ANESTHESIA MACHINE

The anesthesia machine is, conceptually, a pump for delivering medical gases and
inhalation agents to the patient’s lungs.
◾ The function of the anesthesia machine is to :
(1) receive gases from the central supply and cylinders
(2) meter them and add anesthetic vapors
(3) deliver them to the patient breathing circuit.
This machine has evolved over the past 160 years from a rather
simple ether inhaler to a complex device of
valves, pistons, vaporizers, monitors, and electronic circuitry.The “pump”
in the modern anesthesia machine is either a mechanical
ventilatoror the lungs of the spontaneously breathing
patient, or perhaps, a combination of the two.
Anesthesia pump has a supply system: medical
gases from either a pipeline supply or a gas cylinder,
alongside vaporizers delivering potent inhaled anesthetic agents that are
mixed with the medical gases. The anesthesia pump also has
an exhaust system, the waste gas scaveng ing system, which removes excess
gases from the patient’s breath ing circuit. The breathing circuit is a series of hoses, valves,
ilters, switches, and regulators that interconnect the supply system, the patient, and the
exhaust system. Modern anesthesia machines are now more properly referred to as
anesthesia workstations
STANDARDS FOR ANESTHESIA MACHINES AND WORKSTATIONS

The American National Standards Institute (ANSI) and the

American Society for Testing and Materials (ASTM) define standards
for anesthesia machines and workstations, and provide guidelines
to manufacturers regarding their minimum performance, design
characteristics, and safety requirements.
Newly manufactured workstationsmust 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.

The anesthesia workstation must have a prioritized alarm

system that groups the alarms into three categories: high,
medium, and low priority. 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 .

GAS SUPPLIES
Bulk Supply of Anaesthetic Gases In the majority of modern hospitals, piped medical gases
and vacuum (PMGV) systems have been installed. These obviate the necessity for holding
large numbers of cylinders in the operating theatre suite.

Normally, only a few cylinders are kept in reserve, attached usually to the anaesthetic
machine.The advantages of the PMGV system are reductions in cost, in the necessity to
transport cylinders and in accidents caused by cylinders becoming exhausted.
The PMGV services comprise five sections:
bulk store
distribution pipelines in the hospital
terminal outlets, situated usually on the walls or ceilings of the operating theatre suite and
other sites
flexible hoses connecting the terminal outlets to the anaesthetic machine
connections between flexible hoses and anaesthetic machines.

BULK STORE ; OXYGEN SUPPLY

◾ Oxygen may be supplied to the PMGV from a bank of several oxygen cylinders
attached to a manifold. Oxygen cylinder manifolds
consist of two groups of large cylinders (size J). The two groups alternate in supplying
oxygen to the pipelines.
◾ In both groups, all cylinder valves are open so that they empty simultaneously. All
cylinders have non-return valves.The supply automatically changes from one group to the
other when the first group of cylinders is nearly empty.The changeover also activates an
electrical signalling system, which alerts staff to change the empty cylinders.
However, in larger hospitals, pipeline oxygen originates from a liquid oxygen store. Liquid
oxygen is stored at a temperature of
approximately −165 °C at 10.5 bar – a vacuum insulated evaporator (VIE).
Some heat passes from the environment through the insulating layer between the two shells
of the flask, increasing the tendency to evaporation and pressure increase within the
chamber. Pressure is maintained constant by transfer of gaseous oxygen into the pipeline
system (via a warming device). However, if the pressure increases above 17 bar (1700 kPa),
a safety valve opens and oxygen runs to waste. When the supply of oxygen resulting from
the slow evaporation from the surface in the VIE is inadequate, the pressure decreases and a
valve opens to allow liquid oxygen to pass into an evaporator, from which gas passes into
the pipeline system. Liquid oxygen plants are housed some distance away from hospital
buildings because of the risk of fire. Even when a hospital possesses a liquid oxygen plant,
it is still necessary to hold reserve banks of oxygen cylinders in case of supply failure.

