Middle Technical University

Electrical Engineering Technical College

Department of Medical Instrumentation
Engineering Techniques

Medical instruments III

Prepared by:

Asst. Lecturer Luban H. Al-Qudsy

Lecturer Ali Gazi

Lecturer Amal Ibrahim Mahmood
 January 2022
Electrical Engineering Technical College No. of week hours
30
Department of Medical Instrumentation Weeks Th. Pr. Unit
Engineering Techniques 2 3 7
Fourth Year Subject: Medical Instrumentation (III).

‫ ثم اختالفه عن بقية األجهزة االلكترونية لكونه جهاز طبي‬، ‫ دراسة الجهاز الطبي كجهاز الكتروني بحت‬: ‫أهداف المادة‬
‫ودراسة دوائره االلكترونية الداخلية ثم التدريب على كافة الدوائر االلكترونية في األجهزة الطبية و طرق تشغيلها وصيانتها‬
. ‫مما يؤهل الطالب في النهاية استخدام و صيانة األجهزة الطبية بصورة عامة‬

Week Syllabus

1st , 2nd Part 1: general systems and specialized tools in general surgery.

3rd , 4th , 5th Part 2: specialized systems and Inst.

6th , 7th Ophthalmic microsurgical Inst.

8th , 9th Open heart & cardiovascular.

10th Heart – lung machine.

11th , 12th Kidney machine.
13th , 14th Surgical diathermy.
15th , 16th , 17th Artificial organs – internal & external.
18th , 19th , 20th Dental system.
21st , 22nd Gynecology Inst.
23rd, 24th Ultrasonic assisting device.
25th , 26th Audio logical surgical units.
27th , 28th Anesthetic units.
29th , 30th Intensive care units.
Middle Technical University
Electrical Engineering Technical College
Department of Medical Instrumentation Engineering Techniques
Medical instruments III

Mode Unit in study

Introduction to General Systems and Specialized Tools in General Surgery
For
Students of Fourth Stage
Department of Medical Instrumentation Engineering Techniques
(1st and 2nd Weeks)

By Lecturer
A.L. Luban Hamdy
L. Ali Ghazi
1. Overview
Target population:-
For students of the fourth stage in college electrical engineering technical college in
middle technical university
A- Rational
We will clarify the concept of surgery and the operating room in which different surgeries
are performed and study the equipment used in the operating rooms
B- Central Idea
1. Definition of the surgery
2. Types of surgery
3. Operating room

C- Objectives
After studying the General surgery, the student well be able to
1. Define of surgery
2. Explain the operating room
3. understand types of surgery
4. Know the Equipments used in the operating room.

2. Pre test
Decide whether the following sentences are true or false
1. Surgery: Is a medical art dealing with a disease by surgical intervention (noninvasive
method).
2. The bleeding: that also associated with the cutting through the body, and it is managed
mainly by the practices of the surgeon
3. Urology manages pregnancy and delivery of babies.
4. Heart-lung bypass machine: also called a cardiopulmonary bypass pump takes over for
the heart and lungs during some surgeries.
3. Theory
Surgery:
Is a medical art dealing with a disease by surgical intervention (invasive method).
The surgeon: is a physician trained to perform operation and to us other techniques to
treat diseases.
Three aspects are associated with surgery:
1. Pain: associated with cutting in the body, and is managed by the use of anesthetic
agents.
2. The bleeding: that also associated with the cutting through the body, and it is managed
mainly by the practices of the surgeon.
3. The infections: due to bacteria and other microorganisms that exist everywhere on the
earth, it can be controlled and minimized by proper sterilization.
Types of Surgery:
1. Ophthalmology: treats diseases of the eye by various methods including surgery.

2. Otolaryngology: treats diseases of the ear, nose, and throat using various
techniques including surgery.
3. Orthopedics: treats diseases of the bones, joints and other locomotors organs and
structures using various techniques including surgery.

4. Neurosurgery: treats certain diseases of the brain and nervous system using
surgical techniques.

5. Thoracic surgery: surgical specialty that performs operations to treat diseases of

the organs in the chest cavity.
6. Gastroenterology and hepatic surgery: surgical specialty that performs
operations to treat diseases of the organs in the abdominal cavity.

7. Urology: treats diseases of the urinary system using various surgical techniques.

8. Obstetrics: manages pregnancy and delivery of babies.

9. Gynecology: treats diseases of the female reproductive system using various
techniques including surgery.
Operating room:

An operating room (OR), also called surgery center, is the unit of a hospital where
surgical procedures are performed.
An operating room may be designed and equipped to provide care to patients with a
range of conditions, or it may be designed and equipped to provide specialized care
to patients with specific conditions.
Operating rooms are sterile environments; all personnel wear protective clothing called
scrubs. They also wear shoe covers, masks, caps, eye shields, and other coverings
to prevent the spread of germs. The operating room is brightly lit and the temperature
is very cool; operating rooms are air-conditioned to help prevent infection.
Operating room personnel:
1. The surgeon: is a physician who has been trained beyond medical school in the
art of performing operations and postsurgical managements of the patients’
recovery. There are chief surgeon and assistant surgeon.
2. The anesthesiologist: is a physician who administered and control anesthetic
agents and patient response, or nurse trained in anesthesia called a nurse
anesthetist.
3. The circulating nurse: is outside of the sterile zone and is used for various
purposes including keeping records, obtaining supplies, preparing drugs, etc.
4. The scrub nurses work in a sterile zone and must follow the same antiseptic rules
as the surgeon, they are responsible for keeping the instruments, tools and
supplies sterile.
5. Monitoring technicians: is trained to operate and perform elementary
maintenance on a wide variety of physiological monitoring equipment’s such as
pressures monitors, ECG, etc.
6. The cardiovascular technician: is trained to operate and perform elementary
maintenance on a wide variety of life support equipment such as intraaortic balloon
pumps, heart-lung machine.
Operating Room Equipments:
The range of medical Equipments found in various operating rooms depends on several
factors like the types of surgery performed, physicians’ preferences and level of activity.
Operating rooms has special equipment such as respiratory and cardiac support,
emergency resuscitative devices, patient monitors, and diagnostic tools and other
Equipments.

1. Life support and emergency resuscitative Equipments:

Equipment for life support and emergency resuscitation includes the following:
• Heart-lung bypass machine: also called a cardiopulmonary bypass pump takes
over for the heart and lungs during some surgeries, especially heart or lung
procedures. The heart-lung machine removes carbon dioxide from the blood and
replaces it with oxygen. A tube is inserted into the aorta to carry the oxygenated
blood from the bypass machine to the aorta for circulation to the body. The heart-
lung machine allows the heart's beating to be stopped during surgery.
• Ventilator (also called a respirator): assists with or controls pulmonary
ventilation. Ventilators consist of a flexible breathing circuit, gas supply,
heating/humidification mechanism, monitors, and alarms. They are
microprocessor-controlled and programmable, and regulate the volume, pressure,
and flow of respiration.

• Infusion pump: device that delivers fluids intravenously through a catheter.

Infusion pumps employ automatic, programmable pumping mechanisms to deliver
continuous anesthesia, drugs, and blood infusions to the patient. The pump hangs
from an intravenous pole that is located next to the patient's bed.
• Crash cart: also called resuscitation cart or code cart. A crash cart is a portable
cart containing emergency resuscitation equipment for patients who are "coding"
(i.e., vital signs are in a dangerous range). The emergency equipment includes a
defibrillator, airway intubation devices, resuscitation bag/mask, and medication box.
Crash carts are strategically located in the operating room for immediate
accessibility if a patient experiences cardiorespiratory failure.
• Intra-aortic balloon pump (IABP): a device that helps reduce the heart's workload
and helps blood flow to the coronary arteries for patients with unstable angina,
myocardial infarction. Intra-aortic balloon pumps use a balloon placed in the
patient's aorta. The balloon is on the end of a catheter that is connected to the
pump's console, which displays heart rate, pressure, and electrocardiogram (ECG)
readings. The patient's ECG is used to time the inflation and deflation of the balloon.

The optimal positioning of the IABP is shown in (Panel A) the femoral artery
approach and (Panel B) the left brachial artery approach.
• Anesthesia machines: a device that delivers a precisely-known but variable gas
mixture, including anesthetizing and life-sustaining gases. In this sense, anesthesia
units dispense a mixture of gases and vapors of known concentrations in order to
control the level of consciousness or analgesia of the patient undergoing surgery.
2. Patient monitoring equipment
• Monitoring system: comprehensive patient monitoring systems that can be
configured to continuously measure and display various parameters via electrodes
and sensors connected to the patient. Parameters monitored may include the
electrical activity of the heart via an ECG, respiratory (breathing) rate, blood
pressure (noninvasive and invasive), body temperature, cardiac output, and blood
carbon dioxide. Intracranial pressure monitoring may be a capability included in a
physiologic monitor.

• Pulse oximeter: monitors the arterial hemoglobin oxygen saturation (oxygen level)
of the patient's blood with a sensor clipped over the finger or toe.

3. Diagnostic equipment
The use of diagnostic equipment may be required in the operating room. Mobile X- ray
units are used for bedside radiography, particularly of the chest. These portable units use
a battery-operated generator that powers an x ray tube.
 • Handheld portable clinical laboratory devices, called point-of-care analyzers,
are used for blood analysis at the bedside. A small amount of whole blood is
required, and blood chemistry parameters can be provided much faster than if
samples were sent to the central laboratory.

4. Electrosurgery machine: produce currents of intensity needed to cut tissue and

cauterize bleeding blood vessels.
5. Suction apparatus: used to remove blood, mucous, other material from the patient’s
body, mouth, or the surgical wound.

6. Operating Table: An operating table, or surgical table, is the table on which the
patient lies during a surgical operation; Operating tables differ between hospitals and
among rooms in the same hospital. However, most of the tables consist of a
rectangular metal top that rests upon a hydraulic or mechanic, wheeled or fixed base.
The table is designed for placement of the patient in many different positions
according to the type of surgery, while enabling his body structures and his vital
processes to be safeguarded no matter what his surgical position is.

7. Surgical light (Operating Light): is to assist medical personnel during a surgical

procedure by illuminating a local area or cavity of the patient. A combination of
 several surgical lights is often referred to as a “surgical light system”. The light
should offer a good illumination on a flat, narrow or deep surface in a cavity, despite
obstacles such as surgeons' heads or hands, The central luminance cannot exceed
160 000 lux and should not be lower than 40 000 lux.

