DR.

VITHAL DHULKHED
Professor and HOD of Anesthesiology,
Krishna Institute of Medical Sciences,
Karad, Maharashtra ,India
email:[email protected]

1
INTRODUCTION :

Evolution from simple pneumatic device to

computer workstation,

Features are centralized display

and functional integration.

Be familiar with machine to enable Preop

checks

To understand, knowledge of pneumatics

electronics and computer science required2
 Standards for Anesthesia
Machines and Workstations
 Standards for anesthesia machines and workstations
provide guidelines to manufacturers regarding their
minimum performance, design characteristics, and
safety requirements. During the past 2 decades, the
progression of anesthesia machine standards has been
as follows:
 1979: American National Standards Institute
 1988: American Society for Testing and Materials,
 1994: ASTM F1161-94 (reapproved in 1994 and
discontinued in 2000)
 2005: International Electrical Commission (IEC)
 2005: ASTM (reapproved)F1850
 European standard is EN740

3
Machine standards:
Standards -guidelines to manufacturers
for minimum performance, design
characteristics and safety requirements

2000: American society for testing

and materials
(ASTM) F1850 – 00
4
 Contd….
To comply with the 2005 ASTM F1850-00 standard,
newly manufactured workstations must have monitors
that measure the following parameters:
 continuous breathing system pressure,
 exhaled tidal volume,
 ventilatory CO2 concentration,
 anesthetic vapor concentration,
 inspired oxygen concentration,
 oxygen supply pressure,
 arterial hemoglobin oxygen saturation
 arterial blood pressure,
 and continuous electrocardiogram.

5
 Contd…
 The anesthesia workstation must have a
prioritized alarm system that groups the
alarms into three categories: high,
medium, and low.

 These monitors and alarms may be enabled

automatically and made to function by
turning on the anesthesia workstation, or
the monitors and alarms can be enabled
manually and made functional by following
a pre-use checklist.

6
Pressure Units to remember
1 atm. pressure (sea level) =1bar
=760mmHg ≈ 1Kg/cm2
= 14.5 lb/inch2 (psi)
≈ 100 kilopascals (kPa)
= 10 meter water height
= 1000 cm H2O =1000mbar
=1000 hectopascal (hPa)
7
1846 THE ETHER INHALER

8
 DATEX
1927 BoyleOHMEDA
Apparatus
ADU
Ether
, Magill’s
Apparatus,
Ether
KION Mennell’s
Apparatus
SIEMEN’S

9
 HISTORY
The original concept of Boyle's machine was
invented by the British anaesthetist H.E.G.
Boyle in 1917. Prior to this time,
anaesthetists often carried all their equipment
with them, but the development of heavy,
bulky cylinder storage and increasingly
elaborate airway equipment meant that this
was no longer practical for most
circumstances. The anaesthetic machine is
usually mounted on anti-static wheels for
convenient transportation.

10
HISTORY :
• 1917 – Boyle machine with a water sight
feed type of flowmeter is introduced by
Henry Edmund Gaskin Boyle.
• 1920 – A vapourizing bottle is incorporated
to the machine.
• 1926 – A 2nd vaporizing bottle and by-pass
controls are incorporated.
• 1930 – A Plunger device is added to the
vaporizing bottle.
• 1933 – A dry-bobbin type of flowmeter is
introduced.
• 1937 – Rotameters displayed dry-bobbin
type of flowmeters
11
 Anesthetic Machines
• Anesthetic machines began appearing at the end of the 19th century
• Early anesthetic machines were utilized in dental anesthesia for
administration of N2O and O2
• Initial machines were either:
• Continuous flow – continuous flow throughout inspiration and
expiration (eg. Heidbrink, Foregger, Boyle)
• Intermittent flow – flow of gas during inspiration only (eg.
McKesson)
• Machines evolved to incorporate reducing valves, flow meters,
vaporizers and circuits with carbon dioxide absorption

12
Boyle Anesthesia Apparatus c. 1920
• Modification of original machine
developed by Dr. Henry Boyle in 1917
• Coxeter dry flow meter allowed
proportioning of O2, CO2 & N2O
• Two glass vaporizing bottles
• Bottom illustrations:
– Case with accessories
– Machine stand with four cylinder
yokes (2 each for N2O and O2) +
carrying handle

116a,13117
Foregger Metric Gas Machine
Montreal Model c. 1924
• Modification of Richard von Foregger’s
original metric gas machine for use with
cyclopropane
• Eliminated reserve gas tanks, with
exception of O2, because of the
increased use of CO2 absorbers
• “Wet flowmeters” used water
displacement to provide accurate
measurement while introducing
humidity to reduce the risks of interior
static

