ANAESTHESIA VAPORIZERS

Dr Arshad Taqi Consultant Anaesthetist Hameed Latif Hospital Lahore

This article aims to give an outline of the : Physical principles of vaporization Design of a contemporary vaporizer Classification of vaporizers Recent developments in vaporizer design Physical principles Contemporary inhalation agents are in a liquid state at 20C; they begin to evaporate above this temperature. Vaporization of the fluids increases with temperature; the temperature at which all the liquid in a container changes into vapour is its boiling point. Vaporization is an energy dependant process; amount of energy required to convert a given unit of a substance from liquid to vapour state is called latent heat of vaporization. If a volatile agent is allowed to evaporate in a container; it will cause a loss of energy resulting in a fall in the temperature and decreased evaporation unless this energy is replenished by the container and its surroundings. Quantity of heat required to raise the temperature of a substance by 1C is known as specific heat, more the specific heat of a substance more heat will it gain or lose due to a unit change in temperature. Vaporizers should have a high specific heat in order to minimize the fall in temperature due to vaporization. Any loss of heat has to be replenished from the atmosphere; vaporizers are constructed of substances with high thermal conductivity that is the ability of a substance to conduct heat from the environment. The vapour causes pressure on the walls of a closed container; when fully saturated, this pressure is the saturated vapour pressure. Fractional volume of the vapour in a closed container is dependent on its vapour pressure according to Daltons law. When a gas flows through a vapour filled container, it entrains vapour as it flows out at the other end. The carrier gas either bubbles through or flows over the liquid. Halothane has a saturated vapour pressure of 243 at 20C; when fully saturated with vapour final mixture will contain 243x100/760=31.9 or approximately 32% halothane. This is the saturated vapour concentration of halothane. A carrier gas passing through a container filled with halothane at 20C when fully saturated will contain 32% halothane, which is far in excess of its clinical requirement. Sevoflurane with SVP of 160 will constitute 160x100/760 = 21% of the agent. If amount of gas flowing into the container was 100ml, the amount flowing out will increase due to addition of halothane vapour. Amount of halothane in the final mixture can be calculated by the following formula; SVP agent (mmHg)/Total pressure(mm Hg)=Agent vapour (x ml)/Carrier gas(y ml)+Agent vapour(x ml) For halothane in the above example, y = 100 ml/min; therefore, 243 / 760 = x / 100 + x x can be calculated to be 47 ml.

CONTEMPORARY VAPORIZER DESIGN Classification The carrier gas may be drawn by the patients as they breathe through a circuit containing anaesthetic vapour. This Draw over type of vaporizer does not require a compressed gas source; they are simple in design and useful for field conditions. Alternatively, compressed gas passes through a vapour filled container in a Plenum vaporizer. Carrier gas flow is split into a small portion passing through the vaporizing chamber while the rest bypasses this chamber in a variable bypass type of vaporizer. Final concentration of the vapour when these flows are combined is determined by the splitting ratio and saturated vapour pressure of an agent at a given temperature. Most of the contemporary vaporizers including Drager 19 series and Ohmedas Tech series use this design. Measured flow vaporizers like the copper kettle on the other hand require the operator to set the flow to the vaporizer and bypass with separate flowmeters, which means respective flows have to be calculated for each agent for a given temperature and vapour output. There would be no need for a separate vaporization chamber if measured amounts of the volatile agent are directly injected into the fresh gas flow to achieve the desired vapour concentration. Most of the contemporary vaporizers are temperature compensated, agent specific and out of circuit.

FACTORS INFLUENCING THE PERFORMANCE OF VAPORIZERS Temperature: Ether bottles were placed in a water bath or wrapped in towels to replace the heat lost due to vaporization. Modern vaporizers are made of substances with high specific heat and thermal conductivity. Copper has largely been replaced by steel. Vapour output increases non-linearly with increasing ambient temperature (Fig.1). Drager Vapour 19.1 introduced a concentration control dial that took the ambient temperature into account. Current models have incorporated a mechanism to vary the proportion of gas flow into vaporizing chamber with temperature. Bimetallic strips or thermally expanding bellows are used to alter the flow into or out of the vaporizing chamber with changing temperature. These vaporizers are designed to deliver fairly constant vapour output at an ambient temperature range of 15-35C.