Self-test
Fill in the blank with appropriate word(s)
1. The anesthesiologist: is a physician who administered and control ----------
2. The circulating nurse: is outside of the sterile zone and is used for various purposes
including
3. Electrosurgery machine: produce currents of intensity needed to ------------

Post test
Q1. Circle the correct answer:-
1. Ventilator (also called a respirator): assists with or controls
a) Pulmonary ventilation b) blood flow c) anesthetic agents
2. Pulse oximeter: monitors the
a) Respiration rate b) blood pressure c) arterial hemoglobin oxygen saturation
Q2. Define the following:
Operating Table, surgical light.
Key answers
Pre test
1. False 2. True 3. False 4. True
Self-test
1. Anesthetic agents and patient response
2. Keeping records, obtaining supplies, preparing drugs
3. Cut tissue and cauterize bleeding blood vessels

Post test
Q1:
1. A 2.c
Q2:
Operating Table: An operating table, or surgical table, is the table on which the patient lies
during a surgical operation; Operating tables differ among hospitals and among rooms in
the same hospital. However, most of the tables consist of a rectangular metal top that
rests upon a hydraulic or mechanic, wheeled or fixed base. The table is designed for
placement of the patient in many different positions according to the type of surgery, while
enabling his body structures and his vital processes to be safeguarded no matter what his
surgical position is.
Surgical light (Operating Light): is to assist medical personnel during a surgical procedure
by illuminating a local area or cavity of the patient. A combination of several surgical lights
is often referred to as a “surgical light system”. The light should offer a good illumination
on a flat, narrow or deep surface in a cavity, despite obstacles such as surgeons' heads
or hands, The central luminance cannot exceed 160 000 lux and should not be lower than
40 000 lux.
Middle Technical University
Electrical Engineering Technical College
Department of Medical Instrumentation Engineering Techniques
Medical instruments III

Mode Unit in study

Specialized systems and Inst.
Suction Unit
For
Students of Fourth Stage
Department of Medical Instrumentation Engineering Techniques
(3rd Week)

By Lecturer
A.L. Luban Hamdy
L. Ali Ghazi
1. Overview
A-Target population: -
For students of the fourth stage in college electrical engineering technical college in
middle technical university
B- Rational: -
We will introduce a comprehensive overview about surgical suction device and its role in
the operating Room also we will restrict our attention to its other uses in the medical
field.
C- Central ideas: -
1. Definition of suction unit
2. Mechanisms of providing negative pressure or vacuum
3. Components of suction unit
4. Principle of operation of this device
5. Characteristics of all parts and their specifications.
D- Objectives: -
After studying the suction unit, the student will be able to
1. Know the device and its components
2. Identify its various uses
3. Define the Central suction system inside hospitals
4. Understand the Control system of the apparatus

2- Pretest: -
Q: Choose the correct option for the following
1. The essential parts of suction apparatus are
a) Source of vacuum. b). the reservoir. c). the delivery tubing .
.2. The efficiency of suction apparatus depends on
a). The displacement. b). the degree of negative pressure. c). the length and diameter.
d). All the previous options.
3). --------: it is a high vacuum pump, it required hydraulic oil
a) Piston pump. b) Diaphragm. c) Bellow. d) Rotary van.
3- Theory
Medical suction apparatus

Medical Suction Apparatus: Is a medical device used for suction of fluid, mucous, blood
and soft tissue during operation or outpatient clinic.
Medical Suction Apparatus requires a vacuum to function effectively. It uses negative
pressure (vacuum) to remove fluids, secretions, or debris from a patient's body during
medical procedures or treatments. The vacuum created by the apparatus helps to draw
out unwanted substances from areas such as the respiratory tract, surgical wounds, or
other body cavities, aiding in maintaining clear airways and preventing complications.
Note: the physical action of negative pressure involves the movement of fluids or gases
from areas of higher pressure to areas of lower pressure.

BASIC VACUUM
The term vacuum can be defined in two ways: as a space empty of matter or a space in
which the pressure is significantly lower than atmospheric pressure. It is the lower
pressure term that has clinical relevance. In fact, for clinical use, vacuum can be more
simply defined as negative pressure. Suction is defined as the application of negative
pressure to create movement of air, liquids or solids
The essential parts of the suction apparatus are:
1. Source of vacuum.
2. The reservoir.
3. The delivery tubing (which may include a nozzle and catheter)
4. bacterial filter
5. vacuum gauge
The efficiency of suction apparatus depends on:
1. The displacement (the volume of air sucked at unit of time, measured at
atmospheric pressure, usually expressed in liters/min. when the pump is
working).
2. The degree of negative (sub-atmospheric) pressure which can be produced by
pump with regard to the time taken to achieve it.
3. The length and diameter of delivery tube.

Eight means or mechanisms of providing negative pressure or vacuum

1- Venture tube
a short tube with a tapering constriction in the middle that causes an increase in the
velocity of flow of a fluid and a corresponding decrease in fluid pressure and that is used
especially in measuring fluid flow or for creating a suction ,
Commonly used for
1- saliva suction on dental units
2- in dry mode on steam sterilizer

2- Thermotic
This thermotic pump is engineered to provide suction by alternating the expansion and
contraction of air within a cylinder at regular intervals. This unit is designed for such
specialized uses as gastric lavage, abdominal decompression, and is
• Sealed chamber with heating element
• Heating element is De-energized
• Check valve allows air to come into the heating chamber (attached to suction bottle
• Usually very low pressure vacuum, check at chamber for suction
• Fragile heating element especially filaments .Controlled by a bimetallic strip thermostat
Discuss this (Thermotic mechanism can be used to generate negative pressure
(vacuum) through temperature manipulation).
When the chamber is heated, the air inside it expands, creating a lower pressure
compared to the surrounding environment. Conversely, cooling the chamber causes the
air inside to contract, again resulting in higher pressure. This pressure difference is utilized
to generate suction, allowing the unit to remove fluids or gases from a specific area or
source.
3- Peristaltic pump is a type of displacement pump used for moving bodily fluids from the
body and back into the body within sterile tubing to reduce contamination, is mad from
Tubing along rollers (series of rollers – fingers) Fingers (vanes) operated by stepping
motor or electromagnet.
• It operates by using a mechanism that involves squeezing and releasing a flexible
tube or hose to create a pumping action. This design allows for precise control of
the flow rate and the ability to handle a wide range of fluids.
4- Piston pump:
It is a high vacuum pump, it required hydraulic oil. The level of oil should be checked at
periodic time, that works by using a reciprocating piston to move fluid. The piston moves
back and forth inside a cylinder, creating pressure variations that draw in and push out
the fluid.

Reciprocating Piston Pumps: They consist of a hydraulic chamber were a reciprocating piston is
placed. This way, solvent gets in the pump when the piston moves back and is pushed into the
column when the piston moves forward.

Note: the physical principle of a piston pump relies on the reciprocating motion of a piston
to alternately increase and decrease the volume within a cylinder, resulting in suction and
compression strokes that enable the pump to draw in and expel fluids at a controlled rate
and pressure.

5- Bellow:
A bellows is a flexible, expandable, and contractible component typically made of airtight
material. It is often used to create a sealed chamber that can expand, and contract as
needed. Used to draw air from one direction and expel it in another.
6- Diaphragm:
Use rubber diaphragm within well closed chamber to make negative pressure with the
help of two valves, one for suck air and other for push it out.
 7- Rotary van:
Make use of rotating vanes to take the fluid from one side and push it to other side.

8- Centrifugal pump
Motor spins a turbine wheel at high speed (found in common vacuum cleaners) Large
volume of air moves through the pump creating a negative pressure Air movement
carries particles with it Commonly found in high-speed dental suction unit
Note: Impellers play a crucial role in the operation of centrifugal pumps and other fluid-
handling equipment by imparting kinetic energy to the fluid, which results in the movement
and pressurization of the fluid.
Vacuum properties and needs
1. Using a high-capacity pump connected to a large reservoir in a central position.
2. Patient side of pipeline is fitted with a self-closing non interchangeable valve,
attached to reservoir bottle and delivery tube.
3. Should be a trap, to prevent liquid and solid matter being drawn into pipeline system
which difficult to relieve it.
4. A pressure regulator to avoid high pressure applied to patient.
5. A switch on/off to control work of central vacuum pump which operate intermittently
to maintain vacuum in central reservoir.
6. Two pumps used, one in used other is stand by.
7. Output of vacuum should discharge to open air through a filter to avoid spread of
infection.

Reservoir properties:
Whatever the source of vacuum the size of reservoir is important.
1. Sufficient capacity should be allowed for all the matter to be aspirated.
If too big reservoir used, the total time to build up negative pressure in it increased even
if closed completely.
2. Rim of jar should be free from chips, sealing washer, should be in a good order to
avoid any leak.
3. Graduated jar so the aspirated volume especially blood can measure.
4. If a large jar is used, a big neck is selected so hand easily enter to clean it and
sterilization.

Delivery tubing properties:

1. The diameter and length of delivery tubing should allow the greatest possible
amount of suction at the patient end.
2. According to gas law, there is low resistance by wide tube and short length as
possible.
3. Using a firm wall tubing to prevent collapse and kinking.

Suction nozzle and catheter properties:

 1. Smooth out line tip shape to prevent damage to delicate surface.
2. Used mostly disposable plastic suction end, or other which can be cleaned and
sterilized by autoclaving and reused.
3. May be necessary to use a long narrow tube catheter as bronchial suction but
otherwise, excessive length should be avoided.
4. Two moving holes to prevent blockage.
Blockage get when the pressure is too high to pass air into delivery tubes.
Bled valve, a hole at proximal end of catheter to avoid reduced capacity, it can blocked
by a finger if required to increase suction pressure.

Control system of the apparatus:

The following control systems may be used in suction apparatus:
1. Cut off valve: when the level of liquid reaches to a certain limit, it will shut off
connecting with suction source to avoid liquid entering pump and causing it
failure.
2. Bacterial filter:
• Best placed between the reservoir and pump to prevent spread of
infection.
• Should change at regular intervals.
• Sterilizing liquid may be used in reservoir.
3. Vacuum control valve:
To decrease degree of vacuum as a bled valve places between reservoirs and pump.

4. Vacuum gauge:
Calibrated by mmHg from 0-760 fitted to tubing between vacuum central valve and
reservoir on the top of reservoir itself.
5. A stop valve: when a pump gives low displacement, the valve used to occlude
delivery tube.

Operation of suction unit

Suction applies negative pressure, which is any pressure less than atmospheric pressure
(760 mmHg, 100kPa), to allow for the movement of fluids or substances. The suction
developed by the machine will be measured as a pressure. The common units of pressure
are millimeters of mercury (mm Hg) or pascals (Pa or kPa),
 Alternative positions for pressure gauge

Pump
Trap
fahaust
-...J
◄ Nozzle
Bleed hole: when covered,
suction increased at nozzle
Reservoir jar

00 0
000
000

To

11,
4- Post test
Q1: What are the properties of the delivery tubing?
Q2: What are the reservoir properties?
5- Key answer
Pretest solutions:
Self-test solutions
1.a) 2.d) 3. a)
Post Test solutions:
Q1: Delivery tubing properties
1. The diameter and length of delivery tubing should allow the greatest possible amount
of suction at the patient end.
2. According to gas law, there is low resistance by wide tube and short length as possible.
3. Using a firm wall tubing to prevent collapse and kinking.
Q2: Reservoir properties
Whatever the source of vacuum the size of reservoir is important.
Sufficient capacity should be allowed for all the matter to be aspirated
1. If too big reservoir used, the total time to build up negative pressure in it increased even
if closed completely.
2. Rim of jar should be free from chips, sealing washer, should be in a good order to avoid
any leak.
3. Graduated jar so the aspirated volume especially blood can measured.
4. If large jar is used, a big neck selected so hand easily enter to clean it and sterilization.

