ]
[Medli ne Li nk]
47. Synnott A, Wren WS. Ef fect of ni t rous oxi de on the out put of three hal othane
vapori zers. Br J Anaesth 1986;58: 10551058.
[CrossRef ]
[Medli ne Li nk]
48. Loeb RG. The output of f our modern vapori zers i n t he presence of heli um. Can
J Anaesth 1992; 39:888891.
[Medli ne Li nk]
49. Carval ho B, Sanders D. The out put of two sevofl urance vapori zers i n the
presence of hel i um. Br J Anaesth 2002; 88:711713.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
50. Sat terf i el d JM, Russel l GB, Graybeal JM, et al . Anesthetic vapori zers accuratel y
del i ver i sofl urane i n hyperbari c condi t ions. Anesthesiol ogy 1989; 71:A360.
51. Garden AL, Haberkern CM, Buckon ME, et al . Output f rom a Drager Vapor 19.1
on a movi ng t rol l ey. Can J Anaesth 1997;44: 227230.
[Medli ne Li nk]
52. Pal ayi wa E, Hahn CEW. Overf i ll testi ng of anaestheti c vapori zers. Br J Anaesth
1995; 74:100103.
[CrossRef ]
[Medli ne Li nk]
53. Found P, Forrest AP. Vapori zer l evel obst ructi on detected by anestheti c vapor
analysi s. Anesth Anal g 1999;88:469.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
54. Anonymous. Anesthesi a uni t vapori zers. Technol Anesth 2004;24: 7.
55. Bol ton P, Brock-Utne JG, Zumaran AA, et al . A si mpl e method to i denti f y an
external vapori zer l eak (t he SNI FF method). Anest h Anal g 2005;101:606607.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
56. Sincl ai r A, Van Bergen J. Vapori zer overf i l l i ng. Can J Anaest h 1993;40:7778.
[Medli ne Li nk]
57. Lewi s SE, Andrews JJ, Long GW. An unexpected Penlon Si gma El i te vapori zer
l eak. Anesthesi ology 1999;90:12211224.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
58. Thompson C. An unexpected Penl on Si gma Eli te vaporizer l eak. In repl y.
Anesthesi ol ogy 1999; 90:1224.
[Full text Li nk]
[CrossRef ]
59. Yee S, Ol d S. Any whi ch way but l oose?the si gnif icance of gas f l ow di rect ion
t hrough a vapori zer. Anaest hesi a 2000;56:598600.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
60. Cooke R. Any whi ch way but l oose: The si gni f i cance of gas f l ow di recti on
t hrough a vapori zer. A repl y. Anaest hesi a 2000;56:65: 600601.
61. Gupt a S. Poor i nterlock saf et y wi t h datum sevof l urane vapori sers. Anaesthesi a
2000; 55:404.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
62. Bel l GT, Ral ph JK. Drawbacks of pushovers. Anaesthesi a 2000;55:10001002.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
63. Brosnan S, Royst on B, Whi te D. Isof l urane concent rati ons usi ng
uncompensated vapori sers wi thi n ci rcle syst ems. Anaesthesi a 1998; 53:560564.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
64. Whi te D, Royston B. Respi rat ory f eedback ef f ects on vapori sers i n ci rcl e
systems. Anaest hesi a 1998;53:555559.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
65. Mongan PD, Hol lenbeck K, Sol omon J, et al . Compl i ance, fl ow rate, and
venti l atory mode eff ects on drawover vapori zer out put prof i l es. Anesthesi ol ogy
2003; 99:A575.
66. Tayl or JC, Restal l J. Can a drawover vapori zer be a pushover? Anaesthesia
1994; 49:892894.
67. Harri son GR. The cont ami nat ion of vol at i l e anaesthetics in an i n-ci rcl e
vapori zer wi th wat er duri ng prol onged cl osed-ci rcl e anaesthesia. Anaesthesi a
2000; 55:791792.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
68. Crai g GR, Berry CB, Yeats MJ. An evaluati on of the universal PAC and Oxford
mi niature vapori zers f or pediat ric f ield anaesthesia. Anaesthesi a 1995;50:789
792.