PIPELINE SUPPLY SOURCE

◾ Most hospitals today havea central piping system to
deliver medical gases including oxygen, nitrous
oxide, and air to outlets in the operating room. The
central piping system must supply the correct gases at the appropriate
pressure for the anesthesia workstation to functionproperly.
◾ The wall outlet connections for pipeline gases are gas-
speciic. If they are “quick connect” fittings then they are gas-speciic
within thesame manufacturer.
◾ nationally standardized Diameter Index Safety System (DISS)
provides threaded, noninterchangeable connections for medical
gas lines, whichminimizes the risk of misconnection. Regardlessof which
type of gas-speciic connector (DISS or “quick connect”) exists
at the wall end of the hose conducting gas to the anesthesia
machine, the gas enters the anesthesia machine through DISS inlet connections . A pressure
gauge measures the pipeline gas pressure when the machine is connected to a pipeline
supply. A check valve is located downstream from the inlet. It prevents reverse flow of
gases from the machine to the pipeline or the atmosphere.

PIPELINE SUPPLY SOURCE

◾ Nitrous Oxide
Nitrous oxide and Entonox may be supplied from banks of cylnders connected to manifolds
similar to those used
for oxygen.
◾ Medical Compressed Air
Compressed air is supplied from a bank of cylinders into the PMGV system. Air of medical
quality is required,
as industrial compressed air may contain fine particles of oil.
◾ Piped Medical Vacuum:
Piped medical vacuum is provided by large vacuum pumps which discharge via a filter and
silencer to a suitable point,
usually at roof level, where gases are vented to atmosphere.

TERMINAL OUTLETS
◾ Vacuum (coloured yellow) – a vacuum of at least 53 kPa (400 mmHg) should be
maintained at the outlet, which should be able to take a free flow of air of at least 40 L/ min
◾ Compressed air (coloured white/black) at 4 bar – this is used for anaesthetic
breathing systems and ventilators.
◾ Air (coloured white/black) at 7 bar – this is to be used only for powering compressed
air tools and is confined usually to the orthopaedic operating theatre.
◾ Nitrous oxide (coloured blue) at 4 bar.
◾ Oxygen (coloured white) at 4 bar.
◾ Scavenging – there is a variety of scavenging outlets from the operating theatre. The
passive systems are designed to accept a standard 30-mm connection.

TERMINAL OUTLETS

Modern cylinders are constructed from molybdenum steel. They are checked at
intervals by the manufacturer to ensure that they can withstand hydraulic pressures
considerably in excess of those to which they are subjected in normal use.
One cylinder in every 100 is cut into strips to test the metal for tensile strength, flattening
impact and bend tests. Medical gas cylinders are tested hydraulically every 5 years and
the tests recorded by a mark stamped on the neck of the cylinder and this includes test
pressure, dates of test performed, chemical formula of the
cylinder’s content and the tare weight. Cylinders may also be inspected endoscopically or
ultrasonically for cracks or defects on their inner surfaces. Light weight cylinders can be
made from aluminium alloy with a fibreglass covering in an epoxy resin matrix.The
cylinders are provided in a variety of sizes (A to J), and colour- coded according to the gas
supplied. Cylinders attached to the anaesthetic machine are usually size E. The cylinders
comprise a body and a shoulder containing threads into which are fitted a pin index valve
block, a bull- nosed valve or a handwheel valve.The pin index system was devised to
prevent interchangeability of cylinders of different gases. Pin index systems are provided
for the smaller cylinders of oxygen and nitrous oxide (and also carbon dioxide) which may
be attached to anaesthetic machines. The pegs on the inlet connection slot into
corresponding holes on the cylinder valve.
The colour codes used for medical gas cylinders in the United Kingdom. Different colours
are used for some gases in other countries.There is a proposal to harmonize cylinder colours
throughout Europe.The body will be painted white and only the shoulders will be colour-
coded.The shoulder colours for medical gases will correspond to the current UK colours but
will be horizontal rings rather than quarters
.Oxygen, air and helium are stored as gases in cylin-ders and the cylinder contents can be
estimated from the cylinder pressure.The pressure gradually decreases as the cylinder
empties.
FLOWMETERS

