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Anesthesia Concepts > Anesthesia Delivery Systems - EXAM 2 > Flashcards

Anesthesia Delivery Systems - EXAM 2 Flashcards

0
Q

CO2 can also be eliminated from the breathing circuit by the use of _____________ .

A

carbon dioxide absorbent media

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1
Q

CO2 is eliminated from the breathing circuit by washout of ______________?

A

fresh gas flow

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2
Q

Essential requirements of the breathing system are:

A
  • deliver gases from the machine to the alveoli in the same concentration as set and in the shortest possible time
  • effectively eliminate carbon dioxide
  • have minimal apparatus dead space
  • have low resistance
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3
Q

What will decrease resistance in the breathing system?

A

-short tubing, large diameter tubing, avoid sharp bends, caution with valves, minimize connections

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4
Q

2 ways rebreathing is beneficial:

A
  • cost reduction
  • adds humidification/heat to gases
    (do NOT want to rebreathe CO2)
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5
Q

Higher fresh gas flows allows for __________?

A

less rebreathing (in any type of circuit)

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6
Q

What can increase the chance of rebreathing CO2?

A

-dead space

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7
Q

How can apparatus dead space be minimized?

A
  • by separating the inspiratory and expiratory stream as close to the patient as possible
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8
Q

What are the four classification of anesthesia delivery systems?

A
  • open
  • semi open
  • semi closed
  • closed
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9
Q

Characteristics of an open system:

A
  • NO gas reservoir bag
  • NO valves
  • NO breathing of exhaled gas
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10
Q

What are the 2 types of open systems?

A
  • insufflation/blow-by

- open drop

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11
Q

The “Steal” induction is considered to be which kind of delivery system?

A

Open (insufflation)

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12
Q

What are some examples of insufflation (open system):

A
  • blow-by, tent, bronchoscopy port, NC, steal induction
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13
Q

What are the advantages of insufflation?

A
  • avoids direct patient contact
  • no rebreathing of CO2
  • no reservoir bags or valves
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14
Q

What are some disadvantages of insufflation?

A
  • no ability to assist or control ventilation
  • may have CO2/O2 accumulation under drapes
  • no control of anesthetic depth/FiO2
  • environmental pollution
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15
Q

What is an example of a “true” open circuit?

A
  • Schimmelbusch mask (used either ether, chloroform, halothane)
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16
Q

What is an example of the open drop method?

A
  • Ether mask (Schimmelbusch)
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17
Q

Disadvantages of the open drop method are:

A
  • poor control of inspired concentration of anesthetics
  • accumulation of CO2 under mask
  • predisposes to hypoxia risk
  • cannot control ventilation
  • OR pollution/health care provider risk
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18
Q

Semi open system is characterized by what 5 characteristics?

A
  • facemask or ETT
  • pop-off valve
  • reservoir tubing
  • fresh gas inlet
  • reservoir bag
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19
Q

CO2 rebreathing depends on:

A
  • fresh gas inflow rate
  • minute ventilation of patient
  • type of ventilation (spontan or controlled)
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20
Q

What are the 3 function groups of semi open systems? And was is their corresponding Mapleson letter?

A
  • Group 1: Mapleson A (pop-off valve near the facemask, FGF at opposite end)
  • Group 2: Mapleson B & C (pop-off and FGF are near facemask)
  • Group 3: Mapleson D, E, F (FGF near facemask, pop-off at opposite end- opposite of Mapleson A)
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21
Q

Which Mapleson is most efficient during controlled ventilation?

A
  • Mapleson D (can be used for spontaneous and controlled ventilation)
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22
Q

During spontaneous respiration FGF (is determined by an equation):

A
  • FGF= 2-3 x MV
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23
Q

During controlled ventilation FGF (is calculated by this equation):

A
  • FGF= 1-2 x MV
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24
Q

What is unique about Mapleson E (T piece)?

A
  • NO reservoir bag (expiratory limb is the reservoir)

- NO pop-off valve

25
Q

What is unique about Mapleson F (Jackson- Rees)?

A
  • pop-off valve is at the end of the reservoir bag (common in pediatrics)
26
Q

The Bain Circuit is a coaxial modification of ________?

A
  • Mapleson D
27
Q

In the Bain Circuit, FGF within the large bore corrugated tubing allows for:

A
  • allows exhaled gas to to warm the inspired gas

- preserves heat and humidity

28
Q

Bain Circuit can be used for what types of breathing?

A
  • controlled or spontaneous ventilation
29
Q

Disadvantages of the Bain Circuit:

A
  • potential for inner tube leaks, kinking or disconnection
30
Q

The Ambu bag is most similarly related to which Mapleson?

A
  • Mapleson A with non-rebreathing valve
31
Q

Characteristics of the Ambu bag:

A
  • contain non rebreathing valves
  • capable of delivering high FiO2
  • reservoir self filling
  • requires high fresh gas flow
  • depends on minute ventilation
32
Q

Whats are the advantages of the Mapleson System?

A
  • simple components
  • lightweight
  • can provide positive pressure ventilation
  • portable
  • low resistance
  • more predictable anesthetic concentration and decreased room pollution
33
Q

Disadvantage of the Mapleson System:

A
  • requires calculation of FGF
  • control of anesthetic depth is variable
  • if FGF not maintain, possibility of CO2 buildup/rebreathing
  • poor conservation of other gases
  • FGF costly
  • requires special assembly
34
Q

The circle system can be used in which systems?

