2012/11/06
Anesthesia Units
Rob Dickinson
South Africa
An Anesthesia Gas Machine Example
• Layout similar to that of an Ohmeda Modulus II
1
2012/11/06
Facilities & Services Requirements
• Piped & Cylinder Back-up Medical Grade Gases
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
2
2012/11/06
Facilities & Services Requirements
• Piped & Cylinder Back-up Medical Grade Gases
• Oxygen pipeline pressure gauge
Facilities & Services Requirements
• Piped & Cylinder Back-up Medical Grade Gases
• Oxygen pipeline non-return valve
3
2012/11/06
Facilities & Services Requirements
• Piped & Cylinder Back-up Medical Grade Gases
• High pressure (back-up) Oxygen cylinder mounted
on a non-interchangeable safety-indexed gas yoke
(Some anesthesia machines have 2 x Oxygen yokes)
Facilities & Services Requirements
• Piped & Cylinder Back-up Medical Grade Gases
• High pressure Oxygen cylinder non-return valve
4
2012/11/06
Facilities & Services Requirements
• Piped & Cylinder Back-up Medical Grade Gases
• High pressure Oxygen cylinder contents gauge
Facilities & Services Requirements
• Piped & Cylinder Back-up Medical Grade Gases
• High pressure Oxygen regulator
5
2012/11/06
Facilities & Services Requirements
• Piped & Cylinder Back-up Medical Grade Gases
• Machine Oxygen supply pressure
Facilities & Services Requirements
• Piped & Cylinder Back-up Medical Grade Gases
• Nitrous Oxide pipeline connected to the central
supply via a non-interchangeable safety-indexed
gas probe and receptacle
6
2012/11/06
Facilities & Services Requirements
• Piped & Cylinder Back-up Medical Grade Gases
• Medical Air pipeline connected to the central
supply via a non-interchangeable safety-indexed
gas probe and receptacle
Facilities & Services Requirements
• Piped & Cylinder Back-up Medical Grade Gases
• Cylinder yokes
7
2012/11/06
Facilities & Services Requirements
• Piped & Cylinder Back-up Medical Grade Gases
• Cylinder and pipeline pressure gauges
Internal ‘Machine’ Operation
• Main ON/OFF switch and gas cut-off block
8
2012/11/06
Internal ‘Machine’ Operation
• Main ON/OFF switch and gas cut-off block
• 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
Internal ‘Machine’ Operation
• Main ON/OFF switch and gas cut-off block
• On de-activation Oxygen is cut-off and pressure
distal to the ON/OFF valve begins dropping
Switched gas supplies out
To Ventilator
To emergency O2
Flush and external
flowmeter
Machine Gas Supplies in
9
2012/11/06
Internal ‘Machine’ Operation
• Main ON/OFF switch and gas cut-off block
• 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
Switched gas supplies out
To Ventilator
To emergency O2
Flush and external
flowmeter
Machine Gas Supplies in
Internal ‘Machine’ Operation
• Main ON/OFF switch and gas cut-off block
• On many machines the de-activation of this switch
(or an interruption of Oxygen supply pressure) only
cuts off Nitrous Oxide, not Medical Air
Switched gas supplies out
X
To Ventilator
To emergency O2
Flush and external
flowmeter
Machine Gas Supplies in
10
2012/11/06
Internal ‘Machine’ Operation
• 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
Switched gas supplies out
To Ventilator
To emergency O2
Flush and external
flowmeter
Machine Gas Supplies in
Internal ‘Machine’ Operation
• Main ON/OFF switch and gas cut-off block
• Main ON/OFF switch
11
2012/11/06
Internal ‘Machine’ Operation
• Secondary gas regulators
Internal ‘Machine’ Operation
• Secondary gas regulators
• It is essential that flowmeter gas supplies remain
stable as other occasional anesthesia machine and
