CLINICAL ANESTHESIA 0195-5616/99 $8.00 + .

00

EQUIPMENT FOR INHALANT

ANESTHESIA
Sandee M. Hartsfield, MS, DVM

The number of inhalant anesthetics available to practicing veterinar-

ians has increased over the last 15 years. Although not all are labeled
specifically for a veterinary species, desflurane, enflurane, halothane,
isoflurane, methoxyflurane, nitrous oxide, and sevoflurane are used in
clinical and laboratory settings. These drugs have variable physical,
chemical, and clinical properties and should be delivered by individuals
knowledgeable of their pharmacological and clinical effects. To promote
efficiency and safety for both patients and personnel, anesthetic equip-
ment, including anesthesia machines, breathing systems, vaporizers, an-
esthesia ventilators, and ancillary equipment, appropriate for the partic-
ular inhalant anesthetic and patient should be employed. The following
discussion reviews some of the latest innovations in inhalant anesthetic
machines, ventilators, and equipment (especially instruments designed
specifically for veterinary use) and is not intended to endorse products
that are mentioned or to diminish equipment that may not have been
included.

ANESTHESIA MACHINES

Many anesthesia machines, breathing systems, vaporizers, and anes-

thesia ventilators designed for both human and veterinary patients have
been described in detaiP-9 Essentially, all anesthesia machines, breathing
systems, and vaporizers intended for human application can function
appropriately for one or more veterinary species. Equipment for human

From the Department of Veterinary Small Animal Medicine, Texas A&M University,
College Station, Texas

VETERINARY CLINICS OF NORTH AMERICA: SMALL ANIMAL PRACTICE

VOLUME 29 • NUMBER 3 • MAY 1999 645

646 HARTSFIELD

anesthesia must be manufactured and maintained according to standards

set by the American Society for Testing and Materials (ASTM); these
standards are revised and published regularly. 1 Presently, no standards
exist for the manufacture and maintenance of veterinary anesthesia
equipment, and the assurance of safety resides with the manufacturers
and users. Many veterinary anesthesiologists have adopted standards
set for equipment designed for man to ensure that veterinary anesthesia
equipment is safe for their patients.
Even if aged and obsolete equipment is disregarded, quality and
sophistication vary greatly among the contemporary human and veteri-
nary anesthesia machines. By way of comparison, a relatively simple
veterinary anesthesia machine with one vaporizer may cost about $5000,
although an advanced machine with multiple vaporizers and monitors
intended for human application may sell for approximately $100,000.
Nevertheless, a complete anesthesia machine includes a gas source,
regulator, and flowmeter for each medical gas (oxygen on all machines,
nitrous oxide on some machines); a vaporizer for each volatile liquid
inhalant anesthetic; and a breathing system.
Anesthesia machines are fitted for the delivery of one or more
medical gases (oxygen on all machines, nitrous oxide on some machines)
which are supplied in compressed gas cylinders. The cylinder valve
bodies and their corresponding hanger yokes continue to be designed
with incorporation of the pin index safety system to prevent inadvertent
interchange of gases. Most anesthesia machines have pipeline inlets
with diameter-indexed safety system connections for central sources of
medical gases used for the same purpose. Regulators on anesthesia
machines reduce and regulate the pressure of gases supplied to the
components (e.g., flowmeters) located downstream. Some changes have
occurred in pressure regulators on modern anesthesia machines. Older
anesthesia machines usually had regulators set to reduce the pressure of
medical gases to approximately 50 pounds per square inch gauge (psig).
With the increased use of central gas supplies and pipeline systems for
delivery of medical gases at a pressure of about 50 psig to multiple
station outlets throughout a hospital, regulators on anesthesia machines
may be set to lower pressures (e.g., 47 psig). This allows the central gas
source to supply the anesthesia machine preferentially, preventing the
depletion of the small cylinders (e.g., E cylinders) that should be re-
served for emergencies. Current ASTM standards mandate the adjust-
ment of regulators to allow preferential use of pipeline gases. Newer
anesthesia machines, especially those designed for application to man,
may have two or more automatic pressure-reducing regulators in a
series, which results in the delivery of medical gases to the flowmeters
at relatively low pressures (e.g., 12-16 psig).
Flowmeters on anesthesia machines should be manufactured and
arranged according to ASTM standards. The current standard for anes-
thesia machines for human beings requires that there be only one flow
adjustment control for each gas delivered to the common gas outlet.
This guideline is not followed in all contemporary veterinary anesthesia
 EQUIPMENT FOR INHALANT ANESTHESIA 647