[CrossRef ]
[Medli ne Li nk]
69. Li u EHC, Dhara SS. Sevofl urane output f rom the Oxford mi ni ature vapori zer i n
drawover mode. Anaesth I ntens Care 2000;28:532536.
[Medli ne Li nk]
70. Brook PN, Perndt H. Sevofl urane drawover anaesthesi a wi th t wo Oxford
mi niature vapori zers i n seri es. Anaesth I ntens Care 2001;29:616618.
[Medli ne Li nk]
71. Anestheti c vapori zersagent -speci fi c f i l l i ng systems (ASTM/ ISO 5360). West
Conshohocken, PA: Author, 2003.
72. Riegl e EV, Desert spring D. Fai lure of t he agent-speci f i c f i l l i ng device.
Anesthesi ol ogy 1990; 73:353.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
73. Richardson W, Cart er KB. Eval uati on of keyed f i l l ers on TEC vapori zers. Br J
Anaesth 1986;58:353356.
[CrossRef ]
[Medli ne Li nk]
74. Urmey WF, El l iott W, Raemer DB. Vapori zer f i l l syst em l eak. Anesth Analg
1988; 67:711.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
75. Hooda S. Where wrong practi ce is a necessi t y. Anest h Anal g 1999;88:233.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
76. Wi t tmann PH, Wi t tmann FW, Connor T, et al . The nonempt y empty bottl e.
Anaesthesia 1992;47: 721722.
[CrossRef ]
[Medli ne Li nk]
77. Uncl es DR. A compari son of keyed and non-keyed vapori zer f i l l i ng modes and
volat i le agent wastage. Anaesthesia 1993;48: 795798.
[CrossRef ]
[Medli ne Li nk]
78. Wi t tmann PH, Wi t tmann FW, Connor J, et al . A new keyed vapori zer f i l l er.
Anaesthesia 1994;49: 710712.
[CrossRef ]
[Medli ne Li nk]
79. Mart i n LVH. The non-empt y bott l e. Anaesthesi a 1993;48:94.
80. Crai g DB. Vapori zer overf il l ing. Can J Anaesth 1993; 40:10051006.
[Medli ne Li nk]
81. Anonymous. Saf ety al ert : anestheti c bott l e & metal f i l l er incompat i bi li ty. Bi omed
Saf e Stand 1992;22:37.
82. Uncl es DR, Si bel l DM, Conway NE. Desf lurane and the Tec 6 f i l l er syst em.
Anaesthesia 1994;49: 547548.
[CrossRef ]
[Medli ne Li nk]
83. Jol l y DT, Young J. Suspected mal function of the SAF-T-FI LL
TM
val ve assembl y
of t he Suprame (desf l urane, USP) ref i l l bot tl e. Anesth Anal g 2000; 90:742744.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
84. Jol l y DT. Suprane bott l es wi t h damaged O-ri ngs. Can J Anest h 1999;46: 709.
85. Cunni ngham S. Suprane bott les wi t h damaged O-ri ngs. Repl y. Can J Anesth
1999; 46:709710.
86. Rupani G. Ref i ll ing a Tec 6 desf lurane vapori zer. Anesth Anal g 2003;96:1534
1535.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
87. Ri tchi e PA, Cheshi re MA, Pearce NH. Decontaminat ion of hal ot hane f rom
anaestheti c machi nes achi eved by cont inuous f lushi ng wi th oxygen. Br J Anaesth
1988; 60:859863.
[CrossRef ]
[Medli ne Li nk]
88. Riendl J. Hypoxi c gas mixture del i very due to mal f unct i oni ng i nl et port of a
Sel ect-a-t ec vapori zer mani f ol d. Can J Anaest h 1987;34: 431432.
