Anesthesia delivery unit

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Anesthesia delivery unit

• By
• Sojoud al rujoub
• Hadel arar

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An the absents thesia sensation
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The aim of anesthesia

• 1- absence of consciousness (sleeping)
• 2- absence of pain
• 3- muscle relaxation
• sleeping can be achieved by ingection or by
  inhalation
• there is different types of drugs used in
  special amount dependent on time and patent sex ,
  age,

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Preparation for reuse
OR
Ready for use
Contaminated
Dismantling components for disinfection or
sterilization
Check readines for usedocumentation
Desinfection of the contaminated device surface
Dispose of disposables
Fit disinfected / sterilized components to device
Disinfect / sterilize components
Store / make available components
Visual inspection of components for desinfection
/ sterilization
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Types of anesthesia

• 1-general (putting patient to sleep )
• 2- Regional( by blocking part of the body)
• 3- Local( blocking the sight of surgery )
• 4- topical (blocking surface of surgery)

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main parts ?Back side
Connection for pressure sensors of backup gas
cylinders
Monitor connectors
Oxygen sensor
Gas supply ports
Auxiliary power sockets
Waste gas connector
Power cable
Anaesthetic gas scavenging system (AGS)
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what parts ? Front side
Shelf for accessories or patient monitor
12" colour screen
Rotary knob
Mounting Rail for additional equipment
Handles
Main power switch
External fresh gas outlet (optional)
O2 emergency flow
O2 flush
2 Vapors with interlock system
Writing top
Water trap
Drawer
Suction system (optional)
Big Foot
Compact breathing system
Smooth-running castors
Reusable or disposable absorber with bypass
(optional)
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Main parts

• 1-monitor

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• Parameters displayed as measured values
• Airway pressure (Peak, Mean, Plateau, PEEP)
• Expiratory minute volume
• Minute volume leak
• Expiratory tidal volume
• Respiratory rate (calculated from flow and CO2)
• Patient compliance
• Insp. and exp. gas concentrations
• - O2, CO2, N2O
• - Two anaesthetic agents (Hal., Iso., Enf.,
  Sevo., Des.)
• - Delta O2
• MAC value (methods of calculation standard or
  Mapleson)
• Optional oxygen saturation (SpO2)

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• The following parameters can be displayed as
  curves
• Airway pressure (Paw)
• Insp. and exp. flow
• O2 concentration
• CO2 concentration
• Insp. and exp. anesthetic agent concentration
• Bar graphs for tidal volume and volumeter
• Virtual flow tubes
• Econometer (optional)Plethysmogram (optional)

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Standard screenThree curves for each ventilation
mode are displayed with their numerical measured
values on the right-hand side
Standard screen Three curves for each ventilation
mode are displayed with their numerical measured
values on the right-hand side
Standard screen Three curves for each ventilation
mode are displayed with their numerical measured
values on the right-hand side
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operation
Fresh gas status field
Gas flow detection
Total fresh gas flow
O2 concentration
Keys for selection of carrier gas
Softkes
Rotary knob
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Gas monitoring
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Gas measurement
Graphic monitoring
Gas delivery
Ventilator monitoring
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InductionGas Delivery

• Total fresh gas flow 0.2 to 18 L/min
• New S-ORC function active only with gas mixtures
  with carrier gas N2O
• S-ORC deactivated with gas mixtures with carrier
  gas Air
• Manual emergency O2 delivery, prepared for
  inspiratory O2 regulation, automatic flow
  control
• External fresh gas outlet with pressure
  measurement (optional)

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InductionDetails of Screen Layout
Gas measurement modules and bar graphs Keys for
selecting carrier gas (N2O, Air) Status line for
fresh gas Softkeys for setting the fresh gas
flow Indicator LEDs for CS connections Indicator
LEDs for backup gas cylinders Status field
showing the current ventilation mode Alarm field
for alarm messages and their priority System
info displays system info Bargraph for gas
delivery(virtual flow tubes)
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Principle of operation of IRIA (Infrared Rapidly
Identifying Analyzer)
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Gas monitoringImproved IRIA gas analyzer

• Improved IRIA gas analyzer
• Infrared absorption principle
• Gas analysis takes place at 3 wavelengths
  ensuring not only higher accuracy but also
  allowing identification of mixtures and reliable
  quantitative measurement of two gases
• No cross-sensitivities with methane, water
  vapour, acetone, helium and alcohol
• Analysis of all anesthetic agents, CO2 and
  nitrous oxide
• Improved Iria version reduces incidence of
  incorrect messages
• Improved breathing phase algorithm (data based on
  calculated values not real-time curves)
• Physiological anesthetic gas identification
• Separate analysis of O2 cell and gas analyzer

