Anaesthesia Machines

2012/11/06
Anesthesia Units
Rob Dickinson
South Africa
An Anesthesia Gas Machine Example

• Layout similar to that of an Ohmeda Modulus II
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2012/11/06
Facilities & Services Requirements

• Piped & Cylinder Back-up Medical Grade Gases

• Oxygen pipeline connected to the central supply
via a non-interchangeable safety-indexed gas
probe and receptacle
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2012/11/06

• Oxygen pipeline pressure gauge

• Oxygen pipeline non-return valve
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2012/11/06

• High pressure (back-up) Oxygen cylinder mounted
on a non-interchangeable safety-indexed gas yoke
(Some anesthesia machines have 2 x Oxygen yokes)

• High pressure Oxygen cylinder non-return valve
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2012/11/06

• High pressure Oxygen cylinder contents gauge

• High pressure Oxygen regulator
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2012/11/06

• Machine Oxygen supply pressure

• Nitrous Oxide pipeline connected to the central
supply via a non-interchangeable safety-indexed
gas probe and receptacle
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2012/11/06

• Medical Air pipeline connected to the central
supply via a non-interchangeable safety-indexed
gas probe and receptacle

• Cylinder yokes
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2012/11/06

• Cylinder and pipeline pressure gauges
Internal ‘Machine’ Operation

• Main ON/OFF switch and gas cut-off block
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2012/11/06

• The single ON/OFF switch cuts off both the
electrical system and machine gas flows
Switched gas supplies out
To Ventilator
To emergency O2
Flush and external
flowmeter
Machine Gas Supplies in

• On de-activation Oxygen is cut-off and pressure
distal to the ON/OFF valve begins dropping
To Ventilator
To emergency O2
Flush and external
flowmeter
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2012/11/06

• Once the Oxygen pressure distal to the ON/OFF
valve drops to around half the supply pressure, the
gas cut-off block prevents other gases flowing
To Ventilator
To emergency O2
Flush and external
flowmeter

• On many machines the de-activation of this switch
(or an interruption of Oxygen supply pressure) only
cuts off Nitrous Oxide, not Medical Air
X
To Ventilator
To emergency O2
Flush and external
flowmeter
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2012/11/06

• Low Oxygen supply whistle/alarm (not shown)
• On all machines an interruption of Oxygen supply
pressure cuts off Nitrous Oxide, and triggers an
audible pneumatic or electronic alarm
To Ventilator
To emergency O2
Flush and external
flowmeter

• Main ON/OFF switch
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2012/11/06

• Secondary gas regulators

• It is essential that flowmeter gas supplies remain
stable as other occasional anesthesia machine and
cyclical ventilator gas requirements are drawn
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2012/11/06

• Secondary Oxygen regulator

• Secondary Nitrous Oxide regulator
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2012/11/06

• Secondary Medical Air regulator

• Gas flowmeter banks (Rotameters)
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2012/11/06

• Gas flowmeters and mixers
• All Anesthesia Gas Machines have user interface
controls to facilitate the accurate proportioning and
mixing of individual medical gases
Gas mixture out
Medical gas supplies in

from the secondary gas
regulators

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

regulators
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2012/11/06

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

regulators

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

regulators
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2012/11/06

• An Oxygen needle valve and rotameter tube

• Needle valves and rotameters
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2012/11/06

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

regulators

• Link-25 AHD system on an Ohmeda Modulus II
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2012/11/06

• An example of a failed ‘Anti-Hypoxic Device’

• Examples of no ‘Anti-Hypoxic Device’ fitted
X X
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2012/11/06

• An example of electronically measured flow

• An example of software selected gas flow
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2012/11/06

• Vaporizers and Vaporizer Backbars

• Vaporizers
• Anesthesia Gas Machines have Vaporizers fitted to
them in order to introduce accurate concentrations
of inhalational anesthesia drugs to the (carrier) gas
delivered by the flowmeters / gas mixer
Gas mixture Carrier gas
in from the mixture +
flowmeters / additional
mixer unit vapor out
(Now called (Now called
carrier gas) fresh gas)
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2012/11/06

