Anaesthetic machine

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Anaesthetic machine

An anaesthetic machine. This particular machine is a "Flow-I" model, manufactured byMaquet, a

division of Getinge Group, Getinge,Sweden.

Process type

physical change

Industrial sector(s)

anesthesia (medicine)

Main technologies or

vaporization

sub-processes

Feedstock

inhalational anaesthetic agents, chiefly nitrous oxide and volatile

anesthetics

Product(s)

phase transition of feedstock from the liquid phase to the gasphase

Leading companies

Leading companies using this industrial process

Main facilities

hospitals and outpatient surgery centers

Inventor

William T. G. Morton is widely credited for demonstrating the

technique of vaporization ofdiethyl ether. However, many others were
involved in its development. Please refer toHistory of general
anesthesiaarticle for more details.

Year of invention

16 October 1846

The anaesthetic machine (UK English) or anesthesia machine (US English) or Boyle's
machine is used by anaesthesiologists,nurse anaesthetists, and anaesthesiologist assistants to
support the administration of anaesthesia. The most common type of anaesthetic machine in use in
the developed world is the continuous-flow anaesthetic machine, which is designed to provide an
accurate and continuous supply of medical gases (such as oxygen and nitrous oxide), mixed with an
accurate concentration of anaesthetic vapour (such as isoflurane), and deliver this to the patient at a
safe pressure and flow. Modern machines incorporate a ventilator, suction unit, and patient
monitoring devices.
The original concept of Boyle's machine was invented by the British anaesthetist Henry
Boyle (18751941) in 1917. Prior to this time, anaesthetists often carried all their equipment with
them, but the development of heavy, bulky cylinder storage and increasingly elaborate airway
equipment meant that this was no longer practical for most circumstances. The anaesthetic machine
is usually mounted on anti-static wheels for convenient transportation.
Simpler anaesthetic apparatus may be used in special circumstances, such as the TriService
Apparatus, a simplified anaesthesia delivery system invented for the British armed forces, which is
light and portable and may be used effectively even when no medical gases are available. This
device has unidirectional valves which suck in ambient air which can be enriched with oxygen from a
cylinder, with the help of a set of bellows. A large number of draw-over type of anaesthesia devices
are still in use in India for administering an air-ether mixture to the patient, which can be enriched
with oxygen. But the advent of the cautery has sounded the death knell to this device, due to the
explosion hazard.
Many of the early innovations in U.S. anaesthetic equipment, including the closed circuit carbondioxide absorber (aka: the Guedel-Foregger Midget) and diffusion of such equipment to
anaesthetists within the United States can be attributed to Richard von Foregger and The Foregger
Company.
In dentistry a simplified version of the anaesthetic machine, without a ventilator or anaesthetic
vaporiser, is referred to as a relative analgesia machine. By using this machine, the dentist can
administer a mild inhalation sedation with nitrous oxide and oxygen, in order to keep his patient in a
conscious state while depressing the feeling of pain.
Contents
[hide]

1 Components of a typical machine

2 Safety features of modern machines

3 Anesthesia machine vs anesthesia cart

4 See also

5 References

6 External links

Components of a typical machine[edit]

Simple schematic of an anaesthesia machine

A modern anaesthesia machine includes the following components:

Connections to piped hospital oxygen, medical air, and nitrous oxide.

Reserve gas cylinders of oxygen, air, and nitrous oxide attached via a specific yoke with
aBodok seal.
A high-flow oxygen flush which provides pure oxygen at 30-75 litres/minute

Pressure gauges, regulators and 'pop-off' valves, to protect the machine components and
patient from high-pressure gases

Flow meters (rotameters) for oxygen, air, and nitrous oxide, low Flow meters oxygen nitrous
oxide

Updated vaporizers to provide accurate dosage control when using volatile anaesthetics
such as isoflurane and sevoflurane

An integrated ventilator to properly ventilate the patient during administration of anaesthesia

A manual ventilation bag in combination with an Adjustable Pressure Limiting (APL) valve

Systems for monitoring the gases being administered to, and exhaled by the patient

Systems for monitoring the patient's heart rate, ECG, blood pressure and oxygen saturation,
in some cases with additional options for monitoring end-tidal carbon dioxide andtemperature

breathing circuits, circle attachment, or a Bain's breathing system

Safety features of modern machines[edit]

Based on experience gained from analysis of mishaps, the modern anaesthetic machine
incorporates several safety devices, including:

an oxygen failure alarm (aka 'Oxygen Failure Warning Device' or OFWD). In older machines
this was a pneumatic device called a Ritchie whistle which sounds when oxygen pressure is 38
psi descending. Newer machines have an electronic sensor.

Nitrous cut-off or oxygen failure protection device, OFPD: the flow of medical nitrous-oxide is
dependent on oxygen pressure. This is done at the regulator level. In essence, the nitrous-oxide
regulator is a 'slave' of the oxygen regulator. i.e., if oxygen pressure is lost then the other gases
can not flow past their regulators.

hypoxic-mixture alarms (hypoxy guards or ratio controllers) to prevent gas mixtures which
contain less than 21-25% oxygen being delivered to the patient. In modern machines it is
impossible to deliver 100% nitrous oxide (or any hypoxic mixture) to the patient to breathe.
Oxygen is automatically added to the fresh gas flow even if the anaesthetist should attempt to
deliver 100% nitrous oxide. Ratio controllers usually operate on the pneumatic principle or are
chain linked (link 25 system). Both are located on the rotameter assembly, unless electronically
controlled.

ventilator alarms, which warn of low or high airway pressures.

