02.06.2018 - 3 - A. Kollmann Camaiora - Anesthesia Equipment

Anesthetic Equipment
Andrea Kollmann Camaiora

Anesthesia and Intensive Care
Akademiska Sjukhuset
Uppsala - Sweden
No conflict of interests
Summary
• Anesthesia workstation
• Breathing systems
• Gas analyzers
• Invasive arterial pressure
• Safety in the OR: Electrical safety, fire in the OR

Anesthesia workstation
High pressure gas delivery
Receives gas from the cylinders
Gas cylinder and attachments Reduces cylinder pressure

4000-1444 kPa -> 310-420 kPa
Non return valves
To protect the patient, the
Pressure gauges apparatus and maintain
constant pressure
Primary pressure regulator
• Cylinders are not usually used, but it is a necessary safety feature
• Color coded and specific pin index safety system connection

Medical gas cylinders
• Madeof chrome-molybdenum steel or
carbon steel
• Sizes defined by water capacity (L)
• Gases stored in a compressed gaseous
form
• Gascontent =
water capacity (L) x pressure (bar)
• N2O and CO2 are liquefied gasses under

pressure
• Pressure remains constant until
cylinder is empty
Intermediate pressure systems
Receives gas from hospital pipelines 300-400 kPa
• Consists of:
• Pipeline secure inlet connections
• Pipeline pressure gauges and indicators
• Master switch
• Oxygen pressure failure devices
• Oxygen flush
• Additional or secondary regulators
• Flow control valves

Safety devices to secure O2 delivery
1. Oxygen pressure failure system (fail-save valve)
• Anesthesia workstation standards require that when oxygen supply pressure is reduced,
the delivered oxygen concentration at the common gas outlet does not fall below 21%
• Mechanical, pneumatical or electronic cut off devices
• They detect failure based on pressure and not flow, hence they do not protect against
hypoxic gas delivery
Safety devices to secure O2 delivery
2. Anti-hypoxia devices
• Additional regulator upstream of the flow meters
• Flow is constant even if fluctuations in the pipeline pressure
• These reduce the O2 pressure to 14

psig and 26 psig for N2O
3. Oxygen flush
• Delivers 35l/min/O2 directly from pipeline or cylinder
• May cause barotrauma and dilutes inhaled anesthetic

Low pressure systems
Delivers gas from the flowmeters via vaporizers to the patient
• Flowmeters
• Vaporizers and their mounting devices
• Unidirectional and pressure relief valves: set at 35kPa
• Common gas outlet: receives all the gasses and vapors and
delivers the mixture to the breathing system
• Breathing system: traditionally not part of the machine, but

newer ones may have a built in circle system
Flowmeters
1. Mechanical (rotameters)
• Constant pressure variable orifice flowmeters
• Each calibrated for a particular gas
• Bobbin rotation indicates proper working conditions
• Accurate within 10% of indicated flow

Flowmeters
2. Transitional or hybrid flowmeters
• Works with a needle valve. Flow can be

generated without electric power, but the
measurement and display is electronic
3. Electronic flowmeters
• Gas flow set, measured and displayed electronically
• No manual valve
• Backed up with a basic O2 delivery

system in case of power or machine
failure
Flowmeter safety
• Only one flow control be provided for each gas at a time
• A protective barrier around the control minimizes accidental changes in

settings.
• Tubes are made leak-proof with neoprene washers (O-rings) at both ends
of the flow meter assembly.
• The bobbin is visible throughout the

length of the tube
• The tubes have an antistatic coating

Vaporizers
• Volatile anesthetics must be vaporized before being delivered to the patient
• Located between the flowmeters and the common gas outlet
• Physics of vaporization:
• The molecules of volatile anesthetic in a closed container are distributed
between the liquid and gaseous phases
• Vapor pressure depends on the agent´s characteristics and the temperature
• Vaporization requires energy (latent heat of vaporization), which results in a
loss of heat from the liquid
• The tº of the remaining liquid decreases unless heat enters the system
• A liquid´s boiling point is the tº at which its vapor pressure is equal to the
atmospheric pressure
• At higher altitudes the boiling point decreases
Variable bypass vaporizers
• The FGF to the patient is split in 2 by a splitting valve

