Anaesthesia Machines

Introduction
Anaesthetic gas affects the nervous system, resulting in a numbing of the nerve
pathways. There are three types of anaesthesia local, regional and general. This report
will only look at general anaesthetic, in which the patient becomes unconscious,
unaware of what is happening, has no pain, and is immobile. A general anaesthetic
typically employs a gas mixture containing oxygen, nitrous oxide and/or an
anaesthetic agent. These gasses are mixed in the anaesthetic machine, and are
supplied from wall outlets or cylinders. The pressures are reduced by pressure
regulators then pass through an O2 failure alarm. The flow of gas is controlled by
flow meters. The gas is mixed and passed over a vaporiser containing the anaesthetic
agent. An Anti-hypoxic device ensures that the flowmeters deliver a minimum of 25%
O2 to the agent vaporiser. The gas then goes through an over pressure relief valve and
back flow valve, then to the common gas outlet (CGO), ready to be given to the
patient. There is an emergency O2 flush valve connected to give 100% O2 if required.
The gas then enters a patient circuit and ventilator. Expired gas can be stripped of
CO2 in a soda-lime filter and recirculated, or scavenged out of the room.
This machine delivers a constant gas flow to the breathing circuit Some patients
breath spontaneously; in others however muscle relaxants paralyse the lung muscles,
leaving the patient unable to breath by themselves, and need to be ventilated.

Gasses
Pipeline source
The hospital gas pipeline is the primary source of gasses for the anaesthesia machine.

Medical gases
Oxygen
Oxygen is produced by fractional distillation of liquid air. Impurities are permitted in
medical gases as long as they do not exceed small amounts of known contaminates.
Oxygen is stored as a liquid at -150oC to -175oC in a large flask, as the liquid occupies
1/860 the space a gas would. Safety systems and regulators send oxygen to the
hospital pipeline at approximately 50 psi

Nitrous Oxide
Nitrous oxide is manufactured by thermal decomposition of (NH4)2NO3. It is non
flammable but supports combustion (same as oxygen). Nitrous Oxide is also stored as
a liquid at ambient temperature, in large 745psi H tanks connected to a manifold
which regulates the pipeline pressure to approximately 50 psi

Pipeline inlets
The gas pipeline inlets are connected with DISS (diameter index safety system) non-
interchangeable connections. The check valve, located down stream from the pipeline
inlet, prevents reverse flow of gases (from machine to pipeline, or to atmosphere),
which allows use of the gas machine when pipeline gas sources are unavailable.
Gasses cylinder source

Capacity, color, markings of cylinders

Gas Color Service Capacity Pin Position

US Pressure L
(internat'l) psi

Oxygen green (white) 1,900 660 2-5

Nitrous blue (blue) 745 1,590 3-5

Oxide

Air yellow 1,900 625 1-5

(black &
white)

Fig1

Fail-safe, Hypoxic guard, Flowmeters

Hypoxic guard
The anaesthetic failsafe ensures that whenever oxygen pressure is reduced and until
flow ceases, the set oxygen concentration shall not decrease at the common gas outlet.
In addition, the loss of oxygen pressure results in alarms, audible and visible, at 30
psi pipeline pressure. This fail-safe system won’t prevent hypoxic mixtures. For
example, as long as there is pressure in the oxygen line, nothing in the fail safe system
prevents you from turning on a gas mixture of 100% nitrous oxide. However
Datex-Ohmeda hypoxic guard system, uses a "pressure sensor shut off valve"- at 20
psi oxygen, the flow of all other gases are shut off

Flowmeters

Glass flowmeters

The components of a gas flowmeter are, needle valve, indicator float,

knobs, valve stops. Flow increases when the knob is turned
counterclockwise (same as vaporizers). At low flows, the annular-shaped
orifice around the float is (relatively) tubular so (according to Poiseuille's
Law) flow is governed by viscosity. At high flows (indicated on the wider
top part of the float tube), the annular opening is more like an orifice, and
density governs flows.

Regular mechanical needle valves and glass flowtubes are utilized in the
Aestiva;
fig2
Electronic flowmeters

Gas machines with electronic flowmeters have no glass tubes, and the flow rate is
indicated with a bar graph on a monitor screen. There is a needle valve (so flow can
be generated even without electric power). Flows are captured electronically as
follows: flow from the needle valve is conducted to a small chamber of known
volume and held there momentarily by a solenoid valve until the transduced pressure
within the chamber reaches a preset limit. This gives a known mass of gas. This cycle
is repeated sufficiently often for the desired flow rate to occur, and the number of
times the solenoid opens is sensed and can be related to flow. Thus, electronic
flowmeters allow automated anesthesia record-keepers to chart fresh gas flows. They
are also five to ten times as accurate at metering gas flow than glass flowtubes.

fig3

Vaporizers

An anaesthetic vaporiser is attached to an anaesthetic machine which delivers a

given concentration of a volatile anaesthetic agent.The design of these devices takes
account of varying

 ambient temperature
 fresh gas flow
 agent vapour pressure

There are generally two types of vaporisers used on an anaesthesia machine, plenum
and Dual-circuit gas-vapour blender which is exclusively used for the agent
desflurane.
Plenum vaporisers

The plenum vaporiser works by accurately splitting the incoming gas into two
streams. One of these streams passes straight through the vaporiser in the bypass
channel. The other is diverted into the vaporising chamber. Gas in the vaporising
chamber becomes fully saturated with volatile anaesthetic vapour. This gas is then
mixed with the gas in the bypass channel before leaving the vaporiser.A typical
volatile agent, used is isoflurane.
plenum vaporisers are designed to operate within a specific temperature range. They
have several features designed to compensate for temperature changes (especially
cooling by evaporation). They often have a metal jacket weighing about 5kg, which
equilibrates with the temperature in the room and provides a source of heat. In
addition, the entrance to the vaporising chamber is controlled by a bimetallic strip,
which admits more gas to the chamber as it cools, to compensate for the loss of
efficiency of evaporation.

Dual-circuit gas-vapour blender

This vaporiser was created specifically for the agent desflurane. Desflurane boils at
23.5C, which is very close to room temperature. This means that at normal operating
temperatures, the saturated vapour pressure of desflurane changes greatly with only
small fluctuations in temperature. This means that the features of a normal plenum
vaporiser are not sufficient to ensure an accurate concentration of desflurane.
Additionally, on a very warm day, all the desflurane would boil, and very high
(potentially lethal) concentrations of desflurane might reach the patient. desflurane
vaporiser (e.g. the TEC 6 produced by Datex-Ohmeda) is heated to 39C and
pressurised to 200kPa (and therefore requires electrical power). It is mounted on the
anaesthetic machine in the same way as a plenum vaporiser, but its function is quite
different. It evaporates a chamber containing desflurane using heat, and injects small
amounts of pure desflurane vapour into the fresh gas flow. A transducer senses the
fresh gas flow.A warm-up period is required after switching on. The desflurane
vaporiser will fail if mains power is lost. Alarms sound if the vaporiser is nearly
empty. An electronic display indicates the level of desflurane in the vaporiser.
Breathing circuit
The circle circuit is the most popular breathing system. It filters carbon dioxide using
soda-lime which allows re-breathing of all other exhaled gases

Fig4

Circle components
Fresh gas inflow source, inspiratory & expiratory unidirectional valves,
inspiratory & expiratory corrugated tubing, Y connector, overflow (called
popoff, adjustable pressure-limiting valve, or APL valve), reservoir bag,
carbon dioxide absorbent canister and soda-lime granules.