interlocks between the vaporizers preventing inadvertent administration of more than one
volatile agent concurrently
alarms on all the above physiological monitors

the Pin Index Safety System prevents cylinders being accidentally connected to the wrong
yoke

the NIST (Non-Interchangeable Screw Thread) or Diameter Index Safety System, DISS
system for pipeline gases, which prevents piped gases from the wall being accidentally
connected to the wrong inlet on the machine

pipeline gas hoses have non-interchangeable Schrader valve connectors, which prevents
hoses being accidentally plugged into the wrong wall socket

The functions of the machine should be checked at the beginning of every operating list in a
"cockpit-drill". Machines and associated equipment must be maintained and serviced regularly.
Older machines may lack some of the safety features and refinements present on newer machines.
However, they were designed to be operated without mains electricity, using compressed gas power
for the ventilator and suction apparatus. Modern machines often have battery backup, but may fail
when this becomes depleted.
The modern anaesthetic machine still retains all the key working principles of the Boyle's machine
(a British Oxygen Company trade name) in honour of the British anaesthetist Henry Boyle. In India,
however, the trade name 'Boyle' is registered with Boyle HealthCare Pvt. Ltd., Indore MP.

A two-person pre-use check (consisting of an anaesthetist and an operating department practitioner)

of the anaesthetic machine is recommended before every single case and has been shown to
decrease the risk of 24-hour severe postoperative morbidity and mortality. Various regulatory and
professional bodies have formulated checklists for different countries. A free transparent reality
simulation of the checklist recommended by the United States Food & Drug Administration is
available from the Virtual Anesthesia Machine web site ( see below) after registration which is also
free. Machines should be cleaned between cases as they are at considerable risk of contamination
withpathogens.
[1]

[2]

[3]

Anesthesia machine vs anesthesia cart[edit]

An anaesthetic machine

The Anesthesia machine contains mechanical respiratory support (ventilator) and O2 support as well
as being a means for administering anesthetic gases which may be used for sedation as well as total
anesthesia. An anesthesia cart holds extra IV push meds for anesthesia, sedation and reversal,
extra equipment that the person giving anesthesia/sedation might need, and the hardware for
respiratory support and resuscitation.

See also[edit]

Ether Dome

History of general anesthesia

References[edit]
1.

Jump up^ Arbous et al. (2005). Anesthesiology 102. doi:10.1097/00000542-200502000-00005.

2.

Jump up^ http://vam.anest.ufl.edu/guidelines.html

3.

Jump up^ Baillie, JK; P. Sultan; E. Graveling; C. Forrest; C. Lafong (2007). "Contamination of anaesthetic machines with
pathogenic organisms".Anaesthesia 62 (12): 125761. doi:10.1111/j.1365-2044.2007.05261.x. PMID 17991263.

External links[edit]
Wikimedia Commons has
media related
to Anaesthetic machines.

Virtual Anesthesia Machine (VAM) a free transparent reality simulation of a generic

anesthesia machine from the University of Florida

Various anesthesia-related simulations

Virtual Anaesthesia Textbook

FRCA UK resources for UK anaesthetist in training

History of Richard von Foregger and the Foregger Company written by his son, R.
Foregger, this website chronicles one of the leading manufacturers and developers of
anesthesiology equipment in the early 20th century.
Checking Anaesthetic machines
[show]

Anesthesia (outline)

[hide]

Routes of administration / Dosage forms

Solids

Oral

Digestive tract(enteral)

Liquids

Pill
Tablet
Capsule
Pastille
Time release technology
Osmotic delivery system (OROS)
Decoction
Elixir
Electuary
Emulsion
Extended-release syrup
Effervescent powder or tablet
Herbal tea
Hydrogel
Molecular encapsulation

Powder
Softgel
Solution
Suspension
Syrup
Syrup Concentrate for dilution and/or addition of carbonated water
Tincture

Solids
Buccal(Sublabial)Sublingu
al

Liquids

Solids

Respiratory

Liquids

Orally disintegrating tablet (ODT)

Film
Lollipop
Sublingual drops
Lozenges
Effervescent buccal tablet
Chewing gum
Mouthwash
Toothpaste
Ointment
Oral spray

Smoking device
Dry powder inhaler (DPI)
Anaesthetic vaporizer
Vaporizer
Nebulizer
metered-dose inhaler (MDI)

tract

Gas

Ophthalmic /
Otologic / Nasal

Urogenital

Nasal spray
Ear drops
Eye drops
Ointment
Hydrogel
Nanosphere suspension
Insufflation
Mucoadhesive microdisc (microsphere tablet)
Ointment
Pessary (vaginal suppository)
Vaginal ring
Vaginal douche
Intrauterine device (IUD)
Extra-amniotic infusion
Intravesical infusion
Ointment
Suppository
Enema

Rectal (enteral)

Solution
Hydrogel
Murphy drip
Nutrient enema

Dermal

Ointment
Topical cream
Topical gel
Liniment
Paste
Film
DMSO drug solution
Electrophoretic dermal delivery system
Hydrogel
Liposomes
Transfersome vesicles
Cream
Lotion

Oxygen mask and Nasal cannula

Oxygen concentrator
Anaesthetic machine
Relative analgesia machine

Lip balm
Medicated shampoo
Dermal patch
Transdermal patch
Contact (rubbed into break in the skin)
Transdermal spray
Jet injector

Skin

Organs
Injection / Infusi
on
Central nervous system
(into
tissue/blood)

Circulatory /Musculoskeletal

Intradermal
Subcutaneous
Transdermal implant
Intracavernous
Intravitreal
Intra-articular injection
Transscleral
Intracerebral
Intrathecal
Epidural
Intravenous
Intracardiac
Intramuscular
Intraosseous
Intraperitoneal
Nanocell injection
Patient-Controlled Analgesia pump
PIC line

[show]

Routes of administration by organ system

Categories:
Anesthetic equipment

Machines

Drug delivery devices

Dosage forms