Wanida Chongarunngamsang, M.D.

in Anesthesiology
Faculty of Medicine, SWU
1. อธิบายส่วนประกอบและหลักการทำงาน
ของเครื่องดมยาสลบได้อย่างถูกต้อง
2. จำแนกประเภทและเลือกใช้วงจรดม
ยาสลบได้อย่างเหมาะสม
3. ตรวจสอบเครื่องดมยาสลบและอุปกรณ์
ต่างๆ ก่อนการใช้งานได้ตามเกณฑ์
มาตรฐาน
Supply and compressed gases
Delivery system to anesthetic machine
Safety system
Anesthetic machine
Anesthetic breathing system
 A device which delivers a precisely
known but variable gas mixture,
including anesthetizing and life
sustaining gases
 ventilato
Flow meter r

bellow vaporizer

Corrugated
tube APL
valve

Soda
Scavenging
lime
system
Cylinder
Cylinder bank
Liquid oxygen
Pipeline system
Cylinder system
The central gas pipeline supply system is
the primary source of gas supply for the
anesthesia machine

Oxygen, nitrous oxides, and often air

are delivered from their central supply
source to the operating room through a
pipeline network
 The tubing is color coded and connects to the
pipeline inlet of the machine through a
noninterchangeable diameter-index safety syst
em (DISS) fitting that prevents incorrect hose
attachment

 The check valve, located down stream from the

pipeline inlet, prevents reverse flow of gases
(from machine to pipeline, or to atmosphere)
 Connector at user terminal
A. Quick connector (Quick-
coupler)
 Central gas pipeline supply
system

Multiple gas Cryogenic tank

cylinders
Machine’s pipeline inlet

Diameter-Index Safety
System (DISS)
Cylinders attach to the machine via
hanger yoke that utilize a pin index
safety system
Cylinder Oxygen Nitrous Oxide Air
Characteristics
Color White Blue Black/White
(green) (yellow)
State Gas Liquid and gas Gas

Contents (L) 625 1590 625

Empty Weight 5.90 5.90 5.90

(kg)
Full Weight (kg) 6.76 8.80

Pressure Full 2000 750 1800

(psig)
Characteristics of gas cylinders
 Material: Molybdenum steel
 Size: B, D, E, M, G, H or K
Size E H
Dimension 4.1/4” x 26” 9.1/4” x 51”
volume 4.8 L 43.6 L
Nitrous oxide 745 psig/1590 L 745
psig/ 15800 L
Oxygen 1900 psig/660 L 2200
psig/ 6900 L
Diameter index safety system
Pin index safety system
Machine’s pipeline inlet

Diameter-Index Safety
System (DISS)
For small cylinder
connection
 High pressure system
Cylinder supply to
pressure regulator
 Intermediate pressure
system
Pipeline supply to
proportioning system
 Low pressure system
Flowmeters to common
gas outlet
High Intermediate Low Pressure Circuit
 Receives gasses from the high
pressure E cylinders attached to the
back of the anesthesia machine (2200
psig for O2, 745 psig for N2O)
Consists of:
 Hanger Yolk (reserve gas cylinder
holder)
 Check valve (prevent reverse flow of
gas)
 Cylinder Pressure Indicator (Gauge)
 Pressure Reducing Device
(Regulator)
 Usually not used, unless pipeline gas
supply is off
 Hanger Yolk: orients and
supports the cylinder,
providing a gas-tight
seal and ensuring a
unidirectional gas flow
into the machine

 Index pins: Pin Index

Safety System (PISS) is
gas specificprevents
accidental
rearrangement of
cylinders (e.g..
switching O2 and N2O)
Hanger-yoke assembly
 Reduces the high and variable pressures found in
a cylinder to a lower and more constant pressure
found in the anesthesia machine (45 psig)
 Reducing devices are preset so that the machine
uses only gas from the pipeline (wall gas), when
the pipeline inlet pressure is 50 psig.