machines, and two flow adjustment controls for oxygen may be present,
one servicing a flowmeter with a low range of flow (e.g., 0-1 L/min)
and another controlling a flowmeter with a high range of flow (e.g., 0-5
L/min). Although the rationale for two ranges of flow may be more
accurate delivery of oxygen when using closed circle systems in small
patients, the likelihood of error in selection of the flow rate for oxygen
increases. The same purpose can be accomplished by having a double-
taper flowmeter or two flowmeters (the first for fine control or lower
flow and the second for coarse control or higher flow) in a series served
by the same flow adjustment control. An interesting innovation in some
modern anesthesia machines is a mechanism to prevent the flow of
oxygen from being completely turned off, ensuring that 200 to 450 mL/
min of oxygen is flowing to the patient at all times if the machine is
attached to an appropriate oxygen source. 9

VAPORIZERS
Advanced vaporizers are included on newer anesthesia machines
designed for both human and veterinary patients. Although certain
veterinary anesthesia machines can be purchased with nonprecision
vaporizers located within the circle breathing system (in-system vaporiz-
ers; e.g., Stephens Universal Vaporizer, Schein, Port Washington, NY),
most manufacturers of anesthesia machines rely on precision out-of-
system vaporizers. In the United States, manufacturers of anesthesia
machines for man incorporate "concentration-calibrated" out-of-system
vaporizers. At this time, no in-system vaporizers are being manufactured
in the United States for anesthesia machines designed for human pa-
tients, primarily because of resistance to gas flow and unpredictability
of output. 4 The Ohio #8 vaporizer (Ohio Medical Inc., Madison, WI)
which was used for many years in human and veterinary anesthesia is
generally considered to be obsolete. One author states that "the delivered
concentration (with an Ohio #8 vaporizer) is unknown and changes
unpredictably with use." 8 Also, it is difficult to fill in-system vaporizers
as currently designed without substantial pollution of the work environ-
ment with inhalant anesthetic vapors.
Although they are no longer being manufactured, unused Ohio
calibrated vaporizers and Tee 3 vaporizers are available to veterinarians
through various distributors of veterinary anesthesia equipment; these
vaporizers are described fully in the medical and veterinary anesthesia
literature. 2-B The Tee 3 vaporizers (Ohmeda, Liberty Corner, NJ) and
Ohio calibrated vaporizers function well on veterinary anesthesia ma-
chines, and service for recalibration, cleaning, and replacement of worn
parts is readily available. When contracting for service on these vaporiz-
ers, one should be certain that a complete recalibration is to be done.
This means that the recalibration should include evaluation of output at
variable carrier gas flows and operating temperatures.
More advanced "Tee-type" vaporizers are sold with some veterinary
anesthesia machines; Tee 4, Tee 5, and Tee 6 vaporizers (Ohmeda, Liberty
648 HARTSFIELD