[Medli ne Li nk]
89. Hogan TS. Sel ectat ec swi tch malf uncti on. Anaesthesi a 1985;40:6669.
[CrossRef ]
[Medli ne Li nk]
90. Goddard JM, Abbot t TR. Selectatec system: mi spl aced blood. Anaesthesia
1986; 41:439.
[CrossRef ]
[Medli ne Li nk]
91. Col e AGH, Thompson JB, Fodor I M, et al . Anaestheti c machine hazard f rom t he
Sel ectatec bl ock. Anaesthesia 1983;38: 175177.
[CrossRef ]
[Medli ne Li nk]
92. Chi ldres WF. Mal f unct i on of Ohi o Modul us anesthesia machine. Anest hesi ol ogy
1982; 56:330.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
93. Jove F, Mi l l i ken RA. Loss of anesthet ic gases due t o def ect i ve saf et y
equipment . Anesth Analg 1983;62:369370.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
94. Jabl onski J, Reynol ds AC. A potent i al cause (and cure) of a maj or gas leak.
Anesthesi ol ogy 1985; 62:842.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
95. Powel l JF, Morgan C. Sel ectatec gas l eak. Anaest h Intens Care 1993;21: 892
893.
[Medli ne Li nk]
96. Hart l e AJ, Daum REO. Fail ure of Ohmeda Tec 4 saf et y i nterlock. Anaesthesi a
1992; 47:171.
[CrossRef ]
[Medli ne Li nk]
97. Loughnan TE. Gas leak associ ated wi t h a Sel ectatec. Anaest h Intens Care
1988; 16:501.
98. Cart wri ght DP, Freeman MF. Vapori zers. Anaesthesi a 1999;54: 519520.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
99. Duf f PJ, Roll ison RA, Lee TW. Sel ectatec probl ems: again and agai n. Anaesth
I ntens Care 1994;22:622.
[Medli ne Li nk]
100. Dwyer M, Hol land R, Shepherd L, et al . Vapori zer and Sel ectatec l eaks.
Anaesth Intens Care 1994;22:739.
[Medli ne Li nk]
101. Wi l ki nson DJ, Curti s C. A st range leak f rom the anaest heti c machi ne.
Anaesthesia 2002;57: 10381039.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
102. Ong B-C, bi n Kati j o J, Tan B-L, et al . Acut e fai l ure of oxygen del i very.
Anesthesi ol ogy 2001; 95:10381039.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
103. Wrai ght WJ. Another fai l ure of Sel ectat ec bl ock. Anaesthesi a 1990;45:795.
[CrossRef ]
[Medli ne Li nk]
104. James RH. Def ect ive Sel ectatec O-ri ngs. Anaest hesi a 1995;50:184185.
[Medli ne Li nk]
105. Not t MR, Jackl in F. Missi ng O-ri ngs and vol at i l e agents. Anaesthesi a
1995; 50:10011002.
[CrossRef ]
[Medli ne Li nk]
106. Ti ghe SQM, Jones DA. Anaestheti c machi ne checks duri ng anaesthesia.
Anaesthesia 1993;48: 88.
[Medli ne Li nk]
107. Pandi t JJ, Jakubowski P, Wai t CM. Broken O-ri ng causi ng hypoventi lati on.
Anaesthesia 1993;48: 11141115.
[Medli ne Li nk]
108. Berry PD, Ross DG. Mi ssi ng O-ri ng causes unrecogni zed l arge gas l eak.
Anaesthesia 1992;47: 359.
[CrossRef ]
[Medli ne Li nk]
109. Hung CT, Chi eng CF. The Sel ectatec system: another cause of tot al l eakage.
Anaesth Intens Care 1992;20:532533.
[Medli ne Li nk]
110. Duncan JAT. Sel ectat ec swi tch malf uncti on. Anaesthesi a 1985;40:911912.
[CrossRef ]
[Medli ne Li nk]
P. 189


111. Lum ME, Ngan Kee WD, Robi nson BJ. Faul t i n a Sel ectat ec mani f ol d resul t ing
i n awareness. Anaest h Int ens Care 1992;20: 501503.