14
23
 Water’s Cannisters
(Waters “to and fro”) c. 1930
• Ralph M Waters began experiments with CO2
absorption in 1915
• Developed “to and fro” system through
which inspired and expired gases were
directed
• Metal cylinder was packed with absorbent
alkaline granules resulting in economy of
gas use along with heat and moisture
conservation

109
15
a-c
McKesson Nargraf Machine
(Model H) c. 1920
• Modification of Dr. E I McKesson’s Model A
machine of 1910
• Reducing valves admit N2O and O2 into two
bags enclosed in metal drums at equal
pressures
• Gases pass to percentage mixing chamber
with proportion controlled by dial
• Intermittent flow is dependant upon patients
inspiration

16
119
 Heidbrink Apparatus
(mixing head only) c. 1930
• Modification of Dentist Jay
Heidbrink’s original apparatus
introduced in 1912 for administration
of N2O and O2 primarily for dental
anaesthesia
• Proportioning device and valves
reduced cylinder pressure of tank
gases to working pressures

17
143
Midget Kinet-O-Meter c. 1940

• Modification of Dr. Heidbrink’s earlier

apparatus to administer N2O / O2 for
dental anesthesia
• Flow meter panel calibrated for oxygen,
nitrous oxide and cyclopropane along
with four cylinder yokes (two each for O2
and N2O)
• Mounted on a pole to which chart stand
support is attached

18
118
 ventilator
Flow
meter

bellow
vaporizer

APL valve
Corrugated
tube

Scavenging
Soda lime system

19
Basic Schematics

20
An over view

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22
23
The Anesthesia Machine
High Intermediate Low Pressure Circuit

24
 PNEUMATIC SYSTEM
1. HIGH PRESSURE 3. LOW PRESSURE SYSTEM
a. Hanger Yoke a. Flowmeters
b. Power Failure Indicator b. Hypoxia Prevention Safety Devices
c. Pressure Regulators c. Unidirectional (Check) valve
d. Pressure Relief Device
2. INTERMEDIATE PRESSURE SYSTEM e. Low-Pressure Piping
a. Master Switch (Pneumatic component) f. Common (fresh) Gas Outlet
b. Pipeline Inlet Connections
c. Pipeline Pressure Indicators 4.ALTERNATIVE OXYGEN CONTROL
d. Piping
e. Gas Power Outlet
f. Oxygen Pressure Failure Devices
g. Gas Selector Switch
h. Second-Stage Pressure Regulator
i. Oxygen Flush
j. Flow Adjustment Control

25
26
The Electric System:
Master switch:
activates the pneumatic and electric functions.
Off or stand by position :the battery recharge,
electric outlets active.

Power failure indicator

Back up battery.

Electric outlets. power monitors

27
Pneumatic system:

Divided into 3 systems

High pressure, intermediate pressure
and low pressure system.

High pressure system:

cylinders and pressure regulators.
28
Pipeline source: Oxygen, nitrous oxide and air.
A check valve located down stream
Diameter Index Safety System (DISS)
Cylinder source : Gasket for airtight seal,
The gas enters through nipple.
back- flow check valve down stream.
Pin Index Safety System (PISS).
Bourdon Pressure gauge:indicates cylinder pr.
a fixed orifice variable flow, pressure type
For each gas pipeline pressure indicators
cylinder pressure indicators
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 DISS

• Pipeline inlets are connected with

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

30
 PISS

PISS (pin-index safety system) prevents misconnection of a

cylinder to the wrong yoke. Keep cylinders closed except when
checking machine, or while in use (if O2 from pipeline is
unavailable)

31
 Diagram showing
the index positions
of a cylinder valve.

Oxygen: 2 & 5
Nitrous oxide: 3 & 5
Air: 1 & 5
CO2: 1 & 6

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33
 Capacity of cylinders
(from CGA Pamphlet P-2)
Gas Color US Pressure Capacity Pin
(internat'l) psi L Position
Oxygen green (white) 1,900 660 2-5
Nitrous blue (blue) 745 1,590 3-5
Oxide
Air yellow 1,900 625 1-5
(black &
white)

34
CALCULATING VOLUMES*
H tanks = 7000 litres at 2000 psi
E tanks = 700 litres at 2000 psi

QUESTION?
– HOW MANY LITRES IN AN E TANK
READING 750 PSI?