Corner, NJ) are available. All are concentration calibrated. Tee 4 (Fig. 1)
and Tee 5 (Fig. 2) vaporizers are classified as variable-bypass, flow-over
with a wick, temperature-compensated, agent-specific, and out-of-circuit
vaporizers. 4 These vaporizers may be designed for halothane, enflurane,
isoflurane, or sevoflurane, and a separate vaporizer is required for each
anesthetic. Within limits, these vaporizers compensate for variations
in carrier gas flow, temperature, and back pressure. The functional
characteristics of these vaporizers are available in operations manuals
that can be obtained from the manufacturer. The output of a Tee 4
vaporizer does not change if it is not ii).. a directly upright position (e.g.,
vaporizer is tipped), and the Tee 5 has \an internal system of baffles that
prevents liquid anesthetic from reaching the outlet even if the vaporizer
is inverted. Both Tee 4 and Tee 5 vaporizers were intended for use on a
manifold with two or more similar vaporizers in a series, the interlocking
design of which prevents the inadvertent use of two vaporizers simulta-
neously. Tee 4 and Tee 5 vaporizers on veterinary anesthesia machines
are not typically used with a manifold or interlocking system. When
fully charged, the capacity of a Tee 3 or Tee 4 vaporizer is 125 mL of
liquid anesthetic, and the wick retains about 35 mL of liquid; the Tee 5
with dry wicks requires 300 mL of liquid to be fully charged, and the
wicks retain about 75 mL of liquid. The larger capacity of the Tee 5 limits
the need for frequent refilling. The manufacturer's recommendation for

Figure 1. lsotec 4 Vaporizer for administration of isoflurane. The vaporizer is fitted with a
screw-cap filler port, and the control dial is set in the off position.
 EQUIPMENT FOR INHALANT ANESTHESIA 649

Figure 2. Sevotec 5 Vaporizer for administration of sevoflurane. The vaporizer is fitted with
a keyed filler port with instructions for use shown on the diagram next to the filler port. The
control dial is set in the off position.

complete servicing of the Tee 5 is 3 years, although it is 1 year for the

Tee 3 and Tee 4.
The Tee 6 vaporizer is electrically heated and pressurized, and it was
designed specifically for the administration of desflurane. Desflurane has
a low blood-gas solubility coefficient (0.42 at 37°C), which promotes
rapid induction and recovery and ready control of depth of anesthesia.
A special vaporizer is required for desflurane because of its unique
physical characteristics. Desflurane has a high vapor pressure (664 mm
Hg at 20°C); it boils at 23.SOC, which is close to room temperature.
Desflurane's minimum alveolar concentration value is approximately
7%. Compared with other popular inhalant anesthetics, a higher range
for the vaporizer control settings is required for desflurane. Simplisti-
cally, desflurane vapor originates in a heated sump (temperature, 39°C;
vapor pressure, 1500 mm H g), and output from the vaporizer is con-
trolled by the operator, who adjusts the concentration control dial. Tee 6
vaporizers are quite expen sive and require regular maintenance.
Although North American Drager (Telford, PA) discontinued its line
of veterinary anesthesia machines several years ago, many of these
anesthesia machines and vaporizers are still used in veterinary anesthe-
sia practice. The Vapor 19.n series of vaporizers (North American
Drager) can be serviced, and m any remain functional in veterinary
hospitals. The Vapor 19.1 has been the workhorse for Drager's line of
650 HARTSFIELD

anesthesia machines for human beings, and agent-specific vaporizers are

available for enflurane, halothane, isoflurane, and sevoflurane.

VETERINARY ANESTHESIA MACHINES

Several anesthesia machines have entered the veterinary market

over the last 5 years. Examples are those that are available from Anesco
(SurgiVet, Waukesha, WI), Delmarva Laboratories (Midlothian, VA), and
Hallowell Engineering and Manufacturing Corporation (Pittsfield, MA).
Of particular interest are the newer machines for large animal use and
innovative machines for small patients and laboratory animals.
Delmarva Laboratories produces a small animal anesthesia machine
(Fig. 3), and Anesco promotes a full line of anesthesia machines and
ventilators for both small animal (Fig. 4) and large animal patients.
Anesco' s large animal anesthesia machines are compact in design, and
a large animal anesthesia machine and ventilator combination is avail-

Figure 3. Delmarva Small Animal Anesthesia Machine. (Courtesy of Chuck Tracy, Delmarva
Laboratories, Midlothian, VA.)

