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Anaesthesiology > Machine, Breathing Systems and Monitoring > Flashcards

Machine, Breathing Systems and Monitoring Flashcards

1
Q

Three roles of the anaesthetic machine

A
  1. create an artificial atmosphere
  2. maintain general anaesthesia
  3. emergency life support (positive pressure ventilation)
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2
Q

Essential components of anaesthetic machine

A
  • supply of gas
  • measurement of gas
  • anaesthetic vaporisers
  • breathing circuit
  • resuscitation apparatus
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3
Q

Gasses and their outlet colours

A

OXYGEN - white

NITROGEN - black

AIR - white and black blocks

N2O - blue

ENTENOX (50% EACH OF N20 AND O2) - blue and white blocks

CO2 - grey

VACUUM SYSTEM - yellow

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4
Q

Forms of gases when compressed

A

LIQUID (therefore must weigh to determine level)

  • nitrous oxide
  • carbon dioxide

GAS (therefore must see pressure to determin levels)

  • Oxygen
  • Nitrogen
  • Air
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5
Q

Name of the mechanism that alerts one when oxygen supply fails

A

Ritchie Whistle

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6
Q

Minimum ammount of oxygen required during anaesthesia

A

30%

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7
Q

Reasons for higher oxygen requirement during anaesthesia

A
  1. increased ventilation/perfusion mismatch during anaesthesia
  2. exhaled gases are saturated with water vapour, therefore dilution occurs
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8
Q

Formula for minute volume

A

Minute Volume = Tidal Volume x Respiratory Rate

Tidal volume usually = 8 mg.kg-1

Resp rate usually = 9 breaths.minute-1

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9
Q

Functions of anaesthetic breathing system

A
  1. provide sufficient peak inspiratory flow
  2. prevent rebreathing of expired alveolar gas
  3. prevent contamination of inspired gases by atmospheric air
  4. minimal resistance to breathing
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10
Q

Define: Dead Space, Total Dead Space, Physiological Dead Space

A

DEAD SPACE: portion of tidal volume that does not participate in alveolar gas exchange (contains very little CO2, therefore is re-breathable)

TOTAL DEAD SPACE = Apparatus Dead Space + Physiological Dead Space

PHYSIOLOGICAL DEAD SPACE = Anatomic Dead Space + Alveolar Dead Space

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11
Q

T-Piece Breathing Systems: Advantage and Disadvantages

A

ADVANTAGES

  • compact
  • reduced dead space
  • reduced resistance (because no valves)
  • good for controlled ventilation

DISADVANTAGES

  • potential for hypercapnea if fresh gas flow too low
  • wasteful in spontaneous ventilation
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12
Q

Modifications to T-Piece Breathing Systems

A
  1. Jackson-Rees: reservoir bag to R-limb
  2. Mapleson-D: spring-loaded valve to bag inlet
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13
Q

Magill Breathing System

A

Wasteful of Fresh Gas during controlled ventilation.

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14
Q

Coaxial breathing system

A
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15
Q

Circle Breathing System: Advantages and Risks

A

ADVANTAGES

  • economy of gas and volatile agents
  • conservation of heat and moisture
  • prevention of atmospheric pollution

RISKS

  • disconnections
  • unidirectional valves stuck in open position –> CO2 rebreathing
  • expiratory valve stuck in closed position –> pneumothorax
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16
Q

Components of Soda Lime (CO2 reabsorber)

A

calcium hydroxide

sodium hydroxide

water

ethyl violet (pH sensitive dye)

17
Q

Equation of Soda Lime

A
  1. H2O + CO2 —> H2CO3
  2. 2NaOH + CO2 —> Na2CO3 + 2H2O + heat
  3. Na2CO3 + Ca(OH)2 —> CaCO3 + 2NaOH
18
Q

Risks of CO2 absorbers

A
  1. react with volatiles to form carbon monoxide
  2. formation of “Compound A”
19
Q

Clinical Monitoring Used

A
  • respiration
  • oxygenation
  • circulation
  • temperature
  • depth of anaesthesia
  • renal function
  • muscle power
  • blood glucose
20
Q

Stages of Anaesthesia

A

STAGE I: induction to loss of consciousness (LOC)

STAGE II: LOC to automatic breathing

STAGE III-1: automatic respiration to eyeball paralysis

STAGE III-2: eyeball paralysis to intercostal paralysis

STAGE III-3: commencement to completion of intercostal paralysis

STAGE III-4: complete intercostal paralysis to diaphragmatic paralysis

STAGE IV: diaphragmatic paralysis, apnoea, death

21
Q

Stages ideal for anaesthesia

A

Stage III levels 2-3

22
Q

Specialised Monitoring Used

A
  • blood pressure (manual, automatic, direct)
  • ECG
  • pulse oximetry
  • capnography
  • CVP
  • peripheral nerve stimulation
  • bi-spectral index
  • temperature
23
Q

Bi-Spectral Monitor Values

A

100: Awake EEG
0: Electrical silence

65-85: sedation

40-65: general anaesthesia

Anaesthesiology (12 decks)

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