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What equipment is needed to use the anesthesia machine?
- endotracheal tubes
- IV catheter
- administration set
- IV fluid bag
- KY jelly
- lidocaine spray
- ophthalmic ointment
- face mask
- inhalation anesthesia machine
- emergency drugs
- monitoring equipment
- scavenger system
What is the goal of anesthesia?
to deliver a precise amount of anesthetic vapor and O2 to patient
Why do we use the anesthesia machine?
increases safety and convenience of inhalation anesthesia
What type of volatile inhalation anesthetic gases do we use?
What are carrier gases?
volatile anesthetic gas is mixed with carrier gas for delivery?
What carrier gases do we use?
- oxygen + nitrous oxide
What is the function of the anesthesia machine?
- deliver oxygen
- vaporize anesthetic
- mix anesthesic with oxygen
- deliver mixture to patient
- remove exhaled gases
How is inhalation anesthetic supplied?
as a liquid
Vaporize anesthetic must be _____.
Vaporize anesthetic must be delivered at a specific _____.
How is exhaled gas removed?
through the scavenger system and may recirculate to patient after removing CO2
Should oxygen be continuously supplied to the patient?
What color tank is the oxygen tank?
- green in USA
- white everywhere else
What is the O2 pressure gauge?
direct relationship between amount of O2 in tank and it's pressure
Where is the O2 pressure gauge located?
near top of tank
What will the O2 pressure gauge say if it is a full tank?
What will the O2 pressure gauge say if the tank is half full?
What will the O2 pressure gauge say if the tank is considered empty?
What is the atm pressure?
What are the cautions about oxygen?
- oxygen supports combustion
- keep away from flames
- no smoking or sparks near equipment
What color are N2O tanks?
What does the N2O pressure gauge say if it is full?
What is N2O?
a combination of liquid and gas at a certain pressure (770 psi)
When does the N2O pressure drop?
when the tank is almost empty
When is the N2O tank considered empty?
What can happen to the patient as a result of N2O not used correctly?
How do you keep track of the N2O pressure?
weigh the tank
What size tank is the little size?
What size tank is the bigger sizes?
G, H, M
How do you open the tank valve?
How do you close the tank?
What does the pressure gauge read on the tank when it is turned off?
How do you evacuate the pressure in the tank?
- turn off tank
- leave flowmeter on until it reads zero
- then turn off flowmeter
- turn off tank
- push the oxygen flush valve until pressure is gone
What are the different attachments for the tank?
- gas line (for free standing tanks)
- yoke (for small tanks attached directly to the machine)
- safety systems
What is the purpose of the safety system on the tanks?
prevents the wrong tank from being attached
What are the different safety systems for the tanks?
- pin-index saftey system (for yokes)
- special outlets (for gas lines)
- color coding
What is the pressure regulator valve?
- on O2 and N2O tanks
- reduces pressure down to 50 psi
- prevents damage ot patient and machine
Are there separate flowmeters for oxygen and nitrous oxide?
What must be turned on in order for O2 to be delievered to the patient?
O2 tank and flowmeter
What is the flowmeter?
allows rate of gas flow to be set
How is the flowmeter set?
- rate is set according to patient's size and need
- expressed in L/min
What does the flowmeter look like?
graduated narrow glass tube with loose ball inside
How do you turn the flowmeter on?
turn dial to the left
Where do you read the flowmeter?
at the center of the ball
Gas enters the flowmeter at the _____ at _____.
Gas leave the flowmeter at the _____ at _____.
How can the flowmeter be damaged?
- not handling carefully
- over tightening the dial
- not turning it off after use
What is fresh gas?
gas that has not been exhaled from the patient and which is not mixed with gas exhaled from the patient
What does the fresh gas include?
- N2O (if being used)
- anesthetic vapor if using VOC
Where is the fresh gas inlet?
where the fresh gas enters the patient breathing circuit
What is another name for the patient breating circuit?
patient ciruit or anesthetic circuit
What does the patient circuit include?
- one way flutter valves
- breathing hoses
- CO2 absorber
- pop-off valve
- reservoir bag
What is the reservoir bag?
- rebreathing bag
- adjusts to the changing gas volume within the breathing circuit
When a patient inhales what happens to the reservoir bag?