Figure 4. Anesco Small Animal Anesthesia Machine. (Courtesy of Jeff Baker, SurgiVet,
Inc, Waukesha, WI.)
 EQUIPMENT FOR INHALANT ANESTHESIA 651

Figure 5. Anesco Large Animal Anesthesia Machine and Ventilator. Two vaporizers, the
circle breathing system, and the bellows of the ventilator are shown. The stacked inspiratory
and expiratory breathing valves are shown in greater detail in Figure 6.

able (Fig. 5). A notable difference in the configuration of the circle

breathing system of these machines compared with the large animal
circle systems of other manufacturers is the "stacked" unidirectional
valves (Fig. 6).
Special anesthesia machines for laboratory animal use have been
developed to meet the need for simultaneous inhalant anesthesia in
multiple small animals (e.g., rats) with one basic anesthesia machine
and vaporizer. Laboratory animal personnel have developed homemade
anesthetic apparatuses for this purpose, and commercial units are be-
coming available. The controllability of depth of anesthesia in multiple
patients anesthetized simultaneously using only one vaporizer has been
debated. Nevertheless, Anesco has developed a multistation (for two,
four, or six animals) anesthesia delivery system (Fig. 7). The system is
designed to allow control of depth of anesthesia in individual animals.
The machine delivers a specific concentration of anesthetic in a specific
carrier gas (oxygen) flow, with each station receiving at least 1 L of
oxygen per minute. At each station, a separate flowmeter delivers oxy-
gen to dilute the anesthetic concentration to the percentage necessary to
provide the appropriate depth of anesthesia for each patient.
To provide an anesthetic machine-ventilator system for smaller pa-
652 HARTSFIELD

Figure 6. The large animal circle breathing system on an Anesco anesthesia machine. The
carbon dioxide absorbent canister on the far right is shown with the two stacked unidirec-
tional valves to the left of the canister. Also shown are ports for the inspiratory and
expiratory breathing hoses immediately below the canister and the unidirectional valves.
The port for the breathing bag (left) is situated below the pop-oft valve which is attached
to corrugated tubing leading to the scavenging system.

tients, Hallowell has produced its "Anesthesia Work Station" (Fig. 8),
which is described by the manufacturer as "a compact convenient system
for use on animals under 7 kg." The system can be used with a vaporizer
for inhalant anesthesia or without a vaporizer as a ventilator for animals
being maintained with injectable anesthetics. According to the manufac-
turer, the ventilator is capable of displacing a tidal volume of 0 to 100
mL, can produce respiratory rates of 4 to 80 breaths per minute, and has
an adjustable high-pressure limit of 10 to 30 em of water.

BREATHING SYSTEMS

Breathing systems for anesthetized veterinary patients have re-

mained essentially unchanged with regard to essential components and
basic structure. The circle breathing system is commonly used in veteri-
nary anesthesia, and a traditional circle system includes a fresh gas inlet,
a Y-piece, inspiratory and expiratory breathing hoses, inspiratory and
expiratory one-way valves, a reservoir or breathing bag, a canister for
carbon dioxide absorbent, and an overflow ("pop-of£") valve w hich can
adapt to a waste gas scavenging system.
In recent years, some manufacturers of veterinary anesthesia ma-
chines have changed the approach to designing circle systems and have
incorporated a "block" of material with appropriately machined chan-
nels and adapters for attachment of all components of a basic circle
system in a rather compact manner (Figs. 3, 4 and 9).
Anesco incorporates unidirectional valves of the center-mounted
 EQUIPMENT FOR INHALANT ANESTHESIA 653

Figure 7. Anesco Lab/Research Anesthesia System. (Courtesy of Jeff Baker, SurgiVet,