cyclical ventilator gas requirements are drawn
12
2012/11/06
Internal ‘Machine’ Operation
• Secondary gas regulators
• Secondary Oxygen regulator
Internal ‘Machine’ Operation
• Secondary gas regulators
• Secondary Nitrous Oxide regulator
13
2012/11/06
Internal ‘Machine’ Operation
• Secondary gas regulators
• Secondary Medical Air regulator
Internal ‘Machine’ Operation
• Gas flowmeter banks (Rotameters)
14
2012/11/06
Internal ‘Machine’ Operation
• 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
Internal ‘Machine’ Operation
• Gas flowmeters and mixers
• 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
Medical gas supplies in
from the secondary gas
regulators
15
2012/11/06
Internal ‘Machine’ Operation
• Gas flowmeters and mixers
• 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
Medical gas supplies in
from the secondary gas
regulators
Internal ‘Machine’ Operation
• Gas flowmeters and mixers
• 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
Medical gas supplies in
from the secondary gas
regulators
16
2012/11/06
Internal ‘Machine’ Operation
• Gas flowmeters and mixers
• An Oxygen needle valve and rotameter tube
Internal ‘Machine’ Operation
• Gas flowmeters and mixers
• Needle valves and rotameters
17
2012/11/06
Internal ‘Machine’ Operation
• Gas flowmeters and mixers
• 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
Medical gas supplies in
from the secondary gas
regulators
Internal ‘Machine’ Operation
• Gas flowmeters and mixers
• Link-25 AHD system on an Ohmeda Modulus II
18
2012/11/06
Internal ‘Machine’ Operation
• Gas flowmeters and mixers
• An example of a failed ‘Anti-Hypoxic Device’
Internal ‘Machine’ Operation
• Gas flowmeters and mixers
• Examples of no ‘Anti-Hypoxic Device’ fitted
X X
19
2012/11/06
Internal ‘Machine’ Operation
• Gas flowmeters and mixers
• An example of electronically measured flow
Internal ‘Machine’ Operation
• Gas flowmeters and mixers
• An example of software selected gas flow
20
2012/11/06
Internal ‘Machine’ Operation
• Vaporizers and Vaporizer Backbars
Internal ‘Machine’ Operation
• 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)
21
2012/11/06
Internal ‘Machine’ Operation
• 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
Internal ‘Machine’ Operation
• Vaporizers
• All modern Vaporizers are anesthesia agent specific
• Anesthesia agent Saturated Vapor Pressure (SVP)
affects Vaporizer design and calibration
Halothane Enflurane Isoflurane Sevoflurane Desflurane
22
2012/11/06
Internal ‘Machine’ Operation
• Vaporizers
• Liquid vaporization & temperature compensation
Internal ‘Machine’ Operation
• Vaporizers
• Desflurane heating and proportioning
23
2012/11/06
Internal ‘Machine’ Operation
• Vaporizers
• Datex-Ohmeda Aladin Cassette Vaporizers
Internal ‘Machine’ Operation
• Vaporizers and Vaporizer Back bars
• A Vaporizer on a 3 Station Selectatec Back bar
24
2012/11/06
Internal ‘Machine’ Operation
• 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)
Internal ‘Machine’ Operation
• Vaporizer Backbars
• Cagemount (Non-Interlocking Vaporizers)
• Only ONE Vaporizer should be fitted between the
rotameters and the backbar end block
25
2012/11/06
Internal ‘Machine’ Operation
• Vaporizer Backbars
• Original Selectatec (Non-Interlocking Backbars)
• It is recommended that only ONE vaporizer station
should be fitted on the Anesthesia Gas Machine
Internal ‘Machine’ Operation
• Vaporizer Backbars
• 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
26
2012/11/06
Internal ‘Machine’ Operation
• Vaporizer Backbars
• 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’