Middle Technical University

Electrical engineering technical college
Department of Medical Instrumentation Engineering Techniques
Medical instruments III

Mode Unit in study

Specialized systems and Inst.
Cardiac Defibrillators
For
Students of Fourth Stage
Department of Medical Instrumentation Engineering Techniques
(4th and 5th weeks)

By Lecturer
A.L. Luban Hamdy
L. Ali Ghazi
1-Overview

A- Target population
For students of the fourth stage in college electrical engineering technical college in
middle technical university

B- Rationale
We shall establish the basic operating conditions of cardiac defibrillator. We will
introduce a comprehensive overview about this device, its components and working
principle

C- Central ideas

1. Definition of Defibrillator
2. Principle of Defibrillator
3. Defibrillation Waveforms
4. Functional Building Blocks of Defibrillators
5. Cardioversion
D- Objectives: -

After studying the Defibrillator, the student will be able to:-

1. Define Defibrillator
2. Identify components of Defibrillator
3. Understand principle of operation of defibrillator
4. Draw a block diagram of a cardiac defibrillator and explain the functions of each
block.
5. Identify and explain the functions of critical components in a typical defibrillator.
6. Explain synchronous cardioversion and its operating precautions.

2. Pre-test:-

Q. circle the correct answer

1. Monophasic Waveform give a high-energy shock, up ------ ?
a) 5- 100 joules b) 5- 200 joules c) 10 to 360 joules
2. AC defibrillator replaced by various DC defibrillators because?
a) DC signal has less deleterious effect on the heart than AC pulse
b) DC has a diminished convulsive effect on skeletal muscles
c) All previous statements
3. Treatment of ventricular fibrillation is called ------------- ?
a). Cardioversion. b) Defibrillation. c). Pacing. d). ECG

3. Theory

Introduction:

Defibrillators are devices used to supply a strong electric shock to a patient in an effort
to convert excessively fast and ineffective heart rhythm disorders to slower rhythms that
allow the heart to pump more blood. Defibrillators have been in common use for many
decades for emergency treatment of life-threatening cardiac rhythms as well as for
elective treatment of less threatening rapid rhythms.
The most serious arrhythmia treated by a defibrillator is ventricular fibrillation. Without
rapid treatment using a defibrillator, ventricular fibrillation ( see figure 1) causes
complete loss of cardiac function and death within minutes. Atrial fibrillation and the
more organized rhythms of atrial flutter and ventricular tachycardia can be treated on a
less emergent basis. Although they do not cause immediate death, their shortening of
the interval between contractions can impair filling of the heart chambers and thus
decrease cardiac output. Conventionally, treatment of ventricular fibrillation is called
defibrillation, whereas treatment of the other tachycardia’s is called cardioversion.
SA node: (SA stands for sinoatrial ) The SA node is the heart's natural pacemaker. The
SA node consists of a cluster of cells that are situated in the upper part of the wall of the
right atrium (the right upper chamber of the heart). The electrical impulses are generated
there. The SA node is also called the sinus node

AV node : AV stands for Atrioventricular The AV node, which controls the heart rate, is
one of the major elements in the cardiac conduction system. The AV node serves as an
electrical relay station, slowing the electrical current sent by the sinoatrial
(SA) node before the signal is permitted to pass down through to the ventricles.
Fibrillation
Fibrillation is the rapid, irregular, and unsynchronized contraction of muscle fibers.
There are two major classes of cardiac fibrillation: Atrial Fibrillation and Ventricular
Fibrillation.
Atrial fibrillation: is an irregular and uncoordinated contraction of the cardiac muscle of
atria.
Ventricular Fibrillation: is an irregular and uncoordinated contraction of the cardiac
muscle of ventricles.

Defibrillation: is a process in which an electronic device sends an electric shock to the

heart to stop an extremely rapid, irregular heartbeat, and restore the normal heart
rhythm.

Defibrillation should be performed with in the first 8 minutes after cardiac arrest. Ideally,
the sooner, the better.
AC Defibrillator:
Early A.C. Defibrillators needs 2 Amps on exposed heart and 5 Amps on closed heart,
(50, 90 ohms), 60 Hz current, 100–300 V, and the recommended duration ¼ second
only. Energy delivered = 500 watts per second.

AC defibrillator replaced by various DC defibrillators because:

1. DC signal has less deleterious effect on the heart than AC pulse.
2. DC has a diminished convulsive effect on skeletal muscles.
3. Can be used in the conversion of atrial arrhythmia as well.

AC Defibrillator circuit diagram

DC Defibrillator:
In almost all present day trans-thoracic defibrillators, an energy storage capacitor is
charged at a relatively slow rate form AC line by means of step up transformer and
rectifier arrangement, or from a battery and DC to DC converter arrangement. During
trans-thoracic defibrillation the energy stored in the capacitor is then delivered at a
relatively rapid rate (in order of milliseconds) to the chest of the subject. For effective
defibrillation, it’s advantageous to adopt some shaping of the discharge current pulse.
The simplest arrangement involves the discharge of the capacitor energy through the
patient’s own resistance (R), this yields an exponential discharge typical of and RC
circuit, if the discharge is truncated so that the ratio of the duration of the shock to the
time constant of decay of the exponential waveform is small, the pulse of the current
delivered to the chest has an nearly rectangular shape. For a somewhat larger ratio, the
pulse of the current appears nearly trapezoidal rectangular and trapezoidal waveforms
have also been found to be effective in the trans-thoracic defibrillation and such
waveforms have been employed in defibrillators designed for clinical use.
The basic circuit diagram of a DC defibrillator is shown in figure 2. A variable auto-
transformer T1 forms the primary of a high voltage transformer T2. The output voltage of
the transformer is rectified by a diode rectifier and is connected to a vacuum type high
voltage change-over switch. A series resistance Rs limits the charging current to protect
the circuit components, and also helps to determine the time necessary to achieve a full
charge on capacitor. In position a. the switch is connected to one end of an oil-filled 16
micro-farad capacitor. In this position, the capacitor charges to a voltage set by the
positioning of the auto-transformer. When the shock is to be delivered to the patient, a
foot switch or push button mounted on the handle of the electrode is operated. The high
voltage switch changes over to position B and the capacitor is discharged across the
heart through the electrodes.

In a defibrillator, an enormous voltage (about 4000V) is initially applied to the patient.

The high current required impairs the contractility of the ventricles. This is overcome by
inserting a current limiting inductor in series with the patient circuit. The disadvantage of
using an inductor is that any practical inductor will have its own resistance and
dissipates part of the energy during the discharge process. In practice, a 100 mH
inductor will have a resistance of about 20 ohm. The energy delivered to the patient will,
therefore, be only 71% of the stored energy.
The inductor also slows down the discharge from the capacitor by the induced counter
voltage. This gives the output pulse a physiologically favorable shape, the shape of the
waveform that appears across electrodes will depend upon the value of the capacitor
and inductor used in the circuit.

a) Basic circuit diagram for a capacitive–discharge type of cardiac defibrillator. (b) A

typical waveform of the discharge pulse. The actual waveshape is strongly dependent
on the values of L, C, and the torso resistance RL
It has been found experimentally that the success of defibrillation correlates better with
amount of energy stored in the capacitor that with the value of the voltage used. It is for
this reason that the output of a DC defibrillator is always calibrated in term of watt-
seconds or joules as a measure of the electrical energy stored in the capacitor. The
instrument usually provides output form 0-400 Ws and this range provides sufficient
energy for both external and internal defibrillation.
Energy in watt seconds is equal to, E = 0.5 CV2.If a 16 microfarad capacitor is used,
then for the full output of 400 Ws to be available, the capacitor has to b charged to 7000
V.

Classification of Waveform
There are two general classes of waveforms:
1- Monophasic Waveform
A monophasic type, give a high-energy shock, up to 10 to 360 joules due to which
increased cardiac injury and in burns the chest around the shock pad sites

2- Biphasic Waveform
A biphasic type, give two sequential lower-energy shocks of 5 - 200 joules, with each
shock moving in an opposite polarity between the pads.
Low energy biphasic shocks may be as effective as high energy monophasic shocks.
Biphasic waveform defibrillation used in implantable cardioverter defibrillator (ICD) and
automatic external defibrillators.
 b) circuit diagram of biphasic defibrillator

Monophasic waveforms:
1) The Lown waveform: shows the voltage and the current applied to the patient’s
chest plotted against time.
The current will rise very rapidly to about 20A, under the influence of slightly less than
3KV.the waveform then decays back to zero within 5msec duration. The charge
delivered to the patient is stored in a capacitor and is produced by a high voltage DC
power supply. The operator can set the charge level using the set energy knob on front
panel. This knob controls the DC voltage produced by the high voltage power supply, so
can set the maximum charge on the capacitor.
2) mono pulse waveform: this wave is created by a circuit similar to the circuit of lown
waveform but without inductor to create the negative second pulse. Consequently, the
wave form decays to zero in the exponential manner expected of an R-C network.

3) tapered delay: this waveform differs from the two previous pulses in that it uses a
lower amplitude and longer duration to achieve the energy level. The energy transferred
is proportional to the area under the square of the curve. The double-humped waveform
characteristic of tapered delay machines is achieved by placing two L-C section such as
L/C in cascade with each other.
4) trapezoidal waveform:
is another low voltage-long duration shape. The initial output potential is about 800V,
which drops continuously for about 20msec until it reaches 500V.

Types of Defibrillator
1-Internal Defibrillator
An implantable cardioverter-defibrillator (often called an ICD) is a device that briefly
passes an electric current through the heart.
1. It is "implanted," or put in your body surgically.
2. It includes a pulse generator and one or more leads.
3. The pulse generator constantly watches your heartbeat.
External Defibrillator
Electrodes placed directly on the chest.
e.g., AED (Automatic External Defibrillator)

External Electrodes of defibrillator:

The electrodes for external defibrillations are usually metal discs about 3-5 cm in
diameters and attached to highly insulated handles, for internal defibrillation large spoon
shaped electrodes are used. Some of the external electrode contains safety switches
inside the housings and the capacitor is discharged only when the electrodes are
making a good and firm contact with the chest of the patient.
Electrode gel is usually used to reduce contact impedance.
Pre-gelled and self adhesive electrodes have been introduced to meet the requirements
of good and firm contact.
 ⚫ Types of defibrillator electrodes:-
a) Spoon Shaped Electrode
Applied directly to the heart.
b) Paddle type electrode
Applied against the chest wall
c) Pad Type Electrode
Applied directly on chest wall

Cardioversion:

In certain type of arrhythmia (atrial fibrillation) the patients ventricles maintain their ability
to pump blood, evidence by R-wave, these arrhythmias are also corrected by electrical
shock to the heart, but it is necessary to avoid delivering this shock during T-wave.
The shock used to correct the problem may actually create much more serious
arrhythmia such as ventricular fibrillation.
The shock is timed to occur 30 ms after the R- wave peak to prevent ventricles
fibrillation to occur. The machine equipped with synchronizer cct. Is called a
cardioverter.