Inc, Waukesha, WI.)

flap type into its small animal circle system (Fig. 10) instead of traditional
dome valves with rigid discs. The flap valve contacts a valve seat
oriented in a horizontal position as opposed to the vertical orientation
of traditional dome valves. Flap valves of varying designs have been
incorporated into the nonrebreathing valves used in manual
resuscitators. 3• 4 The flap valve is less expensive and appears to function
well in circle systems for small animals.
Delmarva anesthesia machines for small animals include an over-
flow (pop-off) valve that is designed differently from those on most
veterinary anesthesia machines. The pop-off valve can be opened and
closed in the traditional manner, and the user has the option of closing
the valve by pushing downward on a "plunger" which emerges from
the top of the valve housing; releasing the plunger opens the valve
automatically (Fig. 11). This design permits the operator to assist or
control ventilation without continually having to open and close the
valve.
The carbon dioxide absorbent canister varies in some of the anesthe-
654 H ARTSFIELD

Figure 8. Hallowell Anesthesia Work Station . (Courtesy of Stetson Hallowell, Hallowell

Engineering and Manufacturing Corporation , Pittsfield, MA.)

sia machines. Variations in design can be seen in Figures 3 and 4. Some

designs direct gases through the canister in only one direction (e.g., top
to bottom), although others canisters are designed with two chambers
and channel gases down one side of the canister and up through the
other (see Fig. 10).
The Universa F® rebreathing circuit (King Systems, Noblesville, IN)
(Fig. 12) is a relatively new option as a replacement for the standard Y-
piece and corrugated inspiratory and expiratory breathing tubes of an
adult or small animal circle system. The apparatus is a tube within a
tube, with the inner (inspiratory) tube being 15 mm in diameter and the
outer (expiratory) tube being 25 mm in diameter. The manufacturer
indicates that the circuit can be used for patients weighing as much as
136 kg (300 lb).
"Nonrebreathing" systems continue to be used in veterinary anes-
thesia primarily for small patients. The body weight at which one
should change from a circle breathing system to a nonrebreathing system
remains controversial, with some authors recommending nonrebreathing
systems only for extremely small patients (< 3 kg), although others
recommend the systems for patients weighing less than about 7 kg. The
 EQUIPMENT FOR INHALANT ANESTHESIA 655

Figure 9. Delmarva Small Animal Anesthesia Machine Diagram. The channels for the
inhalation and exhalation sides of the circle breathing system are shown. On the diagram
from left to right are the exhalation one-way valve, pop-off valve, inhalation one-way
valve, pressure manometer, and two flowmeters. (Courtesy of Chuck Tracy, Delmarva
Laboratories, Midlothian, VA.)

Figure 10. Anesco Unidirectional Valves on a small animal circle breathing system. The
unidirectional valves are shown attached to the block of material used to support the
canister for carbon dioxide absorbent.
656 HARTSFIELD

Figure 11. Delmarva Pop-Off Valve. The pop-off valve is situated between the unidirectional
valves on this small animal circle breathing system . The pop-off valve is closed by making
the adjustment shown by the arrow. The pop-oft valve can be closed temporarily by
pressing down on the spring-loaded plunger. (Courtesy of Chuck Tracy, Delmarva Labora-
tories, Midlothian, VA.)