[Medli ne Li nk]
112. Beards SC. Mi suse of a Bodok seal . Anaesthesia 1993; 48:175176.
[Medli ne Li nk]
113. Cudmore J, Keogh J. Another Sel ectatec swi t ch mal functi on. Anaesthesia
1990; 45:754756.
[CrossRef ]
[Medli ne Li nk]
114. Pet ty C. Equi pment saf ety: vapori zer excl usion or i nterl ock systems. APSF
Newslett 1992;7:10.
115. Anonymous. Improper sett ing of anesthesi a vapori zer i nterl ock system l eads to
saf ety al ert . Bi omed Saf e Stand 1990;20:91.
116. Si lvasi DL, Haynes A, Brown ACD. Potenti al l y l ethal f ai lure of the vapor
excl usi on system. Anest hesi ol ogy 1989;71:289-291.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
117. Vi ney JP, Gart rel l AD. Incorrectl y adj usted vapori zer exclusi on system.
Anesthesi ol ogy 1994; 81:781.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
118. Buet tner AU. Fai l ure of vapori zer i nterl ock mechani sm. Anaesth Intens Care
2000; 28:451452.
[Medli ne Li nk]
119. Webb C, Ri ngrose D, Stone A. Faul t y i nt erlock on Drager vaporisers.
Anaesthesia 2005;60: 628629.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
120. Popic PM, Jameson LC, Arndt GA. Prel i mi nary resul ts on t he i nci dence of
vapori zer contami nat i on i n sel ected U.S. hospi tal s. Anesthesi ol ogy 1991; 75:A902.
121. Abel M, Ei senkraf t JB. Performance of erroneousl y f i l l ed sevofl urane,
enfl urane and ot her agent -specif ic vapori zers. J Cl i n Moni t 1996;12: 119125.
[CrossRef ]
[Medli ne Li nk]
122. Bl ock FE, Schul t e GT. Observati ons on use of wrong agent i n an anesthesi a
agent vapori zer. J Cl i n Moni t 2000;15:5761.
123. Paul l JD, Sl eeman KW. An anaesthet i c hazard. Br J Anaesth 1971;3:1202.
[CrossRef ]
[Medli ne Li nk]
124. Robert s SL, Forbes RB, Moyers JR, et al . Can ol f acti on i denti f y and quanti f y
volat i le anesthet ics? Anesthesi ol ogy 1985; 63: A193.
125. Hardy J-F. Vapori zer overf i l l i ng. Can J Anaesth 1993;40: 12.
[Medli ne Li nk]
126. Anonymous. Death f rom misconnected vapori zer l eads to $750,000 sett lement .
Bi omed Saf e Stand 1992;22:78.
127. Cheng CJC, Bai l ey AR. Fl ow reversal t hrough the anaesthetic machi ne back
bar: an unusual assembl y faul t . Anaesthesia 2002;57: 8688.
[Full text Li nk]
[Medli ne Li nk]
128. Wal ters C. Fl ow reversal t hrough the anaesthet ic machi ne back bar: an
unusual assembl y faul t . A repl y. Anaesthesi a 2002;57:88.
[Full text Li nk]
129. Col eshil l GG. Safe vapori zers. Can J Anaesth 1988; 35:667668.
[Medli ne Li nk]
130. Wi l l iams L, Barton C, McVey JR, et al . A visual warni ng devi ce f or improved
saf ety. Anest h Anal g 1986;65:1364.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
131. Ludbrook GL, Webb RK, Fox MA, et al . Problems bef ore i nducti on of
anaesthesia: an anal ysis of 2000 i nci dent reports. Anaesth Int ens Care 1993;21:
593595.
[Medli ne Li nk]
132. Mei st er GC, Becker KE. Potenti al f resh gas f l ow l eak through Drger Vapor
19.1 vapori zer wi t h key-i ndex f i l l port . Anest hesi ol ogy 1993;78: 211212.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
133. Ngan J, Cashen D, Ni chol s G. Sevofl urane vapori zers. Can J Anesth
1999; 46:200.