The block diagram of the cardioverter

Cardoiversion after defibrillation

4. Self-test
1 ---------------- The initial output potential is about 800V, which drops continuously for
about 20msec until it reaches 500V
a) trapezoidal waveform b) lown waveform c) tapered delay waveform
2.The most serious arrhythmia treated by a defibrillator is a --------
A. Bradycardia. B. arterial fibrillation. C. Ventricular fibrillation.
5. Post test
Q: Explain with drawing the AC defibrillator.
6. Key answer
Pre test solution
1. c) 2.c) 3. b)
Self-test solution
1. a) 2.c)
Post test solution
AC Defibrillator:
Early A.C. Defibrillators needs 2 Amps on exposed heart and 5 Amps on closed heart,
(50, 90 ohms), 60 Hz current, 100–300 V, and the recommended duration ¼ second
only. Energy delivered = 500 watts per second.

AC defibrillator replaced by various DC defibrillators because

1. DC signal has less deleterious effect on the heart than AC pulse
2. DC has a diminished convulsive effect on skeletal muscles
Can be used in the conversion of atrial arrhythmia as well.3

AC Defibrillator circuit diagram

7. References
S. Ananthi ,2005,”A text book of medical instruments”
Middle Technical University
Electrical engineering technical college
Department of Medical Instrumentation Engineering Techniques
Medical instrument

Mode Unit in study

Dental system
For
Students of Fourth Stage
Department of Medical Instrumentation Engineering Techniques
(6th, 7th, and 8th weeks)

By Lecturer
A.L. Luban Hamdy
L. Ali Ghazi
1. Overview

A-Target population: -
For students of the fourth stage in electrical engineering technical college in middle
technical university
B- Rational: -
Give a comprehensive overview about dental unit Training the student on how the
machine works

C- Central ideas
1. Definition of dental unit
2. Working principle dental unit
3. Components of dental unit

D- Objectives
After studying the dental unit the student will be able to
1. Define the dental unit
2. Understand working principle of dental unit
3. Determine the faults resulting from using this device

2. Pre test
Q: Put True or False in front of each sentences:
1. There are three main cycles in the dental unit.
2. Air in this device should pass through two filters.
3. The ranges of work pressure it between 5-7 bar in dental unit.
3. Theory
Dental unit:
Provides the necessary electrical and air-operated mechanics to the hoses, attachments,
and working parts of the unit.

Dental unit delivery systems

• Front delivery: Positioned over the patient's lap.
• Side delivery: Positioned at either side of the patient's chair.
• Rear delivery: Positioned behind the dental chair.
 Rheostat: A foot-controlled device placed on the floor near the operator to control the
function of the dental handpieces.

Dental unit waterlines: supplies water through hoses or water lines into dental
handpiece.

Air-water syringe: is an instrument that is attached to the dental unit.

Functions
• Deliver a stream of water.
• Deliver a stream of air.
• Deliver a combined spray of air and water.
Operating light is used to illuminate the oral cavity during a procedure.

Oral evacuation system is a means for removing water, saliva, blood, and other
fragments during a dental procedure.
Types:
• Saliva ejector
• High volume evacuator (HVE)
 Disposable traps: Filtering mechanisms for the saliva ejector and high volume
evacuator.
The curing light is used to “harden” or light-cure dental materials. The light used falls
under the visible blue light spectrum. The two main dental curing lights are halogen and
LED. The wavelength of the halogen curing system is (410-480) nm and for the LED curing
system is (420-490) nm. The light intensity is ranged from 600 to 1220 mW/cm2. The
intensity of the curing light is strongly affected by the angles and distance.

An amalgamator is used to triturate dental materials by vigorously shaking the

ingredients. The speed is up to 4,800 rpm.
Central vacuum compressor provides the suction needed for the oral evacuation
systems.
Central air compressor provides compressed air for the air-water syringe and air-
driven hand pieces.
• Note: triturate (mean crush or grind) the mixing or grinding of a powder such as the
mixing of silver alloy and mercury to form amalgam.
Dental Systems Components:
1. Projector: LED light with intensity (15000-30000) lux Projector
2. Chair
3. Basin
4. Cup
5. Saliva ejector
6. Foot switch
7. Fast turbine
8. Micro-motor: A. air motor (17-20KR\m) B. Micro motor (500KR\m)
9. Triple syringe (Water, Air, Spray)
10. Dental X-ray
Three cycle of Dental system:
Electrical cycle Air cycle Water cycle
1. Chair 1. Triple syringe 1. Saliva ejector
2. Projector 2. Fast turbine 2. Basin
3. Basin 3. Slow turbine 3. Cup
4. Cup 4. Triple syringe
5. Saliva ejector
6. Foot switch
7. Triple syringe
8. Fast turbine
9. Slow turbine
Block Diagram of Air Cycle

Figure: Block diagram of Air cycle

Air Cycle
Air in this device should pass through two filter first is glass filter which contain fiber glass
with wide pore the second is the cotton filter with fine pore which serve for air purification
the air is used by the following devices.
1- slow speed turbine (rotate with speed 17-20 KR/min)
2- high speed turbine (rotate with speed 150-500 KR/min)

3- Triples syringe which mixed air with water to discharge it as spray.

Block Diagram of Water Cycles

Figure: Block diagram of Water cycle

Water Cycle
Water come from the source and then enter filter for its purification, then through the
valve and the heater at last go through triple syringe either by automatic or mechanic
manner. Also from the valve the water go through the regulator to the cup. The waste
water and the saliva go through the Basin for discharge out.
 Solenoid Valve
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Parts of Solenoid Valve
1, 12 V. DC Power Supply

Spring

6, Rubber seal I O-ring

7. Orifice

Inlet Thread
Outlet Thread

D C
B

Solenoid at rest. A
valve closed

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A- Input side
B- Diaphragnn
C- Pressu.-e chamber
D- Pressure relief passage
E- !Electro Mechanical Solenoid
F- Output side
Block Diagram for electrical circuit for Dental device

The air flow for compressor and tank:

Compressor-consists from electric motor and pump which connect directly or through a
belt. It draw atmospheric air from the filter and directed it by the one direction check valve
to the reservoir until filling of reservoir. The air pressure in the reservoir is controlled by
pressure meter, and the air compressor is controlled automatically by pressure switch
which tied respectively with motor. The range of work pressure it between 5-7 bar. The air
in air tank should be empty at the end of the day or week .because of water drops may
accumulate in the tank which may lead to the following problems:
1- Break the inner surface of the reservoir.
2- Reduce the size of compressed air.
The block diagram air flow for compressor and tank:
Electric circuit of the compressor

Preventive maintenance of compressor:

1. Weekly Maintenance
A. Check the oil level through the lens of the oil level control, must be level between the
lines (mm, max) must use quality oil for compressor.
B. Empty air tank using vacuum valve.

2. Monthly maintenance
A. Check the compressor and air lines of diversions
B. Inspection and cleaning or replacement candidate entering the air.
C. examination and cleaning of the pressurize pipeline connectivity KP the compressor &
remove dust.

Slow Turbine
It is a part of dental chair device depends on air by its work and has the following
advantages: -
1- high speed 17-20 Krpm.
2- small size
3- Move by air force
4- few fault

It consists of the following parts:-

1. The clutch part with hand piece.
2. Spring and cylindrical holders.
3. Set of ball bearing enable for rotation.
4. The spinner part is the heart of the device contain of metal sheet of mica
5. Container containing entry and exit holes air
6. Lever change the direction of rotation
7. Digging machine.

Mode of operation "operation principle”

The movement of turbine depend on air force .The compressed air with pressure ranging
from 5-7 bar enters through the entrance hole and push the plate of mica forward to rotate
in high speed the iron core of the turbine with the help of ball bearing.

The micro motor circuit

Micro Motor
It is a very small electric motor which replaced the turbine machine and has the following
Advantage:-
1- Small in size, occupies a major place in die device,
2- working on a few constant voltage 22-24 volts.
3- motor speed can be controlled by potentiometer.
4- Rapid turnover motor brushes.

One of the most important faults of this device is the erosion of the brushes due to friction.

Principle of work

1- low voltage transformer to convert input voltage from 220 V to 30 V.

2-Rectifier circuit to convert 30 V -AC to 22-24 V DC.
3-The Dc voltage inter the rotator by brushes connection which produce magnetic field
which intersect with the magnetic field of the permanent magnet of the motor which lead
to its rotation

Chair Action:
1. Chair rise up: by clicking on the key to rise the chair electric motor as well as the
hydraulic pump will work and push the hydraulic fluid from the reservoir and valve that
starts to open so the hydraulic fluid inter the cylinder and push the piston to rise the chair.
2. Chair go down: this action depend on the weight of the patient and the chair itself. By
opening the valve which control the return of the hydraulic fluid to the tank.
3. Forward and backward movement:
By clicking on forward key, the sensor as well as the motor will push the hydraulic fluid
through the opened valve and push the chair piston forward and vice versa moving
backward.
4- Self test
Q/ Put True or False in front of each sentences:
1. Slow turbine depends on Dc voltages by its work.
2. Air in dental unit should pass through one filter.
3. Micro motor used to replace the turbine machine.
4. The maintenance of compressor should be weekly and monthly.
5. Post test
Q1: Draw the Block Diagram of Water Cycles and explain it.
Q2: Draw the block diagram of air flow for compressor and tank and explain it.
6. Key answers
Pretest solutions:
1.T. 2. T 3.T.

Self-Test:
1F. 2. F 3.T 4.T.

Post Test solution:

Q1:
Block Diagram of Water Cycles

Water Cycle
Water come from the source and then enter filter for its purification ,then through the valve
and the heater at last go through triple syringe either by automatic or mechanic
manner .Also from the valve the water go through the regulator to the cup. The waste
water and the saliva go through the Basin for discharge out.

Q2:The air flow for compressor and tank:

Compressor-consists from electric motor and pump which connect directly or through a
belt .it draw atmospheric air from the filter and directed it by the one direction check valve
to the reservoir until filling of reservoir .The air pressure in the reservoir is controlled by
pressure meter, and the air compressor is controlled automatically by pressure switch
which tied respectively with motor .The range of work pressure it between 5-7 bar. The air
in air tank should be empty at the end of the day or week .because of water drops may
accumulate in the tank which may lead to the following problems. 1 -Break the inner
surface of the reservoir 2-Reduce the size of compressed air
The block diagram air flow for compressor and tank:
Middle Technical University
Electrical engineering technical college
Department of Medical Instrumentation Engineering Techniques
Medical instruments III

Mode Unit in study

Gynecology Inst. And Ultrasonic assisting device.
FHR & Labor monitoring Devices
For
Students of Fourth Stage
Department of Medical Instrumentation Engineering Techniques
(9th, 10th, 11th, and 12th Weeks)

By Lecturer
A.L. Luban Hamdy
L. Ali Ghazi
1. Overview
A- Target population:-
For students of the fourth stage in electrical engineering technical college in middle
technical university
B- Rationale: -
We will introduce a comprehensive overview of FHR& Labor monitoring devices and
identify the parts and components of this device.