Figure 12. Universal F Circuit. This system that uses tube-in-a-tube design to replace
conventional breathing tubes is shown with the connecter for the endotracheal tube at the
bottom of the photograph. The connector to the inspiratory unidirectional valve is at the
top, with the connecter (left, center) for the expiratory unidirectional valve on the end of the
short piece of clear corrugated tubing .
 EQUIPMENT FOR INHALANT ANESTHESIA 657

primary arguments for nonrebreathing systems are a slight reduction in

dead space compared with an adult circle system's Y-piece, a reduction
in the volume of gas that the animal must circulate through the breathing
system, and a decrease in resistance to ventilation based on the absence
of one-way valves and fewer contortions of the pathway for gas flow.
These considerations are more important for spontaneously breathing
patients than for patients maintained with controlled ventilation. Many
nonrebreathing systems are modifications of Ayre's T-piece system (An-
esthesia Associates, Inc., San Marcos, CA), and Bain systems (Kendall
Co., Mansfield, MA) have become quite popular. Whether the system is
a Bain circuit or of another design, the development of disposable units
made of plastic materials provides a system that is lightweight and easy
to manipulate. These systems are designed for a single use in man;
veterinarians using these disposable systems multiple times should
avoid reusing contaminated systems and should be certain that the
system is intact and passes standard pre-use checkout procedures; these
checkout procedures have been described in detail. 4• 6

ANESTHESIA VENTILATORS
An anesthesia ventilator provides a mechanical method of applying
controlled ventilation (intermittent positive-pressure ventilation) to an
anesthetized patient; this gives the anesthetist an "extra pair of hands"
to ensure that ventilation is adequate to maintain arterial carbon dioxide
tensions (PaC02) near 40 mm Hg. Most anesthesia ventilators are de-
signed as a bellows (bag) in a bellows housing; the bellows is attached
to the reservoir bag port of the circle breathing system, usually through
a piece of corrugated breathing tubing, thus allowing the bellows to
serve as a replacement for the reservoir bag. The bellows is compressed
by driving gas at a specified number of times per minute (respiratory
rate) and a specified rate of inflow (rate of inflow of gas determines the
inspiratory time for each breath). The ventilator's controls allow the
selection of tidal volume, inspiratory pressure, respiratory rate, and ratio
of inspiratory time to expiratory time, with some variations depending
on the ventilator model.
Although there are exceptions, anesthesia ventilators are "double-
circuit" ventilators and comprise a patient circuit (including the gas
inside the bellows and breathing system, which is supplied from the
flowmeters of the anesthesia machine to meet the metabolic needs of the
patient) and a driving gas circuit (supplied from the ventilator to move
the bellows and control ventilation); gases from the two areas do not
mix with each other. 6
Several anesthesia ventilators are discussed in this section. All anes-
thesia ventilators should be used with knowledge of the instructions and
guidelines provided by the manufacturer. Appropriate pre-use checkout
procedures should be performed for the ventilator, anesthesia machine,
and breathing machine before attaching these devices to a patient.
Anesthesia ventilators designed for man can be applied to veteri-
658 HARTSFIELD

nary patients if those patients fall within the range of body size and
weight for which the ventilator was intended. Veterinary anesthesia
ventilators are sometimes designed to meet the needs of patients that
are quite large (e.g., adult horses) or quite small (<5 kg). Ohmeda
manufactures ventilators for human application; these ventilators are
satisfactory for small animal patients, and some models have been
described. 6 The Ohmeda 7800 ventilator series allows the independent
selection of both respiratory rate and tidal volume rather than selecting
minute volume, which is a significant advantage for small patients. Both
the Ohmeda 7000 and 7800 ventilators allow selection of two sizes of
bellows to accommodate patients with smaller (0-300 mL) and larger
100- 1600 mL) tidal volumes. The Ohmeda 7900 series of ventilators has
been introduced recently and also appears to be applicable to veterinary
patients.
Anesco has produced ventilators for both large and small animals.
The large animal ventilator (see Fig. 5) is designed for use with an
appropriate large animal anesthesia breathing system. It is described as
being pneumatically controlled, pneumatically powered, and time cy-
cled. The bellows descends during expiration, and the bellows h ou sing
shows gradations of tidal volume from 4 to 15 L. The inspiratory-to-
expiratory time ratio is variable. The ventilator has the following con-
trols: on/ off switch, tidal volume (hand wheel mechanism), breaths per
minute (variable, from 0-100), inspiratory time, flow, and pressure.
Anesco's small animal ventilator (Fig. 13), the SAV 2500 Small

