Anaesthesia

Anaesthesia
Inducing an unconscious state where the patient is: - Unaware - Pain-free - Immobile - Memory-free

Anaesthesia (for adults)

Induce it Vascular system (Syringe)

Maintain it Pulmonary system (Anesthesia machine)

Anesthesia oversimplification

Anesthesia

Ventilator

Vaporizer

Anaesthesia / Main parts

Vent. monitor O2 flush Pressure gages Flow meters Vaporizers Ventilator Flow controller AGSS CO2 removal Drawers

Main parts

Ventilator

Why ventilator?

During anesthesia muscles relax (including lung diaphragm)

Lung diaphragm: the muscle who establish positive and negative pressures in order to inhale and exhale air.

Why ventilator?
Ventilator job: to push gas (containing O2, N2Oetc) into the lungs.

OVER simplification!

We can control: volume of gas, speed, frequency, pattern, pressure inside the lung etc.

Ventilation during anaesthesia

Manual or via ventilator

Ventilator

Ventilation via Ventilator

Ventilator types:

1- Gas driven

a) Pneumatically controlled

b) Electronically controlled 2- Electrically driven, electronically controlled

Electrical ventilator

Valve

Valve

Bellow

Piston motor

Electrical ventilator principle

Piston down (gas in) Valve Valve

Bellow

Piston motor

Electrical ventilator principle

Piston up (gas out) Valve Valve

Bellow

Piston motor

Electrical ventilator / real look

Ventilation via bag (manual)

Used sometimes at the end of anesthesia or incase of ventilator failure

valve

valve

Elastic bag (rubber, siliconetc) Drawing for illustration (valves within ventilation part)

Ventilation via bag (manual)

Fresh gas from machine

valve

valve

Elastic bag (rubber, siliconetc)

Ventilation via bag (manual)

Fresh gas to patient

valve

valve

Force by hand

Elastic bag (rubber, siliconetc)

Main parts

Vaporizer

Vaporizer oversimplification

Vaporizer job: to load the gas with anesthetic agent.

OVER simplification!

We can control: type and dose of anesthetic agent.

Vaporizer types

Halothane, Enflurane, Isoflurane, Sevoflurane & Desflurane Each one has its own properties.

Example: Sevoflurane and halothane : easy to inhale Desflurane : very irritating to inhale , shorter duration of action.
Halothane decrease the heart rate and blood pressure Desflurane increase the heart rate and blood pressure

Feature of anesthetic gases

Most important feature ((Reversible effect)) During Anesthesia: Blood Anesthetic agent After Anesthesia: Lungs Brain

Blood
Lungs Brain

Vaporizer internal construction

Summery: fresh gas will flow through the anesthetic agent chamber and enriched with anesthetic agent vapors

IN

OUT

Main parts

Flow controllers

Anesthetic gas content

Anesthetic gas O2 N2O Anesthetic agent Produces an unconscious state Medical Air To lower N2O concentration

Relaxes the muscles

O2 concentration must not be lower than 21% of the total inhaled gas (this is achieved by Anti-hypoxic device)

Anti-hypoxic device / principle

The device that prevent delivery of O2 lower than 21-25% of fresh gas
O2 N2O

Main parts

Flow meters

Flow meters

Glass tubes

Function: control the amount of gas