• One bypasses the vaporizing chamber and is free from volatile agent
• the other passes through the vaporizer chamber and becomes saturated
• The final vapor concentration is controlled by using a flow splitting valve
1. Draw over
• Gases are at ATM pressure and are

drawn through the vaporized chamber
by the inspiratory efforts of the patient.
• Low resistance vaporizer
• Poor accuracy since flow rated vary: at

low flow rated the resistance will
become significant and gases will
bypass the chamber, at high flows
there will be increased dilution of the
vapor and concentration will also
decrease
2. Plenum
• The inspired gases are at higher

than ATM pressure and pressurize
the vapor chamber
• High resistance vaporized
• Accurate in wide range of flows
• Accurate in a wide range of temperatures due to built in temperature

compensation
• Can be used in altitud because partial pressure of the volatile agent

remains constant
Measured flow vaporizers
TEC 6 Desflurane vaporizer
• Desflurane boiling point = 23.5ºC
• Desflurane is heated up to 39ºC

under a pressure of 194 kPA or
1500mmHg
• A continuos flow of desflurane

vapor from the chamber is added to
the FGF via the concentration
control valve
• Shut off valve activated by tilting the

vaporizer
Safety features of vaporizers
Interlock mechanism to prevent using
Transport setting to two agents
prevent spillage of the simultaneously
liquid agent into the
bypass channel
Pin safety system

to prevent filling up
with wrong agent
Breathing systems
• A breathing system may consist of
all or some of:
• Face mask
• Gas hoses and connectors
• Reservoir bag
• CO2 absorber
• Adjustable pressure limiting (APL) valve
• A valve to switch between controlled (CV) and spontaneous ventilation (SV)
• One-way valve to prevent rebreathing

Absorption systems
• Rebreathing alveolar gas conserves
heat and humidity
• CO2 in exhaled gas must be eliminated

to prevent hypercapnia
• Soda lime is the most common

absorbent and is capable of absorbing
up to 23L of CO2 per 100g of
absorbent. It´s main component is
calcium hydroxide (80%)
• Reaction en products: heat, water and

calcium carbonate
• Barium hydroxide is not longer used

due to fire risk
Anesthetic Gas Analysis
• Mass spectrometry and Raman spectroscopy are of
historical interest.
• Most anesthetic gases are measured by infrared

absorption analysis
• Based on the Beer-Lambert law: the absorption of

infrared light passing through a solvent (gas) is
proportional to the amount of the unknown gas
• O2 and N2 do not absorb

infrared light
O2 Analysis
1. Galvanic Cell (fuel cel)
• Contains a lead anode and gold cathode bathed in potassium chloride. At
the gold terminal hydroxyl ions are formed that react with the lead, gradually
consuming it. These are the O2 monitors used on many anesthesia machines
in the inspiratory limb.
2. Paramagnetic Analysis
•O is nonpolar but paramagnetic, and when in a magnetic field, the gas will
2
expand, contracting when the magnet is turned off. By switching the field on
and off and comparing the result to a known standard, the amount of O2 can
be measured. Requires a water trap.
3. Polarographic Electrode
• Has a gold or platinum cathode and a silver anode bathed separated by a
semipermeable membrane. This works only if a small voltage is applied to the
electrodes. The amount of current that flows between the anode and cathode
is proportional to the amount of O2 present.
Invasive Arterial Pressure
• Fluctuations of pressure cause a pulsation of the saline column
• Displaces electromanometer’s diaphragm which has a built in strain

gauge (Wheatstone bridge principle)
• Deformation leads to a change in resistance of the strain gauge

which is sensed electronically
• Wave form built up by

Fourier analysis
Damping
• Anything that reduces energy in an oscillating system will
reduce the amplitude of the oscillations
• Damping is necessary in all systems (critical damping), but

if excessive (overdamping) or insufficient (underdamping)
the output will be affected
Electrical Safety
The risk of electrocution
• Body contact with two conductive materials at different voltage

potential may complete a circuit and result in electrical shock
• Leakage current is present in all electrical equipment as a result

of capacitive coupling, induction between internal electrical
components, or defective insulation.
• The leaks are usually imperceptible to touch (<1mA) and well

bellow the fibrillation threshold (100mA)
• If the current bypasses the high resistance offered by the skin or

is applied directly to the heart (microshock),100 µA may be fatal
• The maximum leakage allowed in OR equipment is 10 µA