A
  • semi open
  • semi closed
  • closed
35
Q

2 advantages of the circle system:

A
  • prevents rebreathing of CO2 by chemical neutralization

- allows re-breathing of other exhaled gases

36
Q

Name the 7 components that characterize the circle system

A
  • FGF source
  • inspiratory and expiratory unidirectional valves
  • inspiratory and expiratory limbs/corrugated tubing
  • Y piece connector
  • adjustable pressure-limiting valve (APL)
  • reservoir bag
  • CO2 absorber
37
Q

What are the 4 functions of reservoir bag?

A
  • accumulation of gas during exhalation
  • assist/control ventilation
  • visual/tactile monitor to observe spontaneous respirations
  • protects against excessive pressure reservoir of gas
38
Q

Desirable requirements of a breathing system:

A
  • economy of fresh gas
  • conservation of heat
  • adequate humidification of inspired gas
  • light weight
  • convenience during use
  • efficiency during spontaneous and controlled ventilation
  • adaptability for adults, children and mechanical ventilators
  • provision to reduce environmental pollution
39
Q

What kind of system does the anesthesia machine use?

A
  • circle system
40
Q

Excess gas can vented out via the ________ to the ________.

A
  • APL valve

- scavenging system

41
Q

Characteristics of breathing tubes:

A
  • large bore, non rigid corrugated tubing
  • rubber or clear plastic
  • 22 mm female fitting w/ machine
  • Patient end: T piece 22 mm male, 15 mm female coaxial fitting
42
Q

List the function of breathing tubes:

A
  • flexible, low resistance, lightweight connection

- reservoir

43
Q

Purpose of the APL valve: (“pop-off valve”, pressure relief, safety-relief valve)

A
  • release gases to the scavenge or atmosphere exhaust port

- provides control of pressure in the system- pressure gauge absorber

44
Q

During spontaneous respiration, what is the function of the APL valve?

A
  • valve is fully open

- closed partially only if reservoir bag collapses

45
Q

During assisted ventilation, what is the function of the APL valve?

A
  • valve partially opened

- bag squeezed on inspiration

46
Q

During mechanical ventilation, what is the function of the APL valve?

A
  • valve closed

- ventilator switch turned on

47
Q

Where is majority of the dead space in the circle system located?

A
  • if the unidirectional valves are working properly, the only dead space in the system is the Y piece and the patient
48
Q

Where must the unidirectional valves be located in the anesthesia circuit?

A
  • between the patient and the reservoir bag on the inspiratory and expiratory limb of the circuit
49
Q

Where can FGF NOT enter the circuit?

A

FGF cannot enter the system btw the expiratory valve and the patient

50
Q

Where can the APL valve NOT be located in the system?

A
  • The APL cannot be located btw the patient and inspiratory valve
51
Q

Semi-open system is mostly used for:

A
  • sedation (mask placed over face to increase FiO2)
52
Q

List the characteristics of a semi-open system:

A
  • no re-breathing occurs
  • requires a very high flow of fresh gas flows (10-15L/min) to eliminate rebreathing of gases
  • no conservation of wastes gases and heat
  • APL valve is open all the way
53
Q

What is the most commonly used breathing system is U.S. practice?

A
  • semi-closed circle system
54
Q

What are 4 characteristics of the semi-closed circle system?

A
  • requires relatively low flow rates (1-3L/min)
  • conserves some heat and gases
  • some re-breathing of agents and exhaled gases (minus CO2)
  • APL valve is closed and partially adjusted as needed
55
Q

Closed circle system are often used in:

A
  • third world countries
56
Q

List 4 characteristics of the closed circle system:

A
  • inflow gas exactly matches metabolic needs/ O2 consumption of the patient using very low flow rates (O2 flow= @ 200ml/min)
  • total re-breathing of all gases after absorption of CO2
  • total conservation of all exhaled gases
  • APL valve is CLOSED
57
Q

Formula for O2 consumption is:

A
  • VO2 = 10 x kg^3/4
58
Q

Name the advantages of the Circle System:

A
  • relative stability of inspired gases
  • conservation of moisture and heat
  • prevention of OR pollution
  • can be used for closed-system anesthesia
  • can be used with fairly with low flows with no rebreathing of CO2
  • economy of anesthetics and gases
  • can scavenge waste gases
59
Q

List the disadvantages of the Circle System:

A
  • complex design
  • has at least 10 connections (potential leaks, disconnections or obstruction)
  • a third of malpractice claims resulted from disconnects or misconnects of the system
  • potential of malfunctioning of valves
  • increased resistance to breathing
  • less portable and convenient than the Mapleson systems
60
Q

Discuss how to perform a leak test for the circle system check:

A
  • set all gas flows to zero, occlude the Y-piece, close the APL valve
  • pressurize the circuit to 30 cm of water pressure using the O2 flush valve
  • ensure pressure hold for 10 seconds
  • listen for sustained pressure alarm
  • open APL valve and ensure pressure decreases
    (this test does not assess integrity of unidirectional valves)
61
Q

Discuss how to perform the flow test of the circle system check:

A
  • attach breathing bag to the Y- piece
  • turn on the ventilator
  • and assess the integrity of the unidirectional valves

Anesthesia Concepts (8 decks)

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