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ANESTHESIA MACHINE

ANESTHESIA MACHINE. ผศ.พญ.สมัญญา ทิศาวิภาต ภาควิชาวิสัญญีวิทยา คณะแพทยศาสตร์ มหาวิทยาลัยศรีนครินทรวิโรฒ. วัตถุประสงค์. เมื่อจบการบรรยายแล้ว นิสิตสามารถ อธิบายส่วนประกอบและหลักการทำงานของเครื่องดมยาสลบได้อย่างถูกต้อง จำแนกประเภทและเลือกใช้วงจรดมยาสลบได้อย่างเหมาะสม

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ANESTHESIA MACHINE

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  1. ANESTHESIA MACHINE ผศ.พญ.สมัญญา ทิศาวิภาต ภาควิชาวิสัญญีวิทยา คณะแพทยศาสตร์ มหาวิทยาลัยศรีนครินทรวิโรฒ

  2. วัตถุประสงค์ เมื่อจบการบรรยายแล้ว นิสิตสามารถ • อธิบายส่วนประกอบและหลักการทำงานของเครื่องดมยาสลบได้อย่างถูกต้อง • จำแนกประเภทและเลือกใช้วงจรดมยาสลบได้อย่างเหมาะสม • บอกวิธีตรวจสอบเครื่องดมยาสลบและอุปกรณ์ต่างๆ ก่อนการใช้งานตามเกณฑ์มาตรฐานได้

  3. Topics 1. Overview of anesthesia machine 2. Components and systems of anesthesia machine 3. Machine checklist

  4. Overview of Anesthesia Machine

  5. Overview of Anesthesia Machine

  6. DEFINITION A device which delivers a precisely-known but variable gas mixture, including anesthetizing and life sustaining gases.

  7. Overview of Anesthesia Machine

  8. BASIC FUNCTIONS

  9. Overview of Anesthesia Machine

  10. Models Conventional anesthesia machine Modern anesthesia workstation

  11. Overview of Anesthesia Machine

  12. Manufacturing Standards • 1988; American Society for Testing and Materials (ASTM) F1161-88 • 1994; ASTM F 1161-94 (discontinued in 2000) • 2000; ASTM F 1850-00 - Backup for 30 min - Monitors: breathing system pressure , exhaled VT , ETCO2, Inhaled anesthetics conc., FiO2, O2 supply pressure, SaO2, BP, and ECG. - Prioritized alarm system; high, medium, low priority

  13. Topics 1. Overview of anesthesia machine 2. Components and systems of anesthesia machine 3. Machine checklist

  14. Components and Systems

  15. Components and Systems

  16. Medical gas: Types

  17. Machine gas inlet • Most machines have gas inlets for oxygen, nitrous oxide, and air. • Separate inlets are provided for the primary pipeline gas supply that passes through the walls of healthcare facilities and the secondary cylinder gas supply.

  18. Medical Gas: sources

  19. Pipeline system • The centralgas pipeline supply system is the primary source of gas supply for the anesthesia machine. • Oxygen is produced by fractional distillation of liquid air and stored as a liquid at -150 to -175oC in a large flask. Safety systems and regulators send oxygen to the hospital pipeline at ~50 psi; the "normal working pressure" of the anesthesia machine. • Nitrous oxide is stored as a liquid, at ambient temperature, in large tanks (745 psi- H tank) connected to a manifold which regulates the pipeline pressure to ~50 psi.

  20. Pipeline system Central gas pipeline supply system Manifold Multiple gas cylinders

  21. Pipeline system Central gas pipeline supply system Cryogenic tank

  22. Pipeline system Connector at user terminal A. Quick connector (Quick-coupler)

  23. Pipeline system Connector at user terminal B. Diameter Index Safety System (DISS)

  24. Pipeline system Machine’s pipeline inlet Diameter-Index Safety System (DISS)

  25. Pipeline system Machine’s pipeline inlet • The tubing is color coded and connects to the pipeline inlet of the machine through a noninterchangeablediameter-indexsafetysystem (DISS) fitting that prevents incorrect hose attachment. • The check valve, located down stream from the pipeline inlet, prevents reverse flow of gases (from machine to pipeline, or to atmosphere), which allows use of the gas machine when pipeline gas sources are unavailable.

  26. Cylinder supply The commonly used sizes are; • The H Cylinders - Sources of gas for small and infrequently used pipeline systems, - Intermediate or long-term sources of gas at the patient’s bedside, and - Backup source of oxygen, when stored in bulk, in case the pipeline of oxygen fails or is depleted.