C- Central ideas:-
1. Monitoring Parameters
2. Components of the FHR & labor monitoring system
3. Working principle of FHR monitoring
4. Methods of Monitoring Uterine Activities

D- Objectives
After studying FHR & Labor monitoring system the student will be able to: -
1. Define the FHR & Labor monitoring devices
2. Describe the clinical significance of fetal heart rate and maternal uterine activities
during labor
3. Describe and compare external and intrauterine methods of monitoring uterine
activities
4. Explain the construction and principle of transducers and sensors used in fetal
monitoring
5. Sketch a simple block diagram of a fetal monitor
2. Pre test
Q: put true or false in front of each of the following sentences:
1. In obstetric applications, the site of investigation varies from 10 to 50 cm below the
surface of the abdomen.
2. The ultrasound Doppler shift method is more practical and easy to use during labor.
3. Movements of the fetal heart wall are slower as compared to valve movements and,
therefore, produce a more frequency shift.

3. Theory

FHR & Labour monitoring Devices

Introduction:
An important clinical instrument for obstetric applications which makes use of the Doppler
shift principle is fetus blood flow detector. The technique is extended to derive an
integrated rate of the fetus heart from blood flow signals and to display it on a suitable
display system. In obstetric applications, the site of investigation varies from 5 to 20 cm
below the surface of the abdomen.

This depends upon the patient and the stage of pregnancy. For obstetric studies,
ultrasonic frequency of about 2 to 2.5 MHz is usually employed, whereas in the study of
blood flow in arteries and superficial blood vessels frequencies around 5-10MHz is
preferred. The level of ultrasonic energy transmitted into the body is generally kept
between 10-15 mW/cm2. Assuming a maximum of 50% conversion efficiency, this would
mean that the transducer should be powered with an electrical energy below 30 mW/cm2.
Fetal blood flow detector
• The Doppler-shift based ultrasound fetal blood flow detectors use hand-held probes
which may be either pencil-shaped or flat and contain two piezo-electric crystals.
• The probe is coupled to the patient’s skin by means of an acoustic gel. This is done
to exclude any air from the interface. The presence of air severely attenuates the
ultrasound.
• The transmitting crystal emits ultrasound (2-2.5 MHz) and the backscattered
ultrasound is detected by receiving crystal. The back-scattered ultrasound
frequency would be unchanged if the reflecting object is stationary.

• If the reflecting object is moving, as would be the fetal heart blood vessels, then the
back-scattered frequency is higher as the blood cells is approaching the probe, and
lower if it is moving away from the probe. The magnitude of the frequency shift (∆ƒ)
varies according to the following formula:
∆ƒ= (2ƒou cosθ)/c
where ƒo represents the transmitted frequency, u is the blood velocity, cosθ is the cosine
of the angle of the sound beam and the object's direction, and c denotes the velocity of
the sound wave in the tissue.
 Constructional details of an ultrasonic Doppler transducer used for fetal heart studies.

The ultrasound Doppler shift method is more practical and easy to use during labor. It is
currently the most reliable method for detecting the fetal heart rate (FHR) pattern that is
interpretable. Signal processing for FHR determination can be based either on detecting
the fetal heart valve motion or on detecting the heart wall motion. The heart valve motion
detection technique is based on the small heart valves involving a longer search period
and frequent repositioning of the transducer. Therefore, it is not preferred for continuous
monitoring applications. Movements of the fetal heart wall are slower as compared to
valve movements and, therefore, produce a smaller frequency shift. This signal is less
precise than the heart valve signal and tends to produce more jitter on the FHR trace
often , they are better suited for continues monitoring, in order to reduce jitter on the
trace, the usual practice is to incorporate a signal smoothing circuit with an averaging
time constant over a window of approximately three heart periods.

Transducers
Two types of ultrasonic transducers for FHR measurement are common use. They are
the narrow beam and the wide-angle beam types. The narrow beam transducer used a
single ultrasound transmitter/receiver piezo-electric crystal pair. The maximum
ultrasound intensity is generally kept below 25 mw/cm2. The typical transducer diameter
is 25 mm. the narrow beam transducer is very sensitive and produces a good trigger
signal for instantaneous heart rate determination.
 However, it takes time to detect a good signal and, therefore, frequent transducer
repositioning is necessary. The broad beam transducers are available in many
configurations. The transducers comprise a number of piezo-electric crystals mounted in
such a way as to be able to detect fetal heart movements over a wider area. In one
arrangement, the ultrasonic transducer is arranged in the shape of a clover-leaf so that it
provides a large area of ultrasonic illumination which allows the monitoring considerable
lateral and descending fetal motion before requiring repositioning.
The transducer housing is flexible to permit it to follow the contour of the abdomen
regardless of the shape changes with contractions. The traducer has three crystals on
the other side acting as a transmitter whereas the crystal placed at the centre acts as a
receiver. An alternative arrangement is the array transducer which has one transmitter
and six peripheral ceramic receiving crystals as in figure 1.

The transmitting crystal emits a 40° divergent beam so that at 10 cm from the skin
surface the beam covers an area of approximately 10 cm from the skin diameter.
This construction ensures continuous recording of the fetal heart activity without the
need to reposition the transducer which is otherwise necessitated due to normal fetal
movement. The transducer has a diameter of 6 cm and can be held in place either by a
simple buckle or a stretch belt.

Figure 1. Multireceiver transducer

Analysis of ultrasonic Doppler signals using a speech spectrograph shows that

frequency components in the range of 100-1000 Hz tended to be more distinctly related
to the fetal heart cycle than components lying outside this frequency range. The band
pass filter, therefore, enhances the signal/noise ratio-the noise in this context banning,
for example, fetal movements at low frequencies and maternal placental blood flow at
high frequencies.
With ultrasonic Doppler signals, there remains the possibility of more than one burst in
each cardiac cycle being detected. In some instruments, this difficulty is overcome by
the dead-time generator, which inactivates the detector for a period of 0.3 sec after an
amplitude burst has been detected. This dead time is chosen on a compromise basis: it
defines a maximum heart rate (200bpm) that can be detected while at rates which are
less than half this maximum, i.e. 100 bpm, it is conceivable to double –count the signal,
although the total signal processing in many instruments goes far in minimizing this
frequency-doubling possibility, the effect remains a fundamental limitation of using the
fetal ultrasonic Doppler signal for recording heart rate.

4. Self-test: -
Q: Fill in the blank for the following sentences:
1. For obstetric studies, ultrasonic frequency of about --------- is usually employed.
2. The study of blood flow in arteries and superficial blood vessels frequencies around --
- ----- is preferred.
3. The maximum ultrasound intensity in FHR is generally kept below ----------.

FHR block diagram:

The principle of ultrasonic Doppler-shift based FHR measuring circuit is shown in the
block diagram in figure 2. This arrangement can be used both with a wide angle beam
as well as a narrow beam transducer. The transmitted signal that leaks into the receiving
path serves as a local-oscillator signal for the mixing diodes in the demodulator. The
output of the demodulator is dc except the presence of a Doppler-shift frequency. The
reflected signal is some 90 to 130 dB lower in amplitude than the transmitted signal.
The high overall gain in the receiving channel (+110 dB) requires special measures to
minimize the effects of interference. One measure used is a low noise, low distortion
oscillator for the transmitter. This reduces interference caused by oscillator harmonics
beating with radio and TV signals. Other measures involve filters in the transducer
connected for attenuating high-intensity high frequency radiation that could drive the
amplifiers into a non-linear operating region. The high frequency section of the circuits is
surrounded by both magnetic and electrical shields.
 Figure2. Ultrasound Doppler-shift based FHR block digram
Depending upon the transducer used, i.e. array or narrow beam, the filter circuit can be
selected to match the Doppler-shifted frequency components. A band pass filter
centered on 265 Hz isolates the Doppler frequencies resulting from the movement of the
heart walls. The array transducer used with this circuit gives a broad ultrasonic beam
that does not require careful positioning to obtain a strong Doppler return from the
relatively large heart walls.
• Figure shows the circuit diagram of the ultrasonic transmitter.
• It consists of an oscillator (X1) that generates an ultrasound frequency followed by
an amplifier (U2) to condition the sine waveform. This waveform is applied to the
transmitter transducer to generate and send ultrasound vibrations through the
body, which get reflected back when the density of the medium changes.
• In the transmitter circuit, the resistor R3 limits the current to transformer T1.
 Figure Block diagram of ultrasound transmitter circuit.

Figure below shows the block diagram of the ultrasound receiver.

Transformer T2 provides isolation between the circuit and the patient's body.
The received reflected ultrasound is converted into electrical signal by the receiving
transducer.
This signal is amplified using an instrumental amplifier and is sent to a bandpass filter.
The filtered signal is sent to a phase-locked loop to generate a voltage signal, which
depends on the frequency applied.
The reflected ultrasound signal is mixed with the transmitted wave, and the beat
frequencies are produced when there is a Doppler shift.
The beat frequency voltage signal is given to an analog-to-digital converter (ADC) and
microcontroller for processing the information and displaying the audio signal on a
speaker, digital heart rate on LCD screen, and for wireless communication.

Block diagram of ultrasound receiver circuit

Monitoring labor activity
During labor, the uterus muscle starts contractions of increasing intensity in a bid to
expel out the child. The intrauterine pressure can reach values of 150 mmHg or more
during the expulsion period. However, a normal patient in spontaneous active labor will
demonstrate uterine contractions occurring at intervals of three to five minutes, with
duration of 30-70 s and peak intensity of 50 to 75 mmHg.
Each uterine contraction diminishes placental perfusion and acts as a transient stress to
the fetus, which may be damaged by excessive contractility or by prolonged duration of
labor. Some patients will spontaneously exhibit much lower uterine activity, in terms of
intensity and frequency of contractions than others but will still show progressive cervical
dilation and an otherwise normal progress of labor.
The labor activity can be recorded either in terms of the intra-uterine pressure measured
directly by means of a catheter or a relative indication of the labor intensity measured
through an external transducer. A plot of the tension of the uterine wall is obtained by
means of a spring loaded displacement transducer.
The transducer performs a quasi-isometric measurement of the tension of the uterus.
The transducer carries a protruding surface of the transducer is displaced as the tension
in the uterus increases. This movement is converted into an electrical signal by a strain
gauge in the transducer housing. The abdominal transducer provides a reliable
indication of the occurrence frequency, duration and relative intensity of the contraction.
The transducers are location sensitive. They should be placed over the fundus where
there is maximum motion with the contraction. The transducer cannot be used in the
same place as the fetal heart rate detector, thus the patient must have two transducers
on her abdomen.
To sense uterine contractions externally, it is necessary to press into the uterus through
abdominal wall. Resistance to pressure is measured either by the motion of a spring or
the force needed to prevent a button from moving.
External strain gauges are used to measure and record the bending of a spring. In some
instruments, a crystal which changes electrical characteristics with applied pressure is
used to measure force against a plunger. This method is automatic and provides pertinent
information.
Figure 3 shows a block diagram of the circuit which measures labor activity externally.
The utilized transducer is linear variable differential transformer (LVDT) transducer.
Figure 4 illustrates what happens when the LVDT's core is in different axial positions. The
LVDT's primary winding, P, is energized by a constant amplitude AC source. The
magnetic flux thus developed is coupled by the core to the adjacent secondary windings,
S1 and S2. If the core is located midway between S1 and S2, equal flux is coupled to each
secondary so the voltages, E1 and E2, induced in windings S1 and S2 respectively, are
equal. At this reference midway core position, known as the null point, the differential
voltage output, (E1 - E2), is essentially zero. As shown in Figure 2, if the core is moved
closer to S1 than to S2, more flux is coupled to S1 and less to S2, so the induced voltage
E1 is increased while E2 is decreased, resulting in the differential voltage (E1 - E2).
Conversely, if the core is moved closer to S2, more flux is coupled to S2 and less to S1,
so E2 is increased as E1 is decreased, resulting in the differential voltage (E2 - E1).
The transducer output is amplified in an AC amplifier. The low frequency labor activity
signal is obtained from the synchronous detector and is further amplified by a dc amplifier.
The activity can be either displayed on a meter or on a direct writing chart recorder.