When a patient exhales what happens to the reservoir bag?
What goes in the reservoir bag?
What happens when the reservoir bag is too small?
- not enough gas is available and patient can not breathe easily
- bag can fill up too fast
What happens when the reservoir bag is too large?
difficult to monitor the bag - there is little volume change between inspiration and expiration
What are the functions of the reservoir bag?
- easier for patient to breath from bag than from gas flow in tube
- allows observation of rate, depth, and rhythm of respiration
- movement of bag from breathing confirms placement of endotracheal tube into trachea
- allows the anethetist to "bag" the patient's lungs
What are the advantages of bagging the patient?
- helps prevent atelectasis (no exchange through collapsed alveoli)
- flushes airways and alveoli with fresh air
- can ventilate patient who can't breathe on his own
How full should the bag be?
about 1/2 - 3/4 full
How do fill the reservoir bag just right?
adjust flowmeter, pop-off valve, and scavenger
Should we use the oxygen flush to keep refilling the bag? Why or why not?
- delivers 100% oxygen and no anesthetic
- dilutes - patient lightens
Whats another name for the one-way valve?
flutter valve or unidirectional valve
What is the purpose of one-way valves?
allows orderly circulation
What is the inhalation valve?
allows gas flow towards patient in the inspiratory or inhalation breathing tube
What is the exhalation valve?
allows gas flow away from patient in the expiratory or exhalation breathing tube
What is the importance of one-way valves?
forces exhaled gas to pass through CO2 absorber for the most efficient delivery
What is the purpose of the y-piece?
attaches together the inhalation and exhalation tubes
What is the purpose of the oxygen flush valve?
allows O2 to bypass flowmeter and vaporizer to deliver 100% O2 into breathign circuit
When can the O2 flush valve be good?
when the patient is too deep because it dilutes the anesthetic gas
When can the O2 flush valve be bad?
when the patient is too light because it dilute the anesthetic gas
What is the purpose of the pop-off valve?
- prevents pressure from building up in patient breathing circuit
- controls patient ventilation (able to bag the patient)
- can keep fully or partly open during most anesthetic procedures
When is the pop-off valve fully closed?
- when bagging the patient
- when using closed or total rebreathing system
What is the scavenger system?
- removal of waste gases
- can either be physically removed from building or can pass through an activated charcoal cartridge
How is the waste gas physically removed from the building using the scavenger system?
- active suction: fan or pump
- passive: pressure or gravity
What does the carbon dioxide absorber canister contain?
What is the purpose of the carbon dioxide absorber canister?
remove exhaled CO2 from breathing circuit and prevents acidosis
What is the active ingredient in the soda lime or barium hydroxide granules?
What chemical reaction takes place in the carbon dioxide absorber canister? And what does it produce?
- takes place between CO2 and calcium hydroxide
- heat and water
How do you know when the carbon dioxide granules are good?
- canister is warm while in use
- stay normal color when in use
- feel soft and crumbly
How do you know when the carbon dioxide granules are bad?
- no warmth when in use
- change color in use
- feel hard and brittle
When replacing the carbon dioxide granules, how much space should you leave at the top?
What is another name for the pressure manometer?
ventilation pressure gauge
What is the purpose of the pressure manometer?
measures pressure inside breathing circuit and patient
Where is the pressure manometer located?
on top of CO2 absorber
Manometer pressure should not exceed _____ during non-bagging use?
15 cm H2O
Manometer pressure should not exceed _____ during bagging use?
20 cm H2O
When does barotrauma occur?
when the manometer pressure exceeds 60 cm H2O
What does barotrauma cause?
- subcutaneous emphysema
- air embolism
What is the purpose of the negative pressure relief valve?
to prevent negative pressure or a vaccum from developing inside the breathing circuit
Where is the negative pressure relief valve located?
on top of the inhalation flutter valve
When does a vaccum occur?
- when the oxygen tank becomes empty
- reservoir bag is flat
What are the different ways to check for leaks in the system?
- turn on O2 and close pop-off valve
- hold off trach tube opening of y-piece
- fill reservoir bag with oxygen and squeeze bag
If leaks are detected...
- minor: tape up
- major: replace parts
- really major: send of for repairs