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VaporDosage of Inhalation Anesthetics
Halothane Enflurane Isoflurane Sevoflurane
Desflurane
Vapor 2000
liquid !
Devapor
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Vapor Principle of Operation Vaporizer with
Supply Dosage
O2 / N2O
100 desflurane vapour is added to the fresh
gas. Amount as set at control
Resistance
PO2/N2O
p
Desflurane vapour
Differential pressure
Control
P
p 0
Desflurane
Open/close valve (closed during heating)
Control valve
Concentration
setting
Gaseous desflurane
approx. 2 bar
approx. 40 C
Liquid desfluraneg
Heating
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Vapor Principle of Operation Vaporizer

• Sutable for
• Halothane
• Enflurane
• Isoflurane
• Sevoflurane

Bypass line
Concentration setting
Vaporizer chamber
Control dial set to "ON
Concentration settings by varying the cross
section of the vaporizer inlet
Halothane 32 Enflurane 23 Isoflurane 30
Sevoflurane 21 Desflurane 87
Temperature
Saturation concentration
20 C
Vapor press. Air pressure
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Exampels of vaporiser
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The absorber (soda lime)

• Used for co2 absorbation

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Absorber system
Pressure gauche APL Valve Vent./Bag
switch Absorber by-pass

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Soda limeFormation of reaction products
Proper usee.g. humidity gt 5
Improper use Soda lime dried out
Halothane, Enflurane, Isoflurane, Desflurane
No carbon monoxide (CO) is formed
Carbon monoxide may form
No CO is formed Compound A may form
No CO is formed Higher concentrations of Compound
A may form
Sevoflurane
Carbon monoxide and Compound A are reaction
products resulting from combination with volatile
anesthetics.
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Soda limeSoda lime/CO2 disposable absorber

• Possibility to replace soda lime during operation
  and individually set the insp. CO2 alarm limit in
  Primus, soda lime can be used until fully
  exhausted
• Absolutely no contact with the soda lime, which
  is classified as irritant to eyes and skin?safety
  for staff, patients and equipment
• Adapter includes CO2 bypassinteresting
  additional feature which supports the recovery
  phase, i.e.spontaneous breathing C02

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Ventilation Advantages of SIMV

• Advantages of SIMV
• Application of mechanical breath during
  expiratory phase is prevented
• Increasing share of spontaneous breathing
  activity
• Lower mean airway pressure
• Lower oxygen consumption
• Improved intrapulmonary gas distribution
• Prevention of muscular atrophy and discoordination

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Ventilator Ventilation Mode

• New excellence criteria for ventilation within
  anaesthesia
• Manual/Spontaneous
• IPPV Delivery of small tidal volumes from 20 -
  1400 ml
• Frequency variation 3 80 1/min
• SIM
• Flow trigger, trigger characteristics adapted to
  patient age
• Adjustable PEEP level
• PCV
• Decelerating flow control
• Leakage monitoring in PCV (MVLeak, volume) and
  compensation
• Ready for spontaneous breathing modes
• PS/CPAP

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Ventilation Comparison of IPPV/PCV
Advantages / disadvantages IPPV Advantages Disa
dvantages Reliable VT application Pressure
peaks possible VT can be preset from body
weight Changing lung characteristics are
ignored PCV Advantages Disadvantages
Low peak pressure Fluctuating VT if C,R
change Sufficient VT despite leakage
Preset Pinsp Adaptation to
current compliance and resistance
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Ventilation IPPV Inspiratory Time Tinsp
Effects of a frequency change for Setting Tinsp
TE Tinsp Mean pressure constant change Oxygenation
constant change Ventilation change change Note
If problems occur when treating patients with
non-stable circulation with increased mean
pressure or maintaining a constant TinspTE
ratio, Tinsp should be adjusted
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VentilationLeakage
Leakage PCV Leakage compensation, i.e. the
ventilator maintains pressure throughout
inspiration ? Volume remains constant IPPV
Part of the volume is lost as leakage from the
system
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Changing patientsLeak test
menu

