Anesthesia Gas Machine- Table of Contents

The Anesthesia Gas Machine 2024 Historical picture

Michael P. Dosch CRNA PhD, Darin Tharp CRNA MS
University of Detroit Mercy - Nurse Anesthesia
This site is https://healthprofessions.udmercy.edu/academics/na/agm/index.htm.

All sections were revised Jan 2024.

Please note that this site does not collect confidential, private or semi-private information such as email addresses, email content, or email exchanges with visitors. No data is recorded or stored.

Section on Using Anesthesia workstations as ICU ventilators added April 2020.

Table of Contents

Introduction	History of site, Author's Disclosure statement, Acknowledgments, How to contact author, Other resources for learning.
Components and systems	Introduction Numbers to remember General features of all anesthesia gas machines Features required by standard Path of gases within the machine Five tasks of oxygen Supply, Processing, Delivery, Disposal model Manufacturers
Supply of gases & electricity	Gas sources Pipeline Cylinders Standards Capacity, color, markings Component parts Storage handling and installation Medical gases Use Electrical power supply Failures and faults (What happens when pipeline oxygen pressure or electrical power is lost?)
Fail-safe, Flowmeters, Hypoxic guard	Fail-safe system Flowmeters How they work Traditional glass flowmeters Transitional (hybrids with needle valve controls, electronic capture and display) Electronic flow control, capture, and display Et (end-tidal) Control Function (flowmeters for FGF, auxiliary oxygen, scavenging, and common gas outlet) Using flowmeters safely Proportioning systems (Hypoxic guard)
Vaporizers	Physical principles Classification Vaporizer interlock Operating principles of variable bypass vaporizers Effect of altitude How to fill vaporizers How much liquid agent does a vaporizer use per hour? Hazards and safety features of contemporary vaporizers Current models
Breathing circuits	Classification Breathing circuits- Non rebreathing (Mapleson and Bain) How do they work? Fresh gas flow requirements Pethick Test for the Bain Circuit Circle System King (limb within limb) Advantages and disadvantages
CO2 absorption	General characteristics and composition Chemistry- soda lime Safe use Changing canisters Clinical signs of exhaustion
Ventilators	Classification Bellows classification New ventilator modes and settings (VCV, PCV, PC-VG, SIMV-Vol, SIMV-Pressure, PSV) Typical ventilator alarms New features Piston ventilators Flexibility (New modes) Accuracy at lower tidal volumes Compliance and leak testing Fresh gas decoupling versus compensation Suitability for low flows Current models Dräger Apollo, Perseus, Fabius GS GE ADU, Aisys, Avance, Aespire, Aestiva Other; Paragon, Anestar Older or obsolete ventilators
Using breathing circuits and ventilators	Humidification Choosing the best fresh gas flow Low flows How to denitrogenate ("preoxygenate") Malignant hyperthermia implications for equipment. Ventilator and Breathing circuit problems and hazards Increased inspired carbon dioxide (troubleshooting and treatment)
Scavenging	Scavenging Systems Purpose Types Practice guidelines Components Hazards Avoiding occupational exposure to waste anesthetic gas
Machine checklist 2008 Medicolegal Cleaning & sterilization	Anesthesia gas machine checklist 2008 Pre-Anesthesia Checklist (PAC) 2008 Electronic checklists- what to add at the end AWS Quick Check for emergencies (and every day) Older anesthesia gas machine checklist Negative pressure leak check Medicolegal Risk management, Quality assurance, Monitoring standards, Manufacturing standards Cleaning and sterilization Sterilization-Moist heat, liquid and gas sterilization methods Care of specific equipment
New gas machines	Dräger Medical Inc. (Telford, Pennsylvania) Perseus, Fabius GS, Apollo GE (Madison Wisconsin) Aisys, Avance, Aespire, Aestiva, Aestiva MRI Other Paragon, Anestar Older or obsolete Narkomed (6000/6400, GS, Julian, MRI, Mobile, 2C, 4), Kion, Ohmeda (Modulus SE, Excel 210/110)
Purchasing equipment	Education and training Advanced ventilation, Computer and monitor integration, Low flows, Laryngeal mask airway and mechanical ventilation, Electronic Checkout Operating costs Installation of new machines
Test yourself	Question and answer format.
Using Anesthesia workstations as ICU ventilators

Introduction

History of site, Author's Disclosure statement, Acknowledgments, How to contact author, Other resources for learning.