  27. Cylinder supply The commonly used sizes are; • The H Cylinders - Sources of gas for small and infrequently used pipeline systems, - Intermediate or long-term sources of gas at the patient’s bedside, and - Backup source of oxygen, when stored in bulk, in case the pipeline of oxygen fails or is depleted.

  28. Free-standing H Cylinder

  29. Cylinder supply • The E cylinders - Backup sources of gas supply to the anesthesia machine, attached directly to the anesthesia machine via a yoke. Hanger- yoke assembly

  30. Cylinder supply • The E cylinders - Portable oxygen sources

  31. Cylinder supply Characteristics of gas cylinders • Material: Molybdenumsteel • Size: B, D,E, M, G, H or K Size E H Dimension 4.1/4” x 26” 9.1/4” x 51” volume 4.8 L 43.6 L Oxygen 1900 psig/660 L 2200 psig/ 6900 L Nitrous oxide 745 psig/1590 L 745 psig/15800 L

  32. Cylinder supply Characteristics of gas cylinders (cont.) • Color coding : Oxygen / Nitrous oxide /Air • Components:Cylinder valveis the most fragile part and consists of - body - port (where the gasexits) - stem (shaft) - handle or hand wheel (to open the valve) - safety relief device - conical depression (opposite the port, it accepts the tip of the screw which secures the cylinder in the yoke) - PISS pins (Pin Index Safety System)

  33. Cylinder Valve A small-cylinder packed valve A large-cylinder packed valve

  34. Pin-Index Safety System (PISS) For small cylinder connection

  35. Diameter-Index Safety System (DISS) For large cylinder connection Nipple and Nut from Hose Body at cylinder

  36. Cylinder supply Characteristics of gas cylinders (cont.) • Cylinder markings: certain codes are stamped near the neck on all medical gas cylinders. 1.Cylinder specification: DOT, type and material used, service pressure (psi) 2. Serial number 3. Commercial designation 4. Manufacturing data: date of manufacture and original test date, inspector’s official mark, Cylinder qualifies for 110% filling 5. Manufacturer’s identifying symbol 6. Retest markings: Data of first 5 year hydrostatic retest, Retester identifying symbol, Cylinder requalifies for 110% filling, Cylinder qualifies for 10-year retest interval. 7. Neck ring owner’s identification

  37. Cylinder supply Cylinder markings Owner’s Identification Cylinder specification Manufacturer’s identifying symbol Cylinder serial No. Commercial designation Retest markings Manufacturing data

  38. Cylinder supply

  39. Cylinder supply Cylinder safety issues: • Standard quality control of cylinder • Prevention of wrong gas cylinder connections • Securing cylinder against breakage • Transfilling • Cylinder hazards: : improper filling: empty, partially filled, overfilled to near bursting pressures : contamination: volatile hydrocarbon : unlabeled, painted over (illegible), incorrectly color coded : fitted with incorrect valve outlet port, loose/inoperable valve assemblies

  40. Cylinder supply Machine cylindrical inlet • Cylinders attach to the machine via hanger-yoke assemblies that utilize aPISS to prevent errors. • Each yoke assembly includes index pins, a washer, a gas filter, and a check valve that prevents retrograde gas flow. • The E cylinders attached to the anesthesia machine are a high-pressure source of medical gases. • Cylinder pressure is usually measured by a Bourdon pressure gauge. A flexible tube within this gauge straightens when exposed to gas pressure, causing a gear mechanism to move a needle pointer.

  41. Electrical power supply • Main electrical power is supplied to the machine through a single power cord which can become dislodged. • New gas machines must be equipped with battery backup sufficient for 30 minutes of limited operation. What functions remain powered during this period is device-specific. • Convenience receptacles are usually found on the back of the machine so that monitors or other equipment can be plugged in. These convenience receptacles are protected by circuit breakers (usually) or fuses.

  42. Components and Systems

  43. PROCESSING • High pressure system • Cylinder supply to pressure regulator • Intermediate pressure system • Pipeline supply to proportioning system • Low pressure system • Flowmeters to common gas outlet

  44. PROCESSING: Gas Machine Piping

  45. HIGH PRESSURE SYSTEM

  46. INTERMEDIATE PRESSURE SYSTEM

  47. LOW PRESSURE SYSTEM

  48. HIGH PRESSURE SYSTEM Consist of those parts which receive gas at cylinder pressure Hanger Yoke (Connecting Yoke) for Cylinders • PISS • Gasket • Check valve Cylinder pressure gauge Cylinder pressure regulators (1st-stage regulators) Oxygen: from up to 1900 psig to 45 psig Nitrous oxide:from up to 745 psig to 45 psig

  49. HIGH PRESSURE SYSTEM

  50. HIGH PRESSURE SYSTEM Hanger-yoke assembly

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