• After change of patient
• Alarm limits, gas delivery settings and
  ventilation parameters are retained
• Activate default settings via Restore Default
  Settings key in Standby
• Perform leak test (takes approx. 30 sec), e.g.
  when replacing ventilation hoses
• Values for system compliance and leakage in
  mechanical ventilation limb are displayed
• Leak tightness of breathing system is shown
  check whether manual ventilation bag is connferm

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Ventilation Changing tidal volume in PCV
Changing tidal volume in PCV
VPatient CPatient (Pinsp - PEEP)
Harder lung (lower C) ? Lower tidal
volume Increased Pmax ? Higher tidal
volume Increased PEEP ? Lower tidal
volume Change to Freq., ramp, Tinsp ? No change
in tidal volume
Assuming sufficient inspiratory time for lung
pressure to reach final value.
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Ventilator Ventilator Design

• Electrically powered and controlled piston
  cylinder unit with 2 rolling seals
• Piston pump generates negative pressure between
  the two membranes (high leak tightness)
• Drive takes place through recirculating ball
  screw of a direct current motor which is fixed to
  the piston
• The vertical movement of the spindle transfers
  the corresponding volume towards the patient
  (tidal volume 1400 ml)
• The signal of the high resolution incremental
  encoder determines the position of the piston
  cylinder unit and allows precise volume dosage in
  µl range
• Light barriers to detect the lower stop position
  of the piston cylinder unit ("zero position) and
  a fully inserted ventilator drawer

Patient part
Cylinder
Rolling seal
Pot piston
Recirculating ball screw
Direct current motor
Light barrier
Incremental encoder
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Ventilator Ventilator Technology

• Ventilator technology
• The position of the piston cylinder minimizes the
  volume and inspiratory system compliance
• In Standby mode, the piston returns to the lower
  end position, ready for the first breath
• In IPPV or SIMV mode, the piston moves back by
  the amount of tidal volume to be delivered (VT x
  1.4)
• In PCV and Man/Spot. mode, the piston starts at
  the lower end position to allow application of
  any size of tidal volume

Standby
Movement of PCU
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Ventilator Gas Flow Diagram
Spontaneous breathing during mandatory ventilation
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Disinfection and sterilizationComponents for
disinfection/sterilization
Dust and particle filter
Anesth. gas scavenging
Breathing system
Sample gas return
APL
IRIA (Gas module)
SPONT
MAN
PAW
Watertrap filter Watertrap
PEEP/ Pmax
Socket
AUTO
MAN
sample line
Y-breathing filter
Breathing bag
Flow sensor
Hose
Absorber
Fresh gas
Y-breathing filter
Gas inlet block
Microbial filter
Ventilator membrane
Socket
Ventilator
Suction
Bacterial filter
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Design of the Breathing System
APL valve
breathing system cover
inspiratory valve
RV1
expiratory valve
RV2
inspiratory nozzle
valve plate
exspiratory nozzle
breathing system block
PEEP membrane
V2 valve
absorber insert
absorber container
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VentilationVentilator Settings in SIMV
Parameters Pmax (PEEP 10) ... 70 mbar VT 20 ...
1400 mL Freq. 3 ... 80 bpm Tinsp 0.2 ... 6.7
sec TIPTinsp 0 ... 60 PEEP 0 ... 20 mbar Flow
trigger 0.3 ... 15 L/min
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Ventilation Pressure Support/CPAP (Option)
PS (Pressure Support) CPAP (Continuous Positive
Airway Pressure)

• Breath is initiated after triggering, insp. Time
  is adjusted to the patient
• Adjustable flow trigger
• Spontaneous breathing at higher pressure level to
  increase functional residual capacity (FRC).
• Spontaneous breathing during anesthesia when
  using laryngeal masks
• Rapid wake-up, so quicker changeover and shorter
  stays in recovery room with no need for
  post-ventilation

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Water Trap

• WaterLockTM water trap
• Optimal positioning of the water trap at the
  front of the device to allow the filling level to
  be checked and the container to be emptied more
  easily
• Perfect protection for precise gas measurements

Info
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Principle of WaterLock TM WaterTrap

• 2 hydrophobic, microporous PTFE membranes (o.2
  µm)
• Impenetrable to bacteria, germs and condensed
  water
• Sample gas is drawn in through pump and separated
  from condensed water by filter 1 (main part of
  gas sample is rerouted back to Iria)
• A second gas flow, which is drawn in via the
  water container and a second filter 2, serves as
  drainage for filter 1
• Blocking of the water trap is prevented