The labor-activity transducers are pressure transducers that drive circuits for obtaining an
electrical indication of pressure by conventional means.
The pressure channel on the recorder is provided with a positioning control. This is done
because the baseline is affected by the static pressure on the transducer that results from
the tension on the belt holding the traducer in place, the control permits the operator to
position the base line on the zero-level line of the recording chart.
 Figure 3. Labour Activity Monitor block diagram.

In external toco-tonometry, movement of the fetus may be superimposed on the labor

activity curve. Stress imposed on the fetal circulatory system by the uterine contractions,
fetal movements or other factors are seen in the response of the fetal heart to these stimuli
and are studied in the correct time relationship.
The internal method measures intra-uterine pressure (IUP) via a fluid-filled catheter. The
catheter is inserted into the uterus through a guide after the rupture of the fetal membranes.
After allowing free flow of amniotic fluid to ensure correct placement, the distal end of the
catheter is usually attached to a pressure transducer of the type used for cardiac studies.

Changes in amniotic pressure are easily transmitted to the gauge by the incompressible
fluid in the catheter. The pressure transducer converts the catheter pressure into an
electrical signal which can be displayed on the strip chart recorder.
Strain gauges, though very accurate, tend to drift up to several mmHg/h or drift with
temperature changes. Therefore, when continuous monitoring is employed, it is necessary
to set zero and calibrate the transducer frequently. The peak pressure may vary according
to which catheter is placed in the uterus. It is necessary to flush the catheter system to
avoid any blockage and to maintain the frequency response.
Although the system is inherently capable of having great accuracy, catheter-obtained
uterine contraction date may be distorted or inaccurate. The IUP may be accurately
recorded only as long as a fluid pool is sustained around the tip of the catheter and leakage
is completely controlled by the descending fetal head.
Since there is no real control of catheter placement, it may slip into an isolated pocket and
receive very high pressure, especially if there is little fluid, also, the uterus only
approximates a closed fluid chamber, and pressures are not necessarily transmitted
equally to all segments. Open segments tend to lose fluid and thus may generate lower
pressures. One study showed that IUP varies by as much as 25% at different points in the
uterus. Thus, the physiological measurement does not approach the instrument in
accuracy or reproducibility.

5. Post test: -
Q1: circle the correct answer
1. Narrow beam transducer used
a) Single ultrasound (transmitter\ receiver) b) number of crystal c) both of them
2. A normal patient in spontaneous active labor will demonstrate uterine contractions
occurring at intervals
a) 1-2 min b) 3 -5 min c) 5 – 10 min

Q2. Explain principle of ultrasonic Doppler-shift based FHR measuring circuit

6- key answer
Pretest solution:
1. False. 2. True. 3. False.

Self test solutions:

1. 2 to 2.5 MHz. 2. 5-10MHz. 3. 25 mw/cm2.

Post test solutions:

Q1. 1) a 2) b

Q2.

FHR block diagram:

The principle of ultrasonic Doppler-shift based FHR measuring circuit is shown in the block
diagram in figure 2. This arrangement can be used both with a wide angle beam as well
as a narrow beam transducer. The transmitted signal that leaks into the receiving path
serves as a local-oscillator signal for the mixing diodes in the demodulator. The output of
the demodulator is dc except the presence of a Doppler-shift frequency. The reflected
signal is some 90 to 130 dB lower in amplitude than the transmitted signal. The high
overall gain in the receiving channel (+110 dB) requires special measures to minimize the
effects of interference. One measure used is a low noise, low distortion oscillator for the
transmitter. This reduces interference caused by oscillator harmonics beating with radio
and TV signals. Other measures involve filters in the transducer connected for attenuating
high-intensity high frequency radiation that could drive the amplifiers into a non-linear
operating region. The high frequency section of the circuits is surrounded by both
magnetic and electrical shields.

Figure2. Ultrasound Doppler-shift based FHR block digram

Depending upon the transducer used, i.e. array or narrow beam, the filter circuit can be
selected to match the Doppler-shifted frequency components. A band pass filter centered
on 265 Hz isolates the Doppler frequencies resulting from the movement of the heart walls.
The array transducer used with this circuit gives a broad ultrasonic beam that does not
require careful positioning to obtain a strong Doppler return from the relatively large heart
walls

7. References
R.S. Khandpour. "Medical instrumentation design and application"
Middle Technical University
Electrical engineering technical college
Department of Medical Instrumentation Engineering Techniques
Medical instruments III

Mode Unit in study

Anesthesia Machine
For
Students of Fourth Stage
Department of Medical Instrumentation Engineering Techniques
(13th and 14th Weeks)

By Lecturer
A.L. Luban Hamdy
L. Ali Ghazi
1- Overview

A- Target Population
For students of the fourth stage in electrical engineering technical college in middle
technical university

B- Rationale
A practical overview of anesthesia machine, its components, definition and training of
the student on this device

C- Central ideas
1. Principles of Operation of anesthesia machine
2. Components of anesthesia machine
3. Gas Supply and Control Subsystem
4. Breathing and Ventilation Subsystem
5. Scavenging Subsystem

D. Objectives
After studying the anesthesia machine the student will be able to
1. Define of anesthesia machine
2. Understand State the functions of an anesthesia machine
3. Identify the device and its importance,
4. Understand principle of operation of anesthesia machine
5. Sketch the gas circuit/piping diagram of a continuous-flow rebreathing anesthesia
machine

.
2. Pre test

Q: put true or false in front of each of the following sentences.

1. Sedation means irreversible patient unconsciousness.
2. The infusion pump required for intravenous anesthesia.
3. The gases commonly used in anesthesia are O2, N2O and air.
4. The variable bypass vaporizer is the most commonly used for vaporization of many
agents.
5. Soda lime is used for absorbing CO2.

3. Theory

Anesthesia Machine
Introduction:

Although anesthesia has been generally described as the part of the medical profession
that ensures that the patient’s body remains insensitive to pain and other stimuli during
surgical operations, anesthesia is understood as a patient care within four different
domains: sedation (reversible patient unconsciousness), relaxation (temporal reduction of
the motoric functions of the patient in order to ease the surgical procedures), analgesia
(insensitivity to pain), and respiration (granting the respiratory function in order to avoid
permanent damage to the different tissues), which has led medical device manufacturers
to develop complex machines for anesthesia delivery and patient monitoring.
Figure 1, which shows a typical setting found in many operating rooms, includes the
equipment required for the delivery of vaporized and intravenous agents in order to allow
the proper sedation method for each patient and surgical procedure.
The main elements of the anesthesia delivery system illustrated include the gas supply
system, the gas mixing subsystem, the vaporizer for inhaled agents, the mechanical
ventilator, the breathing circuit of the patient, the absorber for CO2 removal, the infusion
pumps required for intravenous anesthesia, and the monitoring subsystem for patient and
equipment supervision.
Figure 1. Simplified view of the anesthesia machines in the operating room. (1)
Central gas supply (oxygen, nitrous oxide, and air), (2) high-pressure gas
cylinders, (3) gas flowmeters and mixing controls, (4) anesthetic agent vaporizers,
(5) mechanical ventilator, (6) breathing reservoir bag, (7) absorber for carbon
dioxide removal, (8) patient and machine monitors, (9) monitoring amplifier
modules, (10) infusion pumps, and (11) standing pole.

Principles of Operation
An anesthesia machine is a device that delivers a precisely-known but variable gas
mixture, including anesthetizing and life-sustaining gases. In this sense, anesthesia units
dispense a mixture of gases and vapors of known concentrations in order to control the
level of consciousness or analgesia of the patient undergoing surgery.
Anesthesia is achieved by administering a mixture of O2, the vapor of a volatile liquid
halogenated hydrocarbon anesthetic, and, if necessary, N2O and other gases. As
spontaneous breathing is often depressed by anesthetic agents and by muscle relaxants
administered in conjunction with them, respiratory support is usually necessary to deliver
the breathing gas to the patient. For these purposes, the anesthesia machine must
perform the following functions:
• Assuring the proper oxygen (O2) flow delivery to the patient.
• Vaporizing the volatile anesthetic agent and blending it into a gas mixture with O2,
nitrous oxide (N2O), other medical gases, and air.
 • Granting the ventilation of the patient by controlling spontaneous ventilation and
using mechanical assistance if needed.
• Minimize the anesthesia-related risk to the patient and the clinical personnel.

In Figure 2, the gas flow supplied by either the pipelines (2) or the security high-pressure
cylinders (1) is regulated at the flow meters (5) and mixed in the common gas manifold
entering the vaporizer (8), where this mixture is vaporized with the anesthetic agent used.
This fresh gas flow is then sent to the patient through the breathing circuit (12), that also
collects the expired gas in order to process it through the circuit selected (15). In either
case, the gas will pass through the absorber (14) in order to remove carbon dioxide before
returning to the inspiratory branch. If mechanical ventilation is used, the ventilator (18)
sets the inspiratory and expiratory cycles according to the control adopted.
Figure 2. Schematic diagram of an anesthesia machine for the delivery of inhaled
agents. (1) High-pressure gas cylinder, (2) central gas supply outlet, (3)
unidirectional-flow valve, (4) pressure regulator, (5) gas flowmeter, (6) fail-safe
device, (7) carrier gas selector, (8) vaporizer, (9) oxygen flush valve, (10) fresh gas
flow positive pressure relief valve, (11) unidirectional inspiratory valve, (12) patient
breathing circuit, (13) unidirectional expiratory valve, (14) carbon dioxide absorber,
(15) mechanical ventilation or spontaneous breathing circuit selector, (16)
breathing reservoir, (17) adjustable pressure limiting valve or pop-off valve, (18)
mechanical ventilator, (19) ventilator driving gas selector, (20) scavenging gas
positive pressure relief valve, (21) scavenging gas negative pressure relief valve,
(22) scavenging reservoir bag, and (23) central vacuum inlet.
In the case of spontaneous ventilation, the exhaled gas is scavenged through an
adjustable pressure limiting valve (APL) to the available waste gas removal system (23).