134. Anonymous. Anesthesi a uni t vapori zers. Technol Anesth 1991;12:7.
135. Marsh RHK, Thomas NF. A hazard of the Penl on off -l i ne vapori zer mounti ng
system. Anaest hesi a 1986;41:438.
136. Anonymous. Anesthesi a uni t vapori zers, Technol Anesth 1997;17(10): 9.
137. Moore C, Harmon P. More problems wi t h t he Sel ectatec system. Anaesthesi a
1993; 48:635636.
[CrossRef ]
[Medli ne Li nk]
138. Raj ah A, Zi deman DA. A problem wi th t he TEC 5 vapori zer. Anaest hesi a
1992; 47:271272.
[CrossRef ]
[Medli ne Li nk]
139. Bri dges R. A probl em wi t h a TEC 5 vapori zer. A repl y. Anaesthesia
1992; 47:272.
[CrossRef ]
140. Robi nson JS, Thompson JM, Barrat t RS. Inadvertent contaminati on of
anaestheti c ci rcui ts wi t h hal othane. Br J Anaesth 1977;49:745753.
[CrossRef ]
[Medli ne Li nk]
141. Li ppmann M, Foran W, Gi nsburg R, et al . Contami nat i on of anesthetic
vapori zer contents. Anesthesi ol ogy 1993;78: 11751177.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
142. Anonymous. Concent rati on cal i brated vapori zers. Technol Anesth 1987; 7:2.
143. MacLeod DM, McEvoy L, Wal ker D. Report of vapori zer malf uncti on.
Anaesthesia 2002;57: 299300.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
144. Macart ney NJD, Cohen J. Another case of anaestheti c machine f ai lure.
Anaesthesia 2000;55: 1215.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
145. Wei nberg L, Sawhney S, Skewes D. Saf et y warni ng wi t h Dat ex-Ohmeda S/5
anaestheti c del ivery uni t desi gn. Anaesth I ntens Care 2004;32: 719720.
[Medli ne Li nk]
146. Zi mmer C, Janssen MN, Treschan TA, et al . Near-mi ss acci dent duri ng
magneti c resonance i magi ng by a f l yi ng sevofl urane vaporizer due to
f erromagnet ism undetectabl e by handhel d magnet. Anesthesiol ogy 2004; 100:1329
1330.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
147. Commi tt ee on Technol ogy. Q & A. APSF Newsl et t 2006;21:3031.
P. 190


Questions
For the f ol lowing quest ions, answer
i f A, B, and C are correct
i f A and C are correct
C if B and D are correct
i s D i s correct
i f A, B, C, and D are correct .
1. Whi ch factors wil l cause a shi ft from the l iquid to the vapor phase?
A. Heati ng the vapori zer
B. Cool i ng t he room
C. I ncreasing t he f low t hrough the vapori zer
D. Decreasi ng at mospheri c pressure
Vi ew Answer2. Which statements concerni ng boi li ng poi nt are true?
A. Boi l i ng poi nt i s independent of the atmospheri c pressure
B. Boi l i ng poi nts f or commonl y used vol ati l e anestheti c agents vary bet ween 48C
and 59C at 760 torr
C. Anest het ic agents wi t h hi gh boi l i ng points are more suscepti bl e to vari at ions i n
baromet ric pressure t han agents wi t h l ower boi l ing points
D. Atmospheric pressure and the vapor pressure of an agent are equal at the
boi l ing poi nt
Vi ew Answer3. The concentration of a volati le anestheti c may be
expressed as
A. Vol umes percent
B. The number of uni ts of the vapor in relati on to a t otal of 100 uni ts
C. The part i al pressure
D. The pressure of t he vapor i n rel ati onshi p to t he total pressure exert ed by al l of
t he gases in t he sampl e
Vi ew Answer4. Which of the foll owing accurately reflects the heat of
vaporizati on?