This prevents gas use from the cylinder even if

the cylinder is left open (i.e. saves the cylinder
for backup if the wall gas pipeline fails)
 Cylinders should be kept closed routinely.
Otherwise, if the wall gas fails, the machine will
automatically switch to the cylinder supply
without the anesthetist being aware that the wall
supply has failed (until the cylinder is empty too)
 Receives gasses from the
regulator or the hospital
pipeline at pressures of 40-55
psig
 Consists of:
 Pipeline inlet connections
 Pipeline pressure indicators
 Piping
 Gas power outlet
 Master switch
 Oxygen pressure failure
devices
 Oxygen flush
 Additional reducing devices
 Flow control valves
 Mandatory N2O and O2,
usually have air and suction
too
 Inlets are non-
interchangeable due to
specific threading as per
the Diameter Index Safety
System (DISS)
 Each inlet must contain a
check valve to prevent
reverse flow (similar to the
cylinder yolk)
 Machine standard requires that an anesthesia
machine be designed so that whenever the
oxygen supply pressure is reduced below normal,
the oxygen concentration at the common gas
outlet does not fall below 21%
 Oxygen supply pressure opens the valve as long
as it is above a pre-set minimum value (e.g. 20
psig)

 If the oxygen supply pressure falls below the

threshold value the valve closes and the gas in
that limb (e.g. N2O), does not advance to its
flow-control valve
 The machine standard specifies that whenever
the oxygen supply pressure falls below a
manufacturer-specified threshold (usually 30
psig) a medium priority alarm shall blow within 5
seconds
 Fail-safe valves do not prevent administration of
a hypoxic mixture because they depend on
pressure and not flow

 These devices do not prevent hypoxia from

accidents such as pipeline crossovers or a
cylinder containing the wrong gas
 Receives O2 from pipeline inlet or cylinder
reducing device and directs high, unmetered flow
directly to the common gas outlet (downstream of
the vaporizer)
 Machine standard requires that the flow be
between 35 and 75 L/min
 The ability to provide jet ventilation
 Hazards
 May cause barotrauma
 Dilution of inhaled anesthetic
 Located just upstream of the flow control valves
 Receives gas from the pipeline inlet or the
cylinder reducing device and reduces it further to
26 psig for N2O and 12-16 psig for O2
 Purpose is to eliminate fluctuations in pressure
supplied to the flow indicators caused by
fluctuations in pipeline pressure
 Mechanical
integration of the
N2O and O2 flow-
control valves
 Automatically
intercedes to
maintain a
minimum 25%
concentration of
oxygen with a
maximum N2O:O2
ratio of 3:1
Extends from the flow control valves to the
common gas outlet
Consists of:
 Flow meters
 Vaporizer mounting device
 Check valve
 Common gas outlet
 When the flow control valve is
opened the gas enters at the
bottom and flows up the tube
elevating the indicator

 The indicator floats freely at a

point where the downward
force on it (gravity) equals the
upward force caused by gas
molecules hitting the bottom
of the float
* Note that a leak in the oxygen flowmeter
tube can cause a hypoxic mixture, even when
oxygen is located in the downstream position
Sequence of flow meter
tubes
 A vaporizer is an instrument designed to change
a liquid anesthetic agent into its vapor and add a
controlled amount of this vapor to the fresh gas
flow
Classificatio
n
Advantages:
 Relative stability of inspired concentration
 Conservation of respiratory moisture and
heat
 Prevention of operating room pollution
 PaCO2 depends only on ventilation, not
fresh gas flow
 Low fresh gas flows can be used
Disadvantages:
 Complex design = potential for
malfunction
 High resistance (multiple one-way valves)
= higher work of breathing
Carbon dioxide absorbents
Function:
• conserving gases and volatile
agents

• decreasing OR pollution

• avoiding hazards of carbon

dioxide rebreathing.
Sodalime
Baralime
NaOH 5 %, Ca(OH)2 94 %, KOH 1 %,
silica

Indicators : ethyl violet

 CO2 + H2O --> H2CO3

 H2CO3 + 2 NaOH (or KOH) --> Na2CO3 (or K2CO3) + 2
H2O + Energy
 Na2CO3 (or K2CO3) + Ca(OH)2 --> CaCO3 + 2 NaOH
(or KOH)
Advantages
 Simply, light weight, easy to
positioning
 Remote anesthesia
 Low resistance
Disadvantages
 Require high FGF, more pollution
 loss more heat and water from airway
 Carbon dioxide retention
 Ayre’s T-piece circuit
(Mapleson E)
 most suitable in oxygen
therapy
 caution : require high
flow of humidified oxygen
 Jackson Rees circuit
(Mapleson F)
 most suitable in pediatric
anesthesia (BW < 20 kg.)
 require high flow 2-3
times of minute
ventilation
 Scavenging is the collection and removal
of vented anesthetic gases from the OR

 Scavenging may be active (suction

applied) or passive (waste gases proceed
passively down corrugated tubing throug
h the exhaust grill of the OR)
8 Categories of check:
 Emergency ventilation equipment
 High-Pressure system
 Low-Pressure system
 Scavenging system
 Breathing system
 Manual and automatic ventilation system
 Monitors
 Final Position