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

• Vaporizers
• All modern Vaporizers are anesthesia agent specific
• Anesthesia agent Saturated Vapor Pressure (SVP)
affects Vaporizer design and calibration
Halothane Enflurane Isoflurane Sevoflurane Desflurane
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2012/11/06

• Vaporizers
• Liquid vaporization & temperature compensation

• Vaporizers
• Desflurane heating and proportioning
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2012/11/06

• Vaporizers
• Datex-Ohmeda Aladin Cassette Vaporizers

• Vaporizers and Vaporizer Back bars
• A Vaporizer on a 3 Station Selectatec Back bar
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2012/11/06

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

• Cagemount (Non-Interlocking Vaporizers)
• Only ONE Vaporizer should be fitted between the
rotameters and the backbar end block
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2012/11/06

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

• Selectatec (‘Switchable’ Backbars)
• It is recommended these backbars be removed from
Anesthesia Gas Machines owing to the possibility
of erroneous or lack of drug delivery
X
LHS or RHS
Vaporizer select
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2012/11/06

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

‘Float’ ‘Float’ ‘Shifted’ ◄ ►
Vaporizer Vaporizer Vaporizer Vaporizer

‘Off’ ‘Off’ ‘Disabled’ ‘On’

• An example of Selectatec Pin-Interlocking
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2012/11/06

• Another example of Selectatec Pin-Interlocking

• 3 Station Selectatec Pin-Interlock Back bars
Interlock continuity without

a centre vaporizer fitted
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2012/11/06

• 3 Station Selectatec Pin-Interlock Back bars
No Interlock continuity without
a centre vaporizer fitted
If only two vaporizers are fitted,

one must occupy this position

• Selectatec Pin-Interlock Back bars
• All ‘Pin-Interlock’ compatible Back bars have
vertical pins to exclude the fitment of non-interlock
compatible or original Selectatec vaporizers
‘Exclusion pin’
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2012/11/06

• An example of a removed ‘exclusion pin’
X ‘Exclusion pin’ removed

• Consequences of a removed ‘exclusion pin’
Overdose ‘cocktail’ possible
Selectatec
Compatible
Pin-Interlock Vaporizer but
Vaporizer NOT a
Pin-Interlock
Vaporizer
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2012/11/06

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

• Penlon Vaplok Interlock Back bars
• One to three Vaporizers may be fitted on the
Anesthesia Gas Machine depending upon the model
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2012/11/06

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

• Vaporizer Screw, Pour or Funnel Fillers
• Not recommended if more than one anesthesia
agent type is present or intended for use
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2012/11/06

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

• Anesthetic-agent-specific key-filler bottle adaptors
are color-coded and indexed for both the anesthesia
agent bottle and vaporizer filler mechanism ends
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2012/11/06

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

• Fresh Gas Non-Return Valve
• The ‘Fresh gas’ (carrier gas + drug vapors) passes
through a non-return valve, thus ensuring that any
back pressure doesn’t ‘pump’ the Vaporizer in use
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2012/11/06

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

• The Common Gas Outlet connector is an ISO
standard taper 22M/15F mm tapered cone to
facilitate the connection of breathing circuits
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2012/11/06

• Fitted to this CGO is a semi-closed breathing circuit

• Emergency Oxygen Flush Valve
• From time to time it is required that the patient
breathing circuit be momentarily ‘flushed’ with
pure Oxygen via the Oxygen Flush Valve
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2012/11/06

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

• The Oxygen Flush Valve is recessed and sprung
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2012/11/06

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

• External Oxygen Flowmeter
• Not fitted on all Anesthesia Gas Machines
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2012/11/06
Breathing Circuit and Ventilator

• Patient Breathing Circuit

• Waste Anesthesia Gas Disposal System (WAGS)
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2012/11/06

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

• Ventilator
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2012/11/06

• Ventilator
• Ventilator with O2 Analyzer and Spirometry

• ‘Fresh Gas’ from the Common Gas Outlet
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2012/11/06

• Oxygen Analyzer Sensor

• Inspiratory Valve
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2012/11/06

• Patient Airway Pressure Gauge (PAW)

• Inspiratory Limb
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2012/11/06