Electrical Safety
Surgical Diathermy
• Electrosurgical units generate an ultra-high-frequency electrical current

that passes from a small active electrode (cautery tip) through the patient
and exits by way of a plate electrode (dispersal pad).
• Ventricular fibrillation is prevented by using ultrahigh

frequencies (0.1-3MHz), compared with line power
(50-60Hz)
• Malfunction of the dispersal pad may result from

disconnection, inadequate patient contact of
insufficient conductive gel. The current will find
another place to exit, which may result in a burn
• Precautions include: proper electrode placement,

avoid prostheses and bony protuberances and
elimination of patient-ground contacts
Fires and Thermal Injuries
The risk of electrocution
• Incidence of surgical fires is rare (1:87,000 cases)
• The most common risk factor related to open delivery of oxygen
• The fire triad: fuel, oxidizer and ignition source
• When the surgical site is above the xiphoid and the patient needs >30% O2,
the airway should be secured
• The most important action in case of airway fire is the fast removal of the
endotracheal tube and the gas flow. The tube should be examined for missing
pieces
• If the patient is on fire, the oxidizing gases should be stopped, surgical drapes
removed and fire extinguished by water. If it is not immediately extinguished,
then a CO2 extinguished may be used.
References
• Fundamentals of Anaesthesia 3rd edition
• Morgan and Mikhail's Clinical Anesthesiology 5th Edition
• Hemodynamic monitoring made incredibly visual, 2nd Edition
• Subrahmanyam M, Mohan S. Safety Features in Anaesthesia Machine. Indian

Journal of Anaesthesia 2013;57:472-480
• Garg R, Gupta RC, Analysis of oxygen, anaesthesia agent and flows in

anaesthesia machine. Indian Journal of Anaesthesia. 2013;57: 481-488
• Association of Anaesthetists of Great Britain and Ireland (AAGBI), Hartle A,

Anderson E, Bythell V, Gemmell L, Jones H, et al. Checking anaesthetic
equipment 2012: Association of anaesthetists of Great Britain and Ireland.
Anaesthesia2012;67:660-8.

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Anesthetic Equipment

Andrea Kollmann Camaiora

• Invasive arterial pressure

• Safety in the OR: Electrical safety, fire in the OR

Gas cylinder and attachments Reduces cylinder pressure

• Cylinders are not usually used, but it is a necessary safety feature

• Color coded and specific pin index safety system connection

• N2O and CO2 are liquefied gasses under

• Pipeline secure inlet connections

• Pipeline pressure gauges and indicators

• Oxygen pressure failure devices

• Additional or secondary regulators

• Flow control valves

• Mechanical, pneumatical or electronic cut off devices

• Additional regulator upstream of the flow meters

• Flow is constant even if fluctuations in the pipeline pressure

• These reduce the O2 pressure to 14

• Delivers 35l/min/O2 directly from pipeline or cylinder

• May cause barotrauma and dilutes inhaled anesthetic

• Vaporizers and their mounting devices

• Unidirectional and pressure relief valves: set at 35kPa

• Breathing system: traditionally not part of the machine, but

• Constant pressure variable orifice flowmeters

• Each calibrated for a particular gas

• Bobbin rotation indicates proper working conditions

• Accurate within 10% of indicated flow

• Works with a needle valve. Flow can be

• Gas flow set, measured and displayed electronically

• Backed up with a basic O2 delivery

• A protective barrier around the control minimizes accidental changes in

• The bobbin is visible throughout the

• The tubes have an antistatic coating

• The FGF to the patient is split in 2 by a splitting valve

• Gases are at ATM pressure and are

• Low resistance vaporizer

• Poor accuracy since flow rated vary: at

• The inspired gases are at higher

• High resistance vaporized

• Accurate in wide range of flows

• Accurate in a wide range of temperatures due to built in temperature

• Can be used in altitud because partial pressure of the volatile agent

• Desflurane boiling point = 23.5ºC

• Desflurane is heated up to 39ºC

• A continuos flow of desflurane

• Shut off valve activated by tilting the

Pin safety system

• Gas hoses and connectors

• Adjustable pressure limiting (APL) valve

• A valve to switch between controlled (CV) and spontaneous ventilation (SV)

• One-way valve to prevent rebreathing

• CO2 in exhaled gas must be eliminated

• Soda lime is the most common

• Reaction en products: heat, water and

• Barium hydroxide is not longer used

• Most anesthetic gases are measured by infrared

• Based on the Beer-Lambert law: the absorption of

• O2 and N2 do not absorb

• Displaces electromanometer’s diaphragm which has a built in strain

• Deformation leads to a change in resistance of the strain gauge