Figure 13. Anesco SAV 2500 Small Animal Ventilator. The controls from left to right are
inspiratory flow, expiratory rate, inspiratory time, manual breath, and on-off switch. (Cour-
tesy of Jeff Baker, SurgiVet, Inc, Waukesha, WI.)
 EQUIPMENT FOR INHALANT ANESTHESIA 659

Figure 14. Hallowell EMC Model 2000. Controls on the front of the ventilator include the
on-off switch, respiratory rate, volume, inspiratory hold, and maximum working pressure
limit. (Courtesy of Stetson Hallowell, Hallowell Engineering and Manufacturing Corporation,
Pittsfield, MA.)

Animal Anesthesia Ventilator, is electronically controlled, pneumatically

powered (medical grade oxygen or medical grade air), and time cycled;
it is intended for use with a small animal anesthesia breathing system.
The bellows ascends during expiration, and the bellows housing shows
gradations of tidal volume from 300 to 1500 mL. The ventilator has the
following controls: on/ off switch, breaths per minute (2-15), inspiratory
time, inspiratory flow, manual breath button, pneumatic manual breath
(for use in case of electrical failure), and safety pressure relief valve.
Hallowell has developed anesthesia ventilators that are applicable
to patients of variable size and body weight, and the Hallowell EMC
Model2000 (Fig. 14) has been described previously. 6 The Hallowell EMC
Anesthesia Work Station (see Fig. 8), which includes a ventilator, is
described above in the section on veterinary anesthesia machines.
Mallard Medical (Redding, CA) manufactures ventilators that are
appropriate for both large and small animals; the Mallard Medical Ra-
chael Model 2800 Large Animal Anesthesia Ventilator and Mallard 2800V
Small Animal Anesthesia Ventilator have been described elsewhere.6
The Mallard Model 2800B Large Animal Anesthesia Ventilator System
(ascending bellows; Fig. 15) and Model 2500 Large Animal Anesthesia
Ventilator System (descending bellows; Fig. 16) provide options for
complete units for inhalant anesthesia and controlled ventilation in large
animals. A pediatric bellows is available for adaptation to Model 2800B,
which allows the ventilation of smaller patients such as foals and calves
(see Fig. 15).
660 HARTSFIELD

Figure 15. Mallard Medicai2800B Large Animal Anesthesia Ventilator System. This particu-
lar anesthesia-ventilator system is configured with an optional pediatric bellows assembly
(upper left), one vaporizer, a large animal circle breathing system , and a large animal
bellows assembly. Note that the bellows are designed to ascend during expiration. (Cour-
tesy of Robert Pearson, Mallard Medical, Inc, Redding, CA.)

ENDOTRACHEAL TUBES, MASKS, AND CLOSED

CONTAINERS

Endotracheal tubes should be used in essentially all veterinary

patients that are to be maintained under anesthesia with inhalant anes-
thetics. Murphy-style and Cole-style endotracheal tubes are commonly
used. A properly selected and placed endotracheal tube with a correctly
inflated cuff provides a patent airway, allows application of assisted or
controlled ventilation, and helps to prevent contamination of the work-
place with inhalant anesthetic gases.
A variety of commercially available endotracheal tubes are useful
in veterinary patients. Endotracheal tubes designed for man perform
well in most smaller veterinary patients (e.g., dogs, cats, and patients of
similar size), and human endotracheal tubes with high-volume low-
pressure cuffs are produced in sizes ranging between 3 and 10 mm
internal diameter. Smaller uncuffed tubes can be purchased in both
Murphy and Cole styles. Cuffed Murphy-type endotracheal tubes de-
 EQUIPMENT FOR INHALANT ANESTHESIA 661