Theflowmeter assembly. precisely controls and measures

Gasflow tothe common gas outlet. With traditional glass flowmeter
assemblies, the flow control needle valve
regulates the amount of flow that enters a
tapered, transparent flow tube known as a Thorpe tube. The tube is
tapered such that it has a small cross-sectional area at its lower (low flow) end, and a larger
cross-sectional area at its upper (high flow) end. A mobile indicator float inside the flow
tube indicates the amount of flow passing through the associated flow control valve. The
quantity of flow is indicated on a scale associated with the flow tube. Some newer
anesthesia workstations have now replaced the conventional glass flow tubes with electronic
flow sensors that measure the flow of the individual gases. The flow rate data are then
presented in numerical format, graphical format, or a combination of the two.

Plenum vaporizers. These are intended for unidirectional gas flow, have a relatively high
resistance to flow and are unsuitable for use either as drawover vaporizers or in a circle
system. Examples include the ‘TEC’ type in which there is a variable bypass flow.
SCAVENGING SYSTEM
The principal sources of pollution by anaesthetic gases and vapours include:
discharge of anaesthetic gases from ventilators
expired gas vented from the spill valve of anaesthetic breathing systems
leaks from equipment, e.g. from an ill-fitting face mask
gas exhaled by the patient after anaesthesia. This may occur
in the operating theatre, corridors and recovery room
spillage during filling of vaporizers.

most attention has centred on removing gas from the expiratory ports of breathing systems
and ventilators, other methods of reducing pollution should also be considered:
Reduced use of anaesthetic gases and vapours. The use of the circle system reduces
the potential for atmospheric pollution.
The use of inhalational anaesthetics may be obviated totally by using total
intravenous anaesthesia or local anaesthetic techniques.
Air conditioning: Air conditioning units which produce a rapid change of air in the operating
theatre reduce pollution substantially. However, some systems recycle air, and older
operating theatres, dental surgeries and obstetric delivery suites may not be equipped with
air conditioning.
Care in filling vaporizers. Great care should be taken not to spill volatile anaesthetic agent
when a vaporizer is filled. The use of agent-specific connections reduces the risk of spillage.

SCAVENGING SYSTEM
Disposal systems may be active, semi-active or passive.
Active Systems : These employ apparatus to generate a negative pressure within the
scavenging system to propel waste gases to the outside atmosphere. The system may be
powered by a vacuum pump or a Venturi system. The exhaust should be capable of
accommodating 75 L/ min continuous flow with a peak of 130 L/ min Usually, a reservoir
system is used to permit high peak flow rates to be accommodated. In addition, there must
be a pressure-limiting device within the system to prevent the application of negative
pressure to the patient’s lungs.
Semi-Active Systems :The waste gases may be conducted to the extraction side of
the air-conditioning system, which generates a small negative pressure within the
scavenging tubing. These systems have variable performance and efficiency.
Passive Systems: These systems vent the expired gas to the outside atmosphere Gas
movement is generated by the patient. Consequently the total length of tubing must not be
excessive or resistance to expiration is high. The pressure within the system may be altered
by wind conditions at the external terminal; on occasions, these may generate a negative
pressure, but may also generate high positive pressures. Each scavenging location should
have a separate external

SCAVENGING APPARATUS
Anaesthetic gases vented from the breathing system are removed by a collecting
system. A variety of purpose-built scavenging spill valves is available.
Waste gases from ventilators are collected by attaching the scavenging system to the
expiratory
port of the ventilator.
Connectors on scavenging systems have a diameter of 30 mm to ensure that
inappropriate connections with anaesthetic apparatus cannot be made.