From the description related above, the anesthesia machine may be understood as the
ensemble of the following subsystems:
• Gas supply
• Flow Regulators
• Vaporizer
• Breathing system
• Scavenging system

Gas Supply System

As mentioned above, anesthesia machines do not just administer the anesthetic agents
but also life-sustaining gases, such as oxygen and nitrous oxide (that may be substituted
by medical air or helium, among others), so that dedicated systems have been developed
for precisely supplying the proper concentration of these gases to the patient. In this sense,
the gas supply system relies on three different components: the gas source, the flow
regulators, and the associated safety devices.

Gas Sources
The gases commonly used in anesthesia (oxygen, nitrous oxide, and compressed air) are
under high pressure and may be piped in from a central storage area or used directly from
nearby compressed gas cylinders in case of central supply failure (4–9).

Central Gas Supply

Air is produced and distributed from a compressor plant on-site. These gases are usually
supplied at 345KPa (50 psi) after a two-stage regulation from the nominal pressure of the
tanks. The wall outlets (2) are usually suited with primary and secondary check valves
(that prevent reverse flow of gases from machine to pipeline or atmosphere), a pressure
regulator, and a filter for the removal of the impurities.

Gas Cylinders
In case of central supply failure, the anesthesia machine should be fitted with a backup
source of medical gases in order to grant continuous ventilation to the patient, which has
become mandatory in most countries where the use of backup gas cylinders is specifically
included within the regulations related to anesthesia machines. For this purpose, it is
advisable to include cylinders for oxygen and nitrous oxide delivery.
These compressed gas cylinders (which are mounted on yokes attached to the anesthesia
machine) use a filter, and unidirectional flow check valve, a pressure regulator, and gauge.
The pressure regulator (4) is needed to set the gas pressure below the pipeline supply
pressure (310KPa for the cylinders) in order to prevent recirculation of the gas from the
cylinders to the central supply system. Aside from this pressure regulator, cylinders
usually include additional security features such as a safety relief device consisting of a
frangible disc that bursts under extreme pressure, a fusible plug made of Wood’s metal
that has a low melting point, a safety relief valve that opens at extreme pressure.

Safety Devices
In order to prevent damage associated with hypoxic ventilation, several safety devices are
included within the anesthesia machine. The hypoxic Guard system links the controls of
O2 and N2O in order to avoid the administration of hypoxic gas mixtures (mixtures
containing less than 25% oxygen). This system is complemented by means of the so-
called fail-safe device (6), which shuts off the nitrous oxide supply when the oxygen
pressure at the flow meter falls below a certain threshold value, which typically ranges
from 69KPa (10 psi) to 138KPa (20 psi). Additionally, an oxygen flush valve (9) must be
included in order to allow the rapid (35–75 L/min) washout of the breathing circuit in case
of emergency, as this valve directly injects oxygen into the patient without passing through
any kind of vaporizer (4–9).

Flow Regulators
Anesthesia machines have included independent flow controls for each of the medical
gases used in order to cover the requirements of the anesthesiologist for precisely
controlling the amount of each gas flowing into the breathing circuit attached to the patient.
These flow meters (5) typically consist of a glass tube in which a floating conical element
rotates at different heights as a function of the flow streaming out from the meter. Although
modern machines have included electronic flow meters based on different sensing
principles (ultrasound Doppler, electromagnetic sensing, etc.) and digital displays, it is
advisable to include at least one conventional glass flow meter in order to allow operation
even when electrical power fails.

Vaporizer System
In order to deliver most of the inhaled anesthetic agents through the breathing circuit,
these liquid substances must be vaporized into the carrier gas stream. To achieve this
goal, special devices have been developed and, today, are considered one of the most
important elements found in anesthesia machines. A vaporizer enriches the carrier gas
mixture with a vapor fraction of the volatile agent by means of different principles, leading
to different families of these devices such as those known as variable bypass, heated
blender, measured flow, and the recently introduced injectors. The most common are
shown in Fig.1.

Figure 3. Idealized views of different types of vaporizers. (a) Liquid agent, (b)
mixing chamber, (c) bypass valve, (d) temperature compensation bellows, (e)
pressure relief valve, (f) feedback-controlled metering valve, (g) constant flow
valve, (h) gas mixture bubbler, (i) bypass valve, and (j) injector

Variable Bypass
The variable bypass vaporizer is the most commonly used in today’s machines for the
vaporization of many agents such as enflurane, isoflurane, halothane, and sevoflurane.
This type of vaporizer receives this name because a variable shunt valve (c in Fig. 3)
regulates the proportion of gas flowing into the vaporization chamber and into the mixing
chamber (b). As the gas flowing out of the vaporizer chamber is mixed with the
bypassed gas stream, the concentration of the agent in the gas mixture is directly
related to the splitting ratio of the valve. Temperature compensation bellows (d) are
included in order to compensate for the effect of temperature changes that affect the
equilibrium vapor pressure above the agent. As this kind of vaporizer is able to deliver
accurate concentrations of the anesthetic agent, specific designs and calibration
methods are used for each type of liquid agent.

Figure 2. Schematic of a variable-bypass vaporizer. Arrows indicate direction of gas flow;

heavier arrows indicate larger flow rates. Gas enters the Inlet Port and is split at the
Bypass Cone into two streams. One stream is directed through a bypass channel and the
rest enters the Vaporizing Chamber. Gas entering the Vaporizing Chamber equilibrates
with Liquid Anesthetic Agent to become saturated with Anesthetic Vapor. This
concentrated anesthetic mixture exits the chamber to join, and be diluted by, gas that
traversed the bypass channel. The Concentration Control Dial is attached to the
Concentration Cone, which regulates resistance to flow exiting the Vaporizing
Chamber and thus controls the anesthetic concentration dispensed from the Outlet Port.
Heated Blender
Initially introduced for use with desflurane, the liquid agent is heated within a chamber
before entering the mixing chamber through an adjustable feedback-controlled metering
valve (f) that regulates the vapor stream flow.

Measured Flow
These devices are not able to deliver accurate concentrations of the liquid agent because
they are not calibrated, which is because of the vaporization control implemented, which
is based on a constant flow of carrier gas (g) bubbling up (h) through the liquid agent.

Injector
This recently introduced system uses a valve (i) to regulate the amount of fresh gas
flowing into a pressurized chamber where the liquid agent is stored. As the pressure of
this chamber increases, the agent is forced up through the injector nozzle (j) where it is
atomized within the fresh gas flow. As no vaporization occurs, (just atomization of the
liquid agent), temperature compensation is not required.

Breathing System
Once the anesthetic agent is vaporized at the desired concentration, the gas mixture has
to be administered to the patient in order to get the desired therapeutic effect and the
proper ventilation. For this purpose, anesthesia machines are connected to the patient by
the so-called breathing circuits.

Breathing circuits are often classified either as open systems or closed systems. In open
systems, the fresh gas flow is administered to the patient before being scavenged,
whereas in closed systems, the exhaled gases are processed in order to recycle them,
reducing the total amount of agent required (in order to reduce anesthesia costs and staff
exposure to the agents.

Circle System
The breathing circuit receives the vapor-enriched gas mixture from the vaporizer outlet
and sends it to the patient circuit (12) through the unidirectional inspiratory valve (11),
installed to prevent rebreathing from the patient to this branch of the circuit. The inspired
branch is completed with a security overpressure valve (10) installed in order to release
the gas out of the circuit in case the pressure of the gas mixture going into the patient
circuit exceeds the threshold of 12.5 kPa (125 cm H2O) established by the regulating
authorities. The exhaled gases return through the unidirectional expiratory valve (13)
flowing into the absorber (14), which is installed to remove carbon dioxide in order to
recycle the breathing gas. In the function of the circuit selected (15), part of the exhaled
gases will cycle through the ventilator (18) or the spontaneous breathing circuit formed by
the breathing reservoir bag (16) and the adjustable pressure limiting valve (APL) (17)
before returning to the absorber inlet.

Carbon Dioxide Absorber

Circle systems require the use of chemical elements for carbon dioxide removal from the
exhaled gases before recycling them back to the inspiratory limb of the breathing circuit.
These absorbers present in the form of a canister containing pellets of the absorbing
compound (soda lime), which is placed within a shell connected inline with the circle
system.

Ventilation
Ventilation of the patient should be granted for the supply of the life sustaining gases and
the vaporized anesthetic agent, which is usually done in two ways, depending on the
ventilator assistance strategy adopted. If the patient presents a healthy condition and the
surgical procedure does not interfere with the function of the respiratory system, the
anesthesiologist in charge of the sedation may decide for keeping spontaneous ventilation
throughout the procedure instead of mechanical ventilation.
If the first strategy is adopted, the patient will breathe spontaneously inhaling the gas
mixture through the inspiratory limb of the circuit before exhaling the mixture to the
expiratory one. As the gas is expired, it enters into the reservoir bag (16) connected to the
pop-off or adjustable pressure limiting valve (17), which is sensitive to the pressure of the
exhaled stream. In case this pressure exceeded the preset level, the APL valve will open,
sending a fraction of the exhaled gases directly to the scavenging system. If mechanical
ventilation is used, a similar valve located at the ventilator will release the excess pressure
to the scavenging system, assuring the proper operation of the machine.

Scavenging System
Once the gas mixture has been released by the ventilation circuit, it must be properly
disposed in order to avoid the risks associated with the contamination of the operating
room’s atmosphere. For this purpose, most of the hospitals count on central scavenging
systems based on vacuum pipelines.
In order to guard the patient airway from possible suction by the scavenging system,
modern systems include pressure relief valves. If the suction pressure was greater than
the pressure of the exhaled gas stream, the negative pressure relief valve will open, letting
the air from the operating room flow into the scavenging system until the pressure of the
line reaches the preset value of the valve.
In the opposite case, when the suction pressure was not enough to assure the disposal
of the exhaled gases, a positive pressure relief valve will open, ejecting the exhaled gas
mixture into the atmosphere of the operating room.
This system, based around valves between the anesthesia machine and the scavenging
system, is known as a closed system since the introduction of the first open systems in
recent years. In these other systems, which have become popular, the exhaled gases are
scavenged from a dedicated reservoir bag without requiring pressure relief valves.

Monitoring
In addition to the main components described above (gas delivery, vaporizer, ventilator,
and breathing circuit), anesthesia machines usually include a monitoring subsystem
specifically designed for the supervision of the state of the patient and the proper function
of the whole system in order to:
1. Improve the security of the patient as a whole by preventing potentially harmful
physiological conditions and detecting malfunctions in the normal operation of the
anesthesia delivery unit.
2. Collect several physiological measures, which are considered to be interesting by the
specialist in charge of the anesthetic procedure.
3. Check the integrity of the different components involved in anesthesia administration
and taking corrective actions in response to system malfunctions.
4. Study the degree of change on a certain indicator in order to analyze trends and provide
data required for the forecast of the patient evaluation during the surgical procedure.
5. Validate the impact of a specific therapy on the physiological state of the patient in order
to give personalized anesthetic care.