Fig.1 Effect of Temperature on SVP

Back pressure: Positive pressure ventilation causes back pressure that is transmitted to the vaporizing chamber; vaporizer laden mixture may flow back into the common inlet once the pressure is released during expiration. This may result in the delivery of very high concentrations of vapour. Ohmeda and Drager have incorporated a long inlet to the vaporizing chamber in most of their vaporizers; it minimizes retrograde flow into the common inlet and reduces this pumping effect. Tech 4 has a check valve on the machine outlet and an extensive baffle system in the vaporizing chamber to prevent retrograde flow.

Extremes of fresh gas flow influence the vapour output. Output is decreased at very low flows (<250ml/min); the turbulence in not sufficient to lift the dense anaesthetic vapour at these flows. Vapour output will also fall at very high flows (>15L/min) due to incomplete mixing and saturation. Carrier gas The vaporizers are calibrated with oxygen as the carrier gas. When this is switched to nitrous oxide the vapour output falls sharply, and then rises slowly to a new steady state value. The sharp fall is attributed to the solubility of nitrous oxide in volatile anaesthetics. The steady state values with nitrous oxide as a carrier gas are different for various vaporizers due to poorly understood mechanism. Working of contemporary vaporizer

Fig.2 Schematic of Tec 5 vaporizer

Gas flow enters the vaporizer at (1), where it is split into two streams, the bypass circuit and the vaporizing chamber. Gas flows through the bypass circuit vertically downward from (a) across the sump base (b), through the thermostat to (c), and back up the gas transfer manifold via (d) to (e). Gas flowing to the vaporizing chamber flows from (1) across the sump cover (2) where it is diverted via (3) through the central cavity of the rotary valve and back through the IPPV assembly via (4), (5), and (6). Gas then flows from the IPPV assembly via (7) down the tubular wick assembly, where vapour is added, and then flows across the base of the vaporizing chamber above the liquid agent to (8). From here the gas-vapour mixture flows via (9) through the sump cover to the proportional radial drug control groove of the rotary valve and back into the sump cover (10), where it merges with gas from the bypass circuit. The total flow then exits the vaporizer into the outlet port of the Selectatec manifold.

Ohmeda Tech 5 (Fig. 2) is one example of contemporary variable bypass vaporizer. Carrier gas is split into a vaporizing and bypass flows. Control dial is locked in the OFF position when not in use. The gas is split as a part enters the vaporizing chamber where it flows through a length of tubing before entering the wick assembly, which is designed to increase the surface area for absorption. The length of tubing serves to minimize the pumping effect due to IPPR. Temperature compensation is achieved by a thermostat at the base of the chamber; it is a bimetallic strip that controls the flow through the vaporizing chamber. The vaporizer is attached to a selectatec assembly that prevents from more than one vaporizer being switched on simultaneously. Hazards Present day anaesthesia machines are equipped with ports for more than one vaporizer, which increases the risk of simultaneous administration of more than one anaesthetic agent. Vapour interlock systems are installed to prevent this dangerous situation. Tipping of the vaporizer can result in liquid anaesthetic flowing into the bypass chamber. This may occur while the vaporizer is detached from the backbar of the machine; the result is delivery of extremely high anaesthetic concentration to the patient. The machine should not be used if this happens; vaporizer should be flushed with oxygen at high flow for 20 to 30 minutes. This hazard has been eliminated in the Aladin cassette manufactured by Ohmeda.

