Anesthesia Breathing Systems

Question 1

Links patient to anesthesia machine, delivers oxygen

and anesthetic gases, eliminates carbon dioxide

Answer 1

breathing system

Question 2

what DECREASES resistance of breathing system?

Answer 2

Decreased circuit length
Increased circuit diameter
Avoiding sharp bends
Eliminating valves
Maintaining laminar flow

Question 3

increased fresh gas flow causes a decrease of …

Answer 3

rebreathing and time equilibration

Question 4

You should have __ flows for induction, ___ flows for maintenance and ___ flows for emergence

Answer 4

high, low, high

Question 5

Blowing gas across the face

More a technique than a circuit

Answer 5

insufflation

Question 6

Patient inhales →
air passing through →
vaporizes the liquid agent →
mask gets cold →
condensation and decreased
vapor pressure (proportionate
to temperature)
no longer in use bc ether and chloroform are highly ..

Answer 6

open drop anesthesia

flammable

Question 7

Ambient air is inhaled over liquid agent, flow DEPENDENT

simple, portable, no need for compressed gases

Answer 7

draw over anesthesia

Question 8

Portable, self filling with O2 or ambient air, valve to allow for pos pressure, must have high flows

Answer 8

resuscitation, ambu bag

Question 9

What is the nonrebreathing system we need to be familiar with called?

Answer 9

Mapleson (bain)

Question 10

What components create a mapleson system?

Answer 10

Breathing tube, fresh gas inlet, adjustable pressurelimiting valve (APL), reservoir bag

Question 11

long tubes and/or high compliance result in ?

Answer 11

larger gradient between gas delivery to circuit and to patient

Question 12

large in diameter (22 mm), rubber/corrugated

Answer 12

mapleson breathing tube component

Question 13

High flow required to prevent significant rebreathing and during spontaneous ventilation fresh gas flow must at least equal minute ventilation

Answer 13

maplesons

Question 14

with mapleson during controlled (pos) pressure ventilation, what minute ventilation is required?

Answer 14

2-3 x minute ventilation

Question 15

Anesthesia gases (volatiles, N2O) + O2 + air from
anesthesia machine enter the Mapleson through

Answer 15

fresh gas inlet

Question 16

Controls pressure build-up in the circuit (vents or pops off when a set pressure is reached

Answer 16

APL valve

Question 17

2 functions of the reservoir bag

Answer 17

anesthetic gas reservoir and pos pressure ventilation

Question 18

components of circle system

Answer 18

CO2 absorber, FGI, unidirectional limbs
and valves (I & E), Y-connector, APL valve,
reservoir bag

Question 19

what keeps flow moving forward

Answer 19

check valves

Question 20

what causes valve incompetency?

Answer 20

Warped disk
“Stuck” in up position
Condensation
Malfunction of either side can lead to CO2 rebreathing and hypercapnia

Question 21

best circle set up

Answer 21

-Valves near patient (prevents backflow when circuit leaks)
-FGI between absorber and inspiratory valve (less wasted fresh gas)
-APL between absorber and expiratory valve (conserves absorbent and less venting of
fresh gas)
-Reservoir bag in expiratory limb
(decreases resistance to exhalation and conserves
absorbent)

Question 22

allows for rebreathing of all gases with disposal of CO2

Answer 22

circle system

Question 23

with absorber, CO2 rebreathing is __ even at low flows

Answer 23

prevented

Question 24

the gradient increases between delivered and expired with

Answer 24

low flows

Question 25

Tidal volume that does not move into alveoli

Answer 25

dead space

Question 26

where is dead space?

Answer 26

distal to y piece

Question 27

disadvantages of circle system

Answer 27

Less portable, increased risk of malfunction, problems with absorber, less predictability with low flows

Question 28

what are the 2 methods for CO2 elimination

Answer 28

CO2 absorber | high fresh gas flow

Question 29

rebreathing conserves:

Answer 29

heat, humidity, volatiles

Question 30

neutralize H2CO3 to water and | energy (heat)

Answer 30

Soda lime or Ca2+ lime (salts)

Question 31

when should absorbent be replaced

Answer 31

50-70% color change

Question 32

dry absorbent

Answer 32

dessication

Question 33

breakdown of volatile gases

Answer 33

degredation

Question 34

when is degredation highest?

Answer 34

desflurane

Question 35

CO2 absorbent | resulting in less degradation

Answer 35

amsorb

Question 36

what is the worst degredation?

Answer 36

KOH

Question 37

By-product of sevoflurane degradation by absorbent -Nephrotoxic at 25-50 ppm (easily created in extreme low flows)

Answer 37

compound A

Question 38

what increases risk of compound A

Answer 38

- High concentration - Long anesthesia time (>2 MAC hours) - Low-flow technique (< 2 L/min)

Question 39

Alveolar concentration that prevents movement in 50% | of patients in response to surgical stimuli (incision)

Answer 39

MAC - mean alveolar concentration

Question 40

Absorbent exhaustion in areas where gas enters the absorber and along the canister walls

Answer 40

channeling

Question 41

what is places in cannister to prevent channeling

Answer 41

baffles

Question 42

avoid absorbents with ___

Answer 42

KOH

Question 43

What does a circle system have that the maplesons does not?

Answer 43

Co2 absorber, unidirectional limbs and valves, y connector