Components and systems

Introduction
Numbers to remember
General features of all anesthesia gas machines
- Features required by standard
- Path of gases within the machine
- Five tasks of oxygen
- Supply, Processing, Delivery, Disposal model
Manufacturers

Supply of

gases & electricity

Gas sources
- Pipeline
- Cylinders
  - Standards
  - Capacity, color, markings
  - Component parts
  - Storage handling and installation
  - Medical gases
  - Use
Electrical power supply
Failures and faults (What happens when pipeline oxygen pressure or electrical power is lost?)

Fail-safe,

Flowmeters,

Hypoxic guard

Fail-safe system
Flowmeters
- How they work
  - Traditional glass flowmeters
  - Transitional (hybrids with needle valve controls, electronic capture and display)
  - Electronic flow control, capture, and display
  - Et (end-tidal) Control
- Function (flowmeters for FGF, auxiliary oxygen, scavenging, and common gas outlet)
- Using flowmeters safely
Proportioning systems (Hypoxic guard)

Vaporizers

Physical principles
Classification
Vaporizer interlock
Operating principles of variable bypass vaporizers
- Effect of altitude
How to fill vaporizers
- How much liquid agent does a vaporizer use per hour?
Hazards and safety features of contemporary vaporizers
Current models

Breathing circuits

Classification
Breathing circuits- Non rebreathing (Mapleson and Bain)
- How do they work?
- Fresh gas flow requirements
- Pethick Test for the Bain Circuit
Circle System
- King (limb within limb)
Advantages and disadvantages

CO2 absorption

General characteristics and composition
Chemistry- soda lime
Safe use
- Changing canisters
- Clinical signs of exhaustion

Ventilators

Classification
- Bellows classification
New ventilator modes and settings (VCV, PCV, PC-VG, SIMV-Vol, SIMV-Pressure, PSV)
Typical ventilator alarms
New features
- Piston ventilators
- Flexibility (New modes)
- Accuracy at lower tidal volumes
  - Compliance and leak testing
  - Fresh gas decoupling versus compensation
- Suitability for low flows
Current models
- Dräger Apollo, Perseus, Fabius GS
- GE ADU, Aisys, Avance, Aespire, Aestiva
- Other; Paragon, Anestar
Older or obsolete ventilators

Using breathing circuits and ventilators

Humidification
Choosing the best fresh gas flow
- Low flows
How to denitrogenate ("preoxygenate")
Malignant hyperthermia implications for equipment.
Ventilator and Breathing circuit problems and hazards
- Increased inspired carbon dioxide (troubleshooting and treatment)

Scavenging

Scavenging Systems
- Purpose
- Types
- Practice guidelines
- Components
- Hazards
Avoiding occupational exposure to waste anesthetic gas

Machine checklist 2008

Medicolegal

Cleaning & sterilization

Anesthesia gas machine checklist 2008
- Pre-Anesthesia Checklist (PAC) 2008
- Electronic checklists- what to add at the end
- AWS Quick Check for emergencies (and every day)
- Older anesthesia gas machine checklist
  - Negative pressure leak check
Medicolegal
- Risk management, Quality assurance, Monitoring standards, Manufacturing standards
Cleaning and sterilization
- Sterilization-Moist heat, liquid and gas sterilization methods
- Care of specific equipment

New gas machines

Dräger Medical Inc. (Telford, Pennsylvania)
- Perseus, Fabius GS, Apollo
GE (Madison Wisconsin)
- Aisys, Avance, Aespire, Aestiva, Aestiva MRI
Other
- Paragon, Anestar
Older or obsolete
- Narkomed (6000/6400, GS, Julian, MRI, Mobile, 2C, 4), Kion, Ohmeda (Modulus SE, Excel 210/110)

Purchasing equipment

Education and training
- Advanced ventilation, Computer and monitor integration, Low flows, Laryngeal mask airway and mechanical ventilation, Electronic Checkout
Operating costs
Installation of new machines

Test yourself

Question and answer format.

Using Anesthesia workstations as ICU ventilators