35
36
 High Pressure System
(parts which receive gas at cylinder pressure)
• hanger yoke (including filter and unidirectional
valve)
• yoke block (with check valves)
• cylinder pressure gauge
• cylinder pressure regulators

37
38
 Hanger Yoke Check Valve
minimize trans-filling
orients cylinders
allows change of cylinders
provides unidirectional flow during use
ensures gas-tight seal. minimize leaks to atmosphere if a
yoke is empty.

39
 Anesthesia Components
• Anesthesia Machine
– Frame

– Regulator
• Placed on O2 tanks to decrease pressure
from tank
• 2 types of tanks
– “E” Tanks
» 650L @ 1800PSI
– “H” Tanks
» 7100L @ 2200PSI
• Output pressure
adjusted with knob
40
Pressure regulator:

Force =Pressure × Area

Pc × A1 = Pr × A2
Pc/ Pr = A2 / A1

oxygen,
2200 psig to 50 psig,(45 cyl).
Nitrous Oxide
750 psig to 50 psig ,(45 cyl).

41
42
 Intermediate pressure
system.

Safety device for Oxygen

Supply Pressure Failure :
Ensure oxygen 19% min. at
the common gas outlet.

Pneumatic and Electronic

alarm devices:
oxygen pr. below 30 psig
alarm within 5 seconds.
43
Fail Safe valve:
Pressure Sensor Shut
off Valve:
oxygen pr > 20 psig
opens valve for N2O
Oxygen Failure
Protection Device:
proportioning
principle.
Second stage
pressure regulation:
oxygen 12 and 19 psig.
used for N2O also. 44
Oxygen Failure Protection Device: Drager

Based on a proportioning principle rather than a

threshold principle
Pressure of N2O falls in Propotion of decrease of
Oxygen.Total cutoff seen at <12psig.
Seat nozzle assembly connected to a spring loaded
conical tapered piston

45
46
 Pressure Sensor Shut-off
Valve: Datex Ohmeda
Operates in a threshold manner: either open or
shut
Oxygen pressure moves the piston and pin upward
and the valve opens for N2O
When pressure of oxygen falls below preset value,
force of the valve return spring completely closes
the valve

47
48
49
50
Link–25 system Proportionating Systems

Ensure oxygen supply

at the common gas outlet.
between 23% and 25%.

chain link
nitrous oxide and oxygen
14 tooth & 28 tooth sprockets
Supply at 26 psig & 14psig

51
 Oxygen ratio monitors controller (ORMC)
Sensitive oxygen Ratio Controller (S – ORC]
Similar. Resistors (3: 1
ratio for O2: N2O)

Ensure 25% oxygen by

limiting N2O flow.

ORMC shuts off

N2O if oxygen pr.
< 10 psig

Fabius GS, (S-ORC). shuts

off N2O if O2 flow is <200
mL/min, or if O2 fresh gas
valve is closed. Audible and
visible alarms if pipeline
pressure < 20 53
54
55
56
 Anti-Hypoxic Device

Duel lever system acts on needle valves

Rgulate oxygen and nitrous oxide flows > 1: 3 ratios
57
 Oxygen Supply Failure Alarm

ASTM standard specifies that whenever the oxygen

supply pressure falls below a certain threshold
(usually 30 psig), alarm must get activated within 5
seconds. It should not be possible to disable
this alarm
 They aid in preventing hypoxia caused by problems
occurring upstream in the machine circuitry
(disconnected oxygen hose, low oxygen pressure in the
pipeline, and depletion of oxygen cylinders)

58
59
 OXYGEN FLUSH
 Receives oxygen from
the pipeline inlet or
cylinder pressure
regulator and directs a
high unmetered flow
directly to the common
gas outlet.

 On most anesthesia
machines, the oxygen
flush can be activated
regardless of whether
the master switch is
turned ON or OFF.
 A flow between 35 and
75 L/minute must be
delivered.
60
Low pressure system Ohm’s Law:
Flow meter assembly Voltage = Current × Res.
In hydraulic system:
Pr= Flow x Res i.e. F × R
Pr/ wt of bobbin constt
F  1 / R ( Area)
Hagen – Poiseuille eqn
for laminar flow .:
Flow rate =  r 4 P /8 l
Flow through orifice
 area √ (pr. diff /
Dens)
61
 Law Applicable to Turbulent Flow
i- Tubes L = length
P = rho
(density)
ii- Orifices ΔP =
Pressure
gradient
r2 = Radius

62
Electronic flow meter

Prefer digital system

Solenoid valves
control flow on or
off channels

Computer ontrolled.

Various other types.