Misfilling of the vaporizers with incorrect agent will result in delivery of incorrect concentrations of anaesthetics. Keyed fillers are used to prevent this; this does not eliminate the possibility of wrong agent being filled in the bottle. Agent monitors are the only check on this type of accident. Challenges and solutions of Desflurane Desflurane posed two major problems that could not be solved with conventional vaporizer design. It has a very high vapour pressure (669 mmHg); it would require a very high bypass flow to bring the delivered concentration down to a clinical level of 6-7%. It also has a low boiling point (23C), which means it would be boiling most of the time in our operating rooms. Highly volatile behaviour of the agent also means temperature in its container would rapidly fall unless there is an active source of supply of heat. Ohmeda has introduced a unique vaporizer design in its Tech 6 series (Fig.3). The agent is electrically heated to a temperature of 39C in a sealed chamber where the vapour is kept at a pressure of around 1300mmHg; this eliminates the need for a carrier gas for anaesthetic delivery. Desflurane vapour passes through a variable resistance determined by concentration control dial before joining the fresh gas flow that passes through a fixed resistance. Two flows are physically separated; pressures in two systems are sensed by a differential transducer. Back flow against the fixed resistance increases the pressure on this transducer, which is sensed on the other side resulting in a fall in the variable resistance to desflurane flow; the result is a constant working pressure and vapour output during different fresh gas flows. A sophisticated system of electronic controls and alarms ensures smooth functioning during a wide range of temperature and pressure conditions. The vapour concentration needs to be adjusted manually under hypobaric or isobaric conditions since the vaporizers works under absolute conditions.

Fig.3 Desflurane Vaporizer

Aladin Cassette Datex Ohmeda has introduced a unique vaporizing unit in their new machines. This comes in the form of a cassette that fits into a slot in the machine; it has both vaporizing and bypass channels. Ratio of the flow from the vaporizing and bypass channel is controlled by a throttle valve, which gets its input on temperature and pressure from both channels. A fan placed below the vaporizing channel automatically turns on when the temperature drops; this ensures a working temperature within the chamber. The cassettes are protected against overfilling, tipping and pumping effects. The device is free from the hazards of tipping, overfilling and incorrect filling due to the features inherent in the design. Sophisticated electronic control and safety features make it a promising addition to the anaesthetic vapour delivery systems. Injectors There would be no need for a flow splitting if a small amount of volatile agent was added to fresh gas flow, ensuring its complete vaporization. Siemens Kion uses this principle in a concentrationcaliberated injector (Fig.4). A calibrated throttle valve is opened or closed by the user. The more it is closed, the greater the pressure exerted by the fresh gas flow on the surface of the liquid anesthetic.

This pressure tends to force liquid to atomize at the injector nozzle. The number of molecules of liquid injected is proportional to the resistance to gas flow at the throttle valve (controlled by the concentration-control dial). The liquid droplets vaporize in the flowing fresh gas stream. Thus, since the liquid is not vaporizing (at least within the vaporizer), no thermal compensation is required.

Fig.4 Injector: Kion

FURTHER READING 1. Chapter 6. Vaporizers. Understanding Anesthesia Equipment. Dorsch JA, Dorsch SE.. Lippincott Williams & Wilkins, 2008. ISBN 0781776031, 9780781776035 2. Inhaled Anesthetic Delivery Systems. Brockwell RC, Andrews JJ in Anesthesia. Editor, RD Miller. 6th Edition. 2005. Churchill Livingstone. 3. Anesthesia Vaporizers. Anesthesia Equipment. Gay SM Editor; Mosby 1996 4. Understanding Your Anesthesia Workstation. Brockwell RC,; Jeff JA. 35(1):15-29, 2007. ASA refresher courses. 5. http://www.pharmacology2000.com/physics/Chemistry_Physics/physics17.htm

6. http://www.virtual-anesthesia-textbook.com/vat/machine.htm 7. http://www.wipo.int/pctdb/en/wo.jsp?IA=GB1986000227&DISPLAY=DESC