• Patient Airway Connector to ETT or LMA

• Expiratory Limb
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2012/11/06

• Spirometry Sensor

• Expiratory Valve
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2012/11/06

• CO2 Absorber

• CO2 Absorbent
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2012/11/06

• Reservoir Bag / Vent Valve (Bag position)

• Reservoir Bag
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2012/11/06

• Adjustable Pressure Limit Valve (APL)

• Waste Anesthetic Gas outlet from APL
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2012/11/06

• Waste Anesthetic Gas System (WAGS)

• Waste Anesthetic Gas Reservoir Bag
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2012/11/06

• Positive / Negative Pressure Relief Valves

• WAGS Suction Control Valve
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2012/11/06

• Connector to facility WAGS Evacuator

• CO2 Scrubbed Gas from Absorber
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2012/11/06

• Gas from Absorber and CGO Mix

• Reservoir Bag / Vent Valve (Vent position)
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2012/11/06

• Ventilator Breathing Circuit Connection

• Ventilator Bellows Rises On ‘Exhalation’
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2012/11/06

• Ventilator ‘Bellows Base Valve’ opens

• Excess Waste Anesthesia Gas flow
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2012/11/06

• Ventilator Control Unit

• Inspiratory Phase ‘Exhaust Valve’ closes
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2012/11/06

• Inspiratory Phase ‘Drive Gas Valve’ opens

• Inspiratory Phase ‘Drive Gas’ Flow
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2012/11/06

• Bellows Base Valve Held Closed

• Bellows Compressed by Drive Gas in canister
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2012/11/06

• Inspiratory Phase ‘Breathing Circuit’ Gas Flow

• Inspiratory Phase ‘Breathing Circuit’ Gas Flow
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2012/11/06

• Expiratory Phase ‘Drive Gas Valve’ closes

• Expiratory Phase ‘Exhaust Valve’ opens
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2012/11/06

• Expiratory Phase ‘Drive Gas’ Flow

• Expiratory Phase ‘Drive Gas’ Exhausted
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2012/11/06

• Ventilator Bellows Rises On ‘Exhalation’
Various Anesthesia Gas Machines
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2012/11/06
References
• http://tr.anest.ufl.edu • http://www.gehealthcare.com
• http://www.virtual-anaesthesia-textbook.com • http://www.sharn.com
• http://www.doctorsdepot.com • http://www.metropolitanmedical.com
• http://www.somatechnology.com • http://216.39.195.236/ostia/index.php?xml
• http://www.newtech-medical.com FilePath=journals/ija/vol3n3/inhal2.xml
• http://www.anesthesia.org/winterlude/ • http://www.spacelabshealthcare.com
wl97/acl1.html • http://www.draegermedical.com
• http://longevityllc.com • http ://www.medicalia.co.uk
• http://en.wikipedia.org
• http://www.udmercy.edu
• http://www.alfanaes.freeserve.co.uk
• http://www.oes-medical.co.uk
• http://www.paragonservice.com
• http://soa.group.shef.ac.uk
• http://www.asevet.com
Thank you!
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Anaesthesia Machines

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2012/11/06

An Anesthesia Gas Machine Example

Facilities & Services Requirements

Facilities & Services Requirements

Facilities & Services Requirements

Facilities & Services Requirements

Facilities & Services Requirements

Facilities & Services Requirements

Facilities & Services Requirements

Facilities & Services Requirements

Facilities & Services Requirements

Facilities & Services Requirements

Facilities & Services Requirements

Facilities & Services Requirements

Facilities & Services Requirements

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Switched gas supplies out

Internal ‘Machine’ Operation

Switched gas supplies out

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Gas mixture out

Medical gas supplies in

Internal ‘Machine’ Operation

Gas mixture out

Medical gas supplies in

Internal ‘Machine’ Operation

Gas mixture out

Medical gas supplies in

Internal ‘Machine’ Operation

Gas mixture out

Medical gas supplies in

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Medical gas supplies in

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Halothane Enflurane Isoflurane Sevoflurane Desflurane

Internal ‘Machine’ Operation

Halothane Enflurane Isoflurane Sevoflurane Desflurane

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation

Internal ‘Machine’ Operation