Internal ‘Machine’ Operation
• Vaporizer Backbars
• An example of Selectatec Pin-Interlocking
Side ‘Interlock’ Pins
27
2012/11/06
Internal ‘Machine’ Operation
• Vaporizer Backbars
• Another example of Selectatec Pin-Interlocking
Side ‘Interlock’ Pins
Internal ‘Machine’ Operation
• Vaporizer Backbars
• 3 Station Selectatec Pin-Interlock Back bars
Interlock continuity without
a centre vaporizer fitted
28
2012/11/06
Internal ‘Machine’ Operation
• Vaporizer Backbars
• 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
Internal ‘Machine’ Operation
• Vaporizer Backbars
• 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’
29
2012/11/06
Internal ‘Machine’ Operation
• Vaporizer Backbars
• An example of a removed ‘exclusion pin’
X ‘Exclusion pin’ removed
Internal ‘Machine’ Operation
• Vaporizer Backbars
• Consequences of a removed ‘exclusion pin’
Overdose ‘cocktail’ possible
Selectatec
Compatible
Pin-Interlock Vaporizer but
Vaporizer NOT a
Pin-Interlock
Vaporizer
30
2012/11/06
Internal ‘Machine’ Operation
• Vaporizer Backbars
• Draeger Interlock Back bars
• One to three Vaporizers may be fitted on an
Anesthesia Gas Machine depending upon the model
Internal ‘Machine’ Operation
• Vaporizer Backbars
• Penlon Vaplok Interlock Back bars
• One to three Vaporizers may be fitted on the
Anesthesia Gas Machine depending upon the model
31
2012/11/06
Internal ‘Machine’ Operation
• 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
Internal ‘Machine’ Operation
• Vaporizer Fillers
• Vaporizer Screw, Pour or Funnel Fillers
• Not recommended if more than one anesthesia
agent type is present or intended for use
32
2012/11/06
Internal ‘Machine’ Operation
• Vaporizer Fillers
• Anesthetic-agent-specific key-filler bottle adaptors
are color-coded and indexed for both the anesthesia
agent bottle and vaporizer filler mechanism ends
Internal ‘Machine’ Operation
• Vaporizer Fillers
• Anesthetic-agent-specific key-filler bottle adaptors
are color-coded and indexed for both the anesthesia
agent bottle and vaporizer filler mechanism ends
33
2012/11/06
Internal ‘Machine’ Operation
• Vaporizer Fillers
• QUIK-FIL agent-specific adaptors are color-coded
and often integral to the anesthesia agent bottle
Internal ‘Machine’ Operation
• 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
34
2012/11/06
Internal ‘Machine’ Operation
• Common Gas Outlet (CGO)
• The ‘Fresh Gas’ (from the Vaporizer in use) exits
the Anesthesia Gas Machine frame at the Common
Gas Outlet (CGO)
Internal ‘Machine’ Operation
• 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
35
2012/11/06
Internal ‘Machine’ Operation
• Common Gas Outlet (CGO)
• Fitted to this CGO is a semi-closed breathing circuit
Internal ‘Machine’ Operation
• 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
36
2012/11/06
Internal ‘Machine’ Operation
• Emergency Oxygen Flush Valve
• 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
Internal ‘Machine’ Operation
• Emergency Oxygen Flush Valve
• The Oxygen Flush Valve is recessed and sprung
37
2012/11/06
Internal ‘Machine’ Operation
• External Oxygen Flowmeter
• Many OR interventions do not require general
anesthesia. Oxygen can be flowed to the patient
facemask via an external flowmeter
Internal ‘Machine’ Operation
• External Oxygen Flowmeter
• Not fitted on all Anesthesia Gas Machines
38
2012/11/06
Breathing Circuit and Ventilator
• Patient Breathing Circuit
Breathing Circuit and Ventilator
• Waste Anesthesia Gas Disposal System (WAGS)
39
2012/11/06
Breathing Circuit and Ventilator
• Patient Breathing Circuit