A. I t i s t he amount of heat given of f in t he process of converti ng a li quid i nto a
vapor
B. The temperature of the l i qui d i ncreases as vapori zat i on proceeds
C. The greater the f low, t he higher t he temperature of the l iqui d wi l l become
D. I t i s expressed as cal ories per gram
Vi ew Answer5. Which of the foll owing accurately reflect speci fi c heat?
A. I t i s t he amount of heat needed t o raise t he temperature of a subst ance by 1F
B. The higher t he speci f i c heat the more heat that is requi red to rai se the
t emperat ure of a quanti ty of a substance
C. I t i s the heat requi red to raise 1 mi l l i l i ter of a subst ance by 1F
D. Subst ances wi t h hi gh specif i c heats are pref erred when choosi ng the materi al
f rom whi ch to const ruct a vapori zer
Vi ew Answer6. Most concentration-cali brated vaporizers
A. Recei ve a fl ow f rom a dedi cated f l owmeter
B. Are pl aced downst ream of the f resh gas i nl et
C. Have a dial that i s turned cl ockwi se to i ncrease t he concentrati on
D. Are cal i brat ed i n vol umes percent
Vi ew Answer7. Methods used by vaporizers to vaporize agents i ncl ude
A. Bubbl e through
B. Fl ow over
C. I nj ect ion i nt o a vapori zi ng chamber
D. I nj ect ion i nt o a known vol ume of gas
Vi ew Answer8. Thermal compensation i n a vaporizer is accompl ished by
A. Warmi ng t he room
B. Suppl yi ng heat to the vapori zer
C. Using gl ass in t he vapori zi ng chamber t o conduct heat
D. Al teri ng the fl ow through the vapori zing chamber
Vi ew Answer9. How do changes i n back pressure affect the output of a
vaporizer?
A. The pumpi ng ef fect wi l l i ncrease vapori zer out put
B. A check valve at the machi ne out let is not an ef f ective sol uti on to t he pumpi ng
ef fect
C. The pressuri zing eff ect wi l l decrease vapori zer output
D. The pumpi ng ef f ect i s greater wi t h l ow f resh gas f l ows, l arge pressure
f luctuati ons, and l ow vapori zer set ti ngs
Vi ew Answer10. Acceptable l ocations for a vaporizer on the anesthesia
machine i ncl ude
A. Between the check valve and the common gas outl et
B. Between the common gas outl et and t he breat hi ng system
C. Between the oxygen f l ush and the breathi ng system
D. Between the f l owmeters and the machine outl et
Vi ew Answer11. Advantages of having detachabl e vaporizers i ncl ude
A. A more compact machine i s possi ble
B. Easy removal i f vapori zer f ai l ure occurs
C. Complete removal during mal i gnant hypert hermi a
D. Vapori zers can be used on dif f erent brands of anesthesia machi ne
Vi ew Answer12. If an agent of low potency or volati li ty were placed i n a
vaporizer for agents of high volati li ty and potency,
A. A mi xture of agents wi l l l i kel y be del ivered
B. The vapor output wi l l be hi gher than t he scal e reading
C. The vapori zer output wi l l be l ower than the reading on the di al
D. The mi xture can be det ermined by smel l i ng the agents i n the f resh gas f low
Vi ew Answer13. Actions that coul d cause a vaporizer to be overfi ll ed
i ncl ude
A. Looseni ng the connecti on bet ween t he agent bott le and the f i l l ing devi ce
B. Ti pping the vapori zer
C. Turni ng the control di al on t he vapori zer ON
D. Fi l l i ng a vapori zer i n the anesthesi a work area
Vi ew Answer14. A vaporizer located downstream of the common gas
outlet
A. May be i nstal l ed backward
B. Presents si gnif i cant resistance to gas f l ow
C. May deli ver a hi gh concent rat i on int o the breathing system
D. Can be used i f the vapori zer i s fi rml y f i xed to a hori zontal surf ace
Vi ew Answer