63
64
65
Bag/ventilator selector
switch. In the Bag position,
the reservoir bag and APL
valve are connected to the
breathing system. In the
Ventilator position, the APL
valve and bag are excluded
from the breathing system.
67
 VAPORISER
Physics
The pressure created by vapor phase
over liquid at equilibrium at particular
temp is the saturated vapor pressure.

e.g. Halothane saturated vapor pr.

243 torr at 20 C. The vaporizing
chamber concentration of halothane
i.e 243/760 X 100 %= 32%
68
 Vaporizer

Vaporizer interlock
Ensures only one vaporizer on
Trace vapor output minimal when off
Vaporizers are locked into gas circuit,
ensuring they are seated correctly.

69
Operating principles of variable
bypass vaporizers
(FGF) splits into
carrier gas (<20%,
saturates with vapor)
and bypass gas (>
80%).
rejoin at outlet.

splitting ratio
controlled by control
dial,
temp compensn.
valve. 70
71
Effect of flow rate

Constant at
250 mL to15 L/min,
due to wick , baffle:

Output linear at
20-35 deg C, due to
temp compensating
devices,Wicks

Constructed of metals
with high specific heat
thermal conductivity
72
Effect of intermittent back pressure

pumping effect positive pressure, oxygen

flush valve
increase vaporizer output.
check valves between the vaporizer outlet
and the common gas outlet,
smaller vaporizing chambers, or tortuous
inlet chambers.
73
 Vaporisers

Effect of Low Atmospheric Pressure –

Flow to vaporising chamber increased
Vapor output increased
if measured as partial Pr.
volume % to be set .
= Vol % indicated on Vaporiser× 760 / amb. pr

74
How much liquid agent does a
vaporizer use per hour?

Ehrenwerth and Eisenkraft (1993)

give the formula:

3 x Fresh gas flow (FGF) (L/min) x

volume % = mL liquid used per hour

75
Effect of pressure on flowmeter

Actual flow = Indicated flow / (d0/d1)

d0 = density at atm. Pr
d1 = density at amb. Pr

If pr = 2 ATM d1 = 2,  (d0/d1) = .71

:. Actual flow = .71 of indicated flow

76
77
Desflurane vaporizer Vapor travels via
shut off valve ,
pr. reg. valve
(pr at 1.1 atm
74mmHg at 10L/min)
Pr in the 2 circuit
at same level by
inter facing
electronically
sump at pneumatically by
390c
transducer, control
electronic system
& pr. reg. valve.78
Alladin Vaporiser Various agents used in
sp. cassettes
Color, magnetic coded
Variable bypass type
Check Valve at inlet
CPU controlls flow
control valve
Sensors monitor flows
Information from, RGM,
agent type, temp, Pr,
flow rate of FGF its
composition
determine Conc.
79
Circle system

Circle components: fresh gas inflow source,

inspiratory & expiratory unidirectional valves,

ins& exp corrugated tubing,Y connector, APL

valve, reservoir bag, CO2 absorbent canister

Resistance of circle systems <3 cm H2O.

Dead space is increased (by all respiratory
apparatus). 0.46 if intubated and 0.65 if mask.

Mechanical dead space upto the Y-connector.

80
 Circle system advantages and
disadvantages
Circle advantages:
constant inspired concentrations
conserve respiratory heat and humidity
useful for all ages (may use down to 10 kg,
about one year of age, or less with a
pediatric disposable circuit)
useful for closed system or low-flow
low resistance (less than tracheal tube, but
more than a NRB circuit)
Circle disadvantages:
increased dead space
malfunctions of unidirectional valves
81
 TRADITIONAL CIRCLE BREATHING SYSTEM
Ideal
FGF
arrangement
Unidirectional
Y
CO2
CANIS VENT valve near the
PIECE TOR
patient and APL
just downstream
from exp. Valve.

APL
VALVE
SELECTOR
SWITCH

BAG

82
 Soda Dragersorb
Component Baralyme Medisorb Amsorb
lime 800+
Ca(OH)2 % 94 80 70-80 80 83
NaOH % 2-4 - 1-2 2 -
May contain
KOH % 1-3 0.003 2 -
some
CaCl2 % (humectant) - - - - 1
CaSO4 ( hardener) - - - - 1
Polyvinylpyrrolidine%
- - - - 1
(hardener)