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Starting Up Endotracheal Suction

• New, more efficient endotracheal suction
• optional stand-alone version
• variants ejector or vacuum suction, each with
  NIST connector or direct CS connector
• ejector suction generation of negative
  pressurewith medical air or oxygen

Flow Neg. pressure Ejector gt 27 l/min max. 920
mbar Vacuum gt 27 l/min ? 800 mbar
Drive gas consumption 60 l/min at 3.5 bar
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Starting UpDetails Endotracheal Suction

• Principle
• PTFE bacterial filter to avoid bacteria being
  emitted into ambient air and system becoming
  blocked.
• Positioned in suction flow rather than at ejector
  end.

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Bellows unit

Time cycled volume controlled and pressure
limited ventilator
Tidal volume set, Vt or Vmin measured (optional)
Rate settings
I E Ratio
Airway pressure
20 minutes battery back up
Off / Standby - test / On
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External flow tube supports regional anesthesia
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Preparation How often does equipment need
disinfection/sterilization?
The intervals for individual components are
determined by the position of the filters
1. Without filter
2. With device-side filter
3. With filter at Y-piece
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COMPETITORS
Aestiva Compact (?) Breathing system..
AESTIVA COMPACT BREATHING SYSTEM
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InductionAlarm priority
Clear differentiation of alarm priorities,
audible and visual
Alarm priority Alarm tone intensity Alarm field
color Alarm continuous Caution intermittent Adv
isory (application) single tone Technical
information none
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InductionAlarm Tone Silencing

• Preventive alarm tone silencing
• Even when no alarm has been given, all alarms can
  be preventively deactivated for 2 minutes (e.g.
  when suctioning patient)
• Display of remaining alarm silence time
• Any other alarm which occurs is silenced and
  indicated by only a brief tone
• The function "suppression of alarm monitoring for
  two minutes" remains active
• in preparation

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InductionAlarm Line

• Extended alarm line
• Alarm line display of up to 3 alarm fields
  (grouped from high to low priority)
• Display more than 3 alarms currently active
  key "all alarms appears

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MACDefinition I
Info
The minimum alveolar concentration of an
inhalation anaesthetic (MAC50) is the alveolar
concentration at which 50 of all patients cease
to react with defensive movements to skin
incisions. Larsen, anesthesia
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MACDetail Extended MAC Definitions

• MAC95
• the same as MAC50 but based on 95 of all
  patients tested
• MAC EI50 / MAC EI95
• EI endotracheal intubation
• 50/95 value at which laryngoscopy and a
  subsequent EI do not cause coughing
• e.g. enflurane 1 MAC EI50 / EI95 1.4 / 1.9 MAC
• MAC BAR50 / MAC BAR95
• BAR blocking adrenergic cardiovascular
  responses
• 50/95 value at which adrenergic reactions to
  incisions are repressed
• e.g. enflurane 1 MAC BAR50 / BAR95 1.6 / 2.6
  MAC

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MACAge Compensation II - Summary
W.W. MaplesonEffect of age on MAC in humans a
meta-analysissource British Journal of
Anesthesia 1996

• MAC reduction of 6 per decade beginning in
  the first year (of life)
• age 40 years is the hub
• equation for ages gt 1 year

MAC MAC40 10(-0.00269 (40-age))
This equation is not valid for ages lt 1 year
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MACMAC Value Calculation
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MACMAC for Age 40 years
agent 1 MAC (100 O2) Halothane
0.77 Enflurane 1.7 Isoflurane
1.15 Desflurane 6.65 Sevoflurane 2.
1 N2O 105
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MACAge Correction


Age Corr.Age
MAC 80 Years MAC 40 Years 0,78
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MACExample 1

Measured exp. values for a 40-year-old
patient Isoflurane 0.6 Enflurane 0.5 N2O
51 What is the correct MAC value?

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MACDetail Reducing Factors

• age
• reduced about 6 per ten (10) years
• maximum needed for infants of 3 and 4 months
• temperature
• MAC-reduced for hypothermia (cardiac
  surgery!)(MAC value 0 at approximately 20 C)
• pregnancy
• MAC reduced (by 25 for Hal, 40 Iso)
• established in experiments on animals changes in
  endocrine
• Opioide
• MAC-reducing influence (e.g. with Fentanyl)
• established in experiments on animals a
  reduction of 65 Enf, 67 Iso