• Semi-closed Carbon Dioxide absorber circuit
Breathing Circuit and Ventilator
• Ventilator
40
2012/11/06
Breathing Circuit and Ventilator
• Ventilator
• Ventilator with O2 Analyzer and Spirometry
Breathing Circuit and Ventilator
• ‘Fresh Gas’ from the Common Gas Outlet
41
2012/11/06
Breathing Circuit and Ventilator
• Oxygen Analyzer Sensor
Breathing Circuit and Ventilator
• Inspiratory Valve
42
2012/11/06
Breathing Circuit and Ventilator
• Patient Airway Pressure Gauge (PAW)
Breathing Circuit and Ventilator
• Inspiratory Limb
43
2012/11/06
Breathing Circuit and Ventilator
• Patient Airway Connector to ETT or LMA
Breathing Circuit and Ventilator
• Expiratory Limb
44
2012/11/06
Breathing Circuit and Ventilator
• Spirometry Sensor
Breathing Circuit and Ventilator
• Expiratory Valve
45
2012/11/06
Breathing Circuit and Ventilator
• CO2 Absorber
Breathing Circuit and Ventilator
• CO2 Absorbent
46
2012/11/06
Breathing Circuit and Ventilator
• Reservoir Bag / Vent Valve (Bag position)
Breathing Circuit and Ventilator
• Reservoir Bag
47
2012/11/06
Breathing Circuit and Ventilator
• Adjustable Pressure Limit Valve (APL)
Breathing Circuit and Ventilator
• Waste Anesthetic Gas outlet from APL
48
2012/11/06
Breathing Circuit and Ventilator
• Waste Anesthetic Gas System (WAGS)
Breathing Circuit and Ventilator
• Waste Anesthetic Gas Reservoir Bag
49
2012/11/06
Breathing Circuit and Ventilator
• Positive / Negative Pressure Relief Valves
Breathing Circuit and Ventilator
• WAGS Suction Control Valve
50
2012/11/06
Breathing Circuit and Ventilator
• Connector to facility WAGS Evacuator
Breathing Circuit and Ventilator
• CO2 Scrubbed Gas from Absorber
51
2012/11/06
Breathing Circuit and Ventilator
• Gas from Absorber and CGO Mix
Breathing Circuit and Ventilator
• Reservoir Bag / Vent Valve (Vent position)
52
2012/11/06
Breathing Circuit and Ventilator
• Ventilator Breathing Circuit Connection
Breathing Circuit and Ventilator
• Ventilator Bellows Rises On ‘Exhalation’
53
2012/11/06
Breathing Circuit and Ventilator
• Ventilator ‘Bellows Base Valve’ opens
Breathing Circuit and Ventilator
• Excess Waste Anesthesia Gas flow
54
2012/11/06
Breathing Circuit and Ventilator
• Ventilator Control Unit
Breathing Circuit and Ventilator
• Inspiratory Phase ‘Exhaust Valve’ closes
55
2012/11/06
Breathing Circuit and Ventilator
• Inspiratory Phase ‘Drive Gas Valve’ opens
Breathing Circuit and Ventilator
• Inspiratory Phase ‘Drive Gas’ Flow
56
2012/11/06
Breathing Circuit and Ventilator
• Bellows Base Valve Held Closed
Breathing Circuit and Ventilator
• Bellows Compressed by Drive Gas in canister
57
2012/11/06
Breathing Circuit and Ventilator
• Inspiratory Phase ‘Breathing Circuit’ Gas Flow
Breathing Circuit and Ventilator
• Inspiratory Phase ‘Breathing Circuit’ Gas Flow
58
2012/11/06
Breathing Circuit and Ventilator
• Expiratory Phase ‘Drive Gas Valve’ closes
Breathing Circuit and Ventilator
• Expiratory Phase ‘Exhaust Valve’ opens
59
2012/11/06
Breathing Circuit and Ventilator
• Expiratory Phase ‘Drive Gas’ Flow
Breathing Circuit and Ventilator
• Expiratory Phase ‘Drive Gas’ Exhausted
60
2012/11/06
Breathing Circuit and Ventilator
• Ventilator Bellows Rises On ‘Exhalation’
Various Anesthesia Gas Machines
61
2012/11/06
References
• [Link] • [Link]
• [Link] • [Link]
• [Link] • [Link]
• [Link] • [Link]
• [Link] FilePath=journals/ija/vol3n3/[Link]
• [Link] • [Link]
wl97/[Link] • [Link]
• [Link] • http ://[Link]
• [Link]
• [Link]
• [Link]
• [Link]
• [Link]
• [Link]
• [Link]
Thank you!
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