Anesthesia Delivery System Supervision

System failures or malfunctions (such as hypoxic gas mixture administration, poor
ventilation of the lungs because of low-volume gas mixture supply, or misconnections in
the administration piping, overdosing, etc.). Seriously endanger patients undergoing the
anesthetic procedure. In order to avoid the undesired effects of these failures, granting
the proper operation of the anesthesia delivery unit, several variables should be monitored,
such as:
- Inspired oxygen concentration.
- Anesthetic vapor concentration.
- Carbon dioxide concentration.
- Air pressure.
- Exhaled gas volume.
- Manually operated valves and regulators set-points.

Gaseous Concentrations
Oxygen concentration has to be continuously monitored in order to reduce the risk of
administration of hypoxic or hyper oxygenated gas mixtures. Delivery of inappropriate gas
mixtures should trigger the proper alarming mechanism. Although most of the devices limit
the minimum rate of oxygen to a minimum of a 25%, inspired oxygen concentration has
to be sensed at the inhalatory branch of the breathing circuit by means of transducers.

Patient Monitoring
As happens in most of the medical procedures, anesthesia should minimize the patient’s
perception of pain while preserving the normal functionality of all of the body systems. In
order to grant the integrity of the patient, certain physiological parameters should be
monitored to correct possible alterations before they lead to permanent cellular damage.
In this sense, monitoring the oxygenation using pulse oximeter, ventilation, circulation,
temperature, blood pressure, ECG, and neurological function of the patient using EEG is
mandatory when performing anesthetic procedures. Among others, typical anesthetic
protocols include the acquisition of hemodynamic, respiratory, and neurological variables.

Monitoring the Depth of Anesthesia

Brain stem auditory evoked responses have become the closest to depth of anesthesia
monitoring, but it is difficult to perform, is expensive, and is not possible to perform during
many types of surgery. A promising new technology, called bi-spectral index (BIS
monitoring) is purported to measure the level of patient awareness through multiple
analysis of a single channel of the EEG.

4. Self-Test

Q: Fill in the blank for the following

1 ----------- , means temporal reduction of the motoric functions of the patient.
2. The main elements of the anesthesia delivery system include --------------, ----------------
- and
3 ------------- used for shuts off the nitrous oxide supply when the oxygen pressure at the
flow meter falls below a certain threshold value.

5. Post test

Post test:
Q1: what are the function of anesthesia machine?
Q2: draw the variable bypass vaporizer.

6. Key answer

Pretest solution:
1. False. 2. True. 3. True. 4. True. 5. True.

Self test solutions:

1. Relaxation. 2. The gas supply system, the vaporizer, the mechanical ventilator. 3.
Fail safe device.

Post test solutions:

Q1: the anesthesia machine must perform the following functions:
• Assuring the proper oxygen (O2) flow delivery to the patient.
• Vaporizing the volatile anesthetic agent and blending it into a gas mixture with O2,
nitrous oxide (N2O), other medical gases, and air.
• Granting the ventilation of the patient by controlling spontaneous ventilation and
using mechanical assistance if needed.
• Minimize the anesthesia-related risk to the patient and the clinical personnel.
• Q2
 :

7. References
S. Ananthi ,2005,”A text book of medical instruments”
Middle Technical University
Electrical engineering technical college
Department of Medical Instrumentation Engineering Techniques
Medical instruments III

Mode Unit in study

Electrosurgical unit (Surgical diathermy)
For
Students of Fourth Stage
Electrical engineering technical college
Department of Medical Instrumentation Engineering Techniques
(15th and 16th Weeks)

By Lecturer
A.L. Luban Hamdy
L. Ali Ghazi
1. Overview
A-Target population: -
For students of the fourth stage in electrical engineering technical college in middle
technical university
B- Rational
We will establish a general concept a bout electrosurgical unit and explain principle of
operation of this device.
C- Central ideas
1. Definition of electrosurgical unit
2. Principle of Operation
3. Modes of Electrosurgery
4. Active electrodes, and the dispersive return electrode
5. Functional Building Blocks and ESU Generators
D- Objectives
After studying the electrosurgical unite the student will be able to : -
1. Define of electrosurgical unit
2. Describe the tissue response to electrosurgical current in terms of desiccation
fulguration, and cutting
3. Identify the characteristics of the cut, coagulation, and blended electrosurgical
waveforms
4. Explain the constructions and functions of active electrodes, and the dispersive return
electrode.
5. Sketch the block diagram of an electrosurgical generator and explain the functions of
each block.

2. Pre- test
Q: choose the correct statement
1. The CWRF is achieve
a) Cutting b) coagulation c) blended
2. Older types of surgical diathermy work on the
a) Solid state b) spark gap c) LC oscillator
3. Theory
ELECTROSURCICAL UNIT
Electric devices to assist in surgical procedures by providing cutting and homeostasis
(stopping bleeding) are widely applied in the operating room. These devices are also
known as electrocautary apparatuses. They can be used to incise tissue, to destroy tissue
through desiccation, and to stop bleeding by causing coagulation of blood. The process
involves the application of an RF arc between a probe and tissue to cause localized
heating and damage to that tissue.
The basic electrosurgical unit is shown in Figure 1.
The high-frequency power needed to produce the arc comes from a high-power, high-
frequency generator. The power to operate the generator comes from a power supply, the
output of which may in some cases be modulated to produce a waveform more
appropriate for particular actions. In this case, a modulator circuit controls the output of
the generator. The application of high-frequency power from the generator is ultimately
controlled by the surgeon through a control circuit, which determines when power is
applied to the electrodes to carry out a particular action. Often the output of energy from
the high-frequency generator needs to be at various levels for various jobs. For this reason,
a coupling circuit is inserted between the generator output and the electrodes to control
this energy transfer.
Figure 1 (a) Block diagram for an electrosurgical unit. High-power, high-frequency
oscillating currents are generated and coupled to electrodes to incise and coagulate
tissue, (b) Three different electric voltage waveforms available at the output of
electrosurgical units for carrying out different functions.
The electric waveforms generated by the electrosurgical unit differ for its different modes
of action. To bring about desiccation and coagulation, the device uses damped sinusoidal
pulses, as shown in Figure 1(b). The RF sine waves have a nominal frequency of 250 to
2000 kHz and are usually pulsed at a rate of 120 per second. Open-circuit voltages range
from 300 to 2000 V, and power into a 500 ohm loud ranges from 80 to 200 W. The
magnitude of both voltage and power depends on the particular application,
Cutting is achieved with a CW RF source, as shown in Figure 1(b). Cutting is done at
higher frequency, voltage, and power, because the intense heat at the spark destroys
tissue rather than just desiccating it as is the case with coagulation. Frequencies range
from 500 kHz to 2.5 MHz with open-circuit voltages as high as 9 kV, Power levels range
from 100 to 750 W, depending on the application.
The cutting current usually results in bleeding at the site of incision, and the surgeon
frequently requires ''bloodless" cutting. Electrosurgical units can achieve this by combining
the two waveforms, as shown in Figure 1(b). The frequency of this blended waveform is
generally the same as the frequency for the cutting current. For best results, surgeons
prefer to operate at a higher voltage and power when they want bloodless cutting than
when they want cutting alone.
Many different designs for electro surgical units have evolved over the years. Modern units
generate their RF waveforms by means of solid-state electronic circuits. Older units were
based on vacuum tube circuits and even utilized a spark gap to generate the waveforms
shown in Figure 1(b).

Spark-Gap based electrosurgical unit:

As explained earlier, older types of surgical diathermy work on the “spark gap” principle.
Fig. 2 gave the circuit diagram of a simple spark-gap type diathermy unit. The AC mains
supply voltage is stepped up to several thousand volts by the mains transformer and
applied to several spark gaps in series. Twice per cycle of the mains (on the + and - half
cycles) sparks are produced. The capacitor is discharged through the gaps is an
oscillatory fashion, the combination of L and C being chosen to oscillate at some 800 kHz.
The output of the diathermy thus consists of bursts of damped radio-frequency waves at
intervals of 10ms (one complete mains cycle takes 20 m sec at 50 Hz). A tapping on the
output transformer allows the output current to be adjusted.
A typical maximum power output would be 250 W. The basic surgery arrangement is
shown below in Fig. 4.
Figure 2. The circuit diagram of the spark-gap electrosurgical unit.

Spark-gap generators are very robust, but anesthetic explosion risks are greater with them,
and they do generate a substantial proportion of harmonic frequencies. These can cause
interference with communications and monitoring equipment. Valve and transistor
oscillators seem to be preferred by surgeons, and any interfering radiation from them can
be more easily suppressed by filter circuits because of the greater purity.

Typical electrosurgical units:

A block diagram of a typical electrosurgical unit is shown in Figure 3. The RF oscillator

provides the basic high-frequency signal, which is amplified and modulated to produce
the coagulation, cutting, and blended waveforms. A function generator produces the
modulation waveforms according to the mode selected by the operator. The RF power
output is turned on and off by means of a control circuit connected either to a hand switch
on the active electrode or to a foot switch that can be operated by the surgeon. An output
circuit couples the power generator to the active and dispersive electrodes- The entire
unit derives its power from a power-supply circuit that is driven by the power lines.
Electrodes used with electrosurgical units come in various sizes and shapes, depending
on the manufacturer and the application. The active electrode is a scalpel-like probe that
is shaped for the function for which it is intended.
 Figure 3. The block diagram of typical electrosurgical unit.

The simplest form consists of a probe that appears to be similar to a test probe used with
an electronic instrument such as a multimeter or an oscilloscope, A pointed metallic probe
fits into an insulating handle and is held by the surgeon as one would hold a pencil. The
finger switch located on the handle is momentarily depressed when the surgeon wants to
apply power to the probe.
Whereas the purpose of the active probe is to apply energy to the local tissue at the tip of
the probe and thereby to effect coagulation, cutting, or both, the dispersive electrode has
a different function. It must complete the RF circuit to the patient without having current
densities high enough to damage tissue. The simplest dispersive electrode is a large,
reusable metal plate placed under the buttocks or back of the patient. Most procedures
use a 70 cm2 disposable conductive adhesive polymer dispersive electrode placed on the
thigh. Another type has a gel-soaked sponge backed by metal foil and surrounded by
foam and pressure-sensitive adhesive. Another capacitive type has a thin Mylar insulator
backed by foil and its entire face coated with pressure-sensitive adhesive. It is important
that this electrode make good contact with the patient over its entire surface so that "hot
spots" do not develop.
 Figure 4. The basic arrangement of the electrosurgical unit.
4- Self-test
Q: Fill in the blanks with appropriate words
1. Blended can be achieved by combining the --------
2. The RF power output is turned on and off by means of a -------
5- Post test
Q: draw block diagram of typical electrosurgical unit.

6- Key Answer
Pretest solution
1. a 2. B
Self-test solution
1. Two waveforms 2. Control circuit

Posttest solution
7. References:
S.Ananthi, 2005. “A text book of medical instruments”
Middle Technical University
Electrical engineering technical college
Department of Medical Instrumentation Engineering Techniques
Medical instruments III

Mode Unit in study

Laser in Ophthalmic Surgery
For
Students of Fourth Stage
Electrical engineering technical college
Department of Medical Instrumentation Engineering Techniques
(17th and 18th Weeks)

By Lecturer
A.L. Luban Hamdy
L. Ali Ghazi