Water Content % 14-19 As water of 16-20 ~14 14.5

crystallization
Ba(OH)2-8H2O% - 20 - - -
Size (mesh) 4-8 4-8 4-8 4-8 4-8
Indicator Yes Yes Yes Yes Yes
83
Lithium hydroxide lime (LitholymeTM)- contains: LiCl as
the catalyst to accelerate the formation of CaCO3; ethyl
violet as the indicator; and does not contain KOH or
NaOH." The CO2 absorbing capacity is similar to
Sodasorb- and more than Amsorb
Does not produce CO from breakdown of desflurane or
other methyl-ethyl ethers even when dessicated
It is stated
– does not produce Compound A, even when
desiccated
– when exhausted, undergoes a permanent color
change
– generates less heat than soda lime
– is comparable in price to soda lime

84
KING’S CIRCLE
SYSTEM

BAIN’S
CIRCUIT

85
 Anaesthesia Ventilator

Substitute for breathing bag

Power source, preumatic or electric

Ascending bellows,Descending bellows

or
piston type,computer controlled stepper
motor

Advance ICU features incorporated 86

87
Ascending bellows-
Insp. Phase –
Driving gas enters housing
chamber
pr. also in pilot line
Relief valve closes
Bellows ompressed
Exp. Phase
Driving gas exits
Pressure in housing also
over the relief valve
Fresh gas and expired
gases fill the bellows when
2 – 3cm H2O pressure in
bellows the relief valve
88
opens
Descending bellows or Piston

Use fresh gas decoupling

system (FDS)
Insp. Phase FDS Closes
FGF diverted to bag
Exp., vent. exhaust
valves closed.Gas
delivered to patient
Exp. Phase – Bellows or
piston refill under slight
–ve Pr. from reservoir
bag ( FDS opens) Excess
gases open
exhaust valve

89
 Tidal Volume compensation
Dynamic, Automatically adjusts for changes in:
– fresh gas flow
– lung compliance
– compression losses
Accurate Volume Delivery
Allows the clinician to focus on the patient rather
than on the ventilator controls
0 to 30 LPM of Fresh Gas can be compensated for
90
 FRESH GAS
COMPENSATION
Traditionally in anaesthesia ventilators
fresh gas is delivered continuously to
the system.

With no method of compensation the

fresh gas increases the delivered tidal
volume during inspiration.

The higher the fresh gas flow, the

greater the tidal volume. 91
 Fresh Gas Compensation cont’d
Fresh gas contribution = fgf in ml x inspiratory time
60
Example:
fgf = 5L/min tidal vol = 600ml freq = 10 I:E =1:2
Inspiratory time = 60 x 1 = 2secs
10 3
fresh gas contribution = 5000 x 2 = 166ml
60
Therefore tidal volume needs to be reduced by this
amount
New TV to achieve correct ventn = 600 – 166 = 434ml

92
DYNAMIC COMPLIANCE COMPENSASTION

Compression of the gas within the breathing

system reduces the tidal volume delivered to
the patient.
To ensure that the correct tidal volume is
delivered the system , compliance must be
calculated - this is done at start up & the value
retained in memory.
When a patient is connected the combined
compliance is obtained - system + patient.
The tidal volume is then increased to
compensate for the compressed volume within
the system 93
 Dyn. Compliance Compensation -
cont’d
At start up a known volume is delivered to
the system & the pressure recorded.
Compliance is then calculated:
Compliancesystem = __volume in ml__
pressure in cmH20
Required tidal volume for accurate ventilation
= set tidal volume x _1 + Csys
Ctotal - Csys
Csys = system compliance
Ctotal = compliance of system + patient
94
 Dyn. Compliance Compensation-cont’d
Example:
At start up - known volume = 200ml; pressure =
25cmH20
Csys = 200 = 8ml/cmH20
25
With patient connected - volume = 500ml; pressure
= 20cmH20
Ctotal = 500 = 25ml/cmH20
20
New TV = 500 x 1 + 8__ = 500 x 1+ 0.47
25 - 8
= 735ml
95
 Low-flow adaptation
Concern about env contamination
waste of expensive volatile agents
for minimal (<0.5 lpm) or low flow (<1.0
lpm)
small volume of the breathing circuit
smaller time constant
Gas analyzer extraction returned to
circuit,
Monitoring FiO2 accurate at endotr.
tube 96
 Low-flow adaptation……
Flow meters, Spirometers, well
calibrated , accurate
O2/N2O proportionating capability
scavenger system should not extract
gas
changes in FGF shouldn ‘t alter set TV,
adequate warning for reductions in
peak airway pr
97
The future of the "Anesthesia
Machine"
Fast, inexpensive, small, powerful
computers, wireless technology, and
the internet are revolutionizing
anesthesia
Accurate record keeping, and improved
patient care through the use of
expert systems
Anesthesiologists must take a leading
role in the development and
implementation of new technology
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