Figure 16. Mallard Medical 2500 Large Animal Anesthesia Ventilator System. Positioned
from top to bottom on the machine are the ventilator controls, an oxygen flowmeter and
two vaporizers, the large animal circle breathing system, and the bellows and bellows
housing. Note that the bellows is designed to descend during expiration. (Courtesy of
Robert Pearson, Mallard Medical, Inc, Redding, CA.)

signed especially for veterinary patients are commercially produced in

a broad range of sizes for both small and large animals (e.g., up to
approximately 30 mm internal diameter), and tubes of specific dimen-
sions can be obtained at extra cost (Bivona, Gary, IN).
Contemporary high-quality endotracheal tubes are made from sili-
cone rubber or polyvinyl chloride. This author does not recommend the
use of red rubber tubes because they are opaque, prone to cracking, and
difficult to clean and sterilize effectively.
Specially designed endotracheal tubes are available in styles in-
tended for both human and veterinary use. Armored tubes contain
helical plastic or w ire within the walls to prevent collapse of the lumen
when the tube is bent, and such tubes are indicated for procedures that
require the patient's head and neck to be maintained in flexion. Other
types of endotracheal tubes, including double-lumen tubes for bronchial
intubation, are common in human anesthesia and may be applicable to
special procedures in veterinary anesthesia.
662 HARTSFIELD

Face masks are used to facilitate administration of oxygen and

inhalant anesthetics to veterinary patients, and they are usually used
with a relatively high inflow of fresh gases (commonly 2-5 L/min in
small animal patients) to promote oxygenation and induction and to
minimize dead space in the mask by diluting exhaled carbon dioxide. A
face mask is attached to a breathing system (e.g., the Y-piece of a circle
system or the patient end of a Bain system), which provides a reservoir
of gases to meet the patient's tidal and minute volume demands and
provides for attachment to a scavenging system for removal of excess
gases. Masks should fit snugly to prevent unnecessary contamination of
the workplace with waste anesthetic gases; nevertheless, some escape of
gas into the environment is inevitable, and masking procedures should
be performed in well-ventilated areas. A clear mask with the diaphragm
containing a hole to accept the patient's muzzle allows a good fit in
most veterinary patients. Such masks are made and distributed by a
number of commercial companies.
Closed containers (induction chambers) are also useful for induction
and oxygenation in small veterinary patients, especially those small
patients that may be difficult to restrain for intravenous inductions. Such
inductions are usually performed with relatively high flows of fresh
gases as is the case with masking procedures, and some contamination
of the working environment occurs whenever the animal is removed
from the container. Inhalant inductions with closed containers are best
performed in a fume hood, or at least in a well-ventilated room with a
high rate of air exchange. Closed containers are available from several
manufacturers and distributors. Clear break-resistant containers with
tightly fitting lids with ports for the entry of fresh gases and exit of
excess gases into a scavenger system are desirable.

CONCLUSIONS

New developments and improvements in veterinary anesthesia

equipment help to increase the quality of care that veterinarians can
provide to their patients. The use of anesthesia machines, vaporizers,
breathing systems, ventilators, and ancillary anesthetic equipment is
essential in the administration of inhalant anesthetics. The equipment
should be used responsibly, however, and veterinarians should remain
current in their knowledge about the use of such equipment.

References

1. American Society for Testing and Materials: Standard specification for minimum perfor-
mance and safety requirements for components and systems of anesthesia gas machines
(ASTM F1161-88). In Annual Book of ASTM Standards, section 13, Medical Devices and
Services. West Conshohocken, PA, American Society for Testing and Materials, 1997,
p 425
 EQUIPMENT FOR INHALANT ANESTHESIA 663

2. Bednarski RM: Anesthetic equipment. Semin Vet Med Surg 8:1, 1993
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Address reprint requests to

Sandee M. Hartsfield, DVM
Department of Veterinary Small Animal Medicine
Texas A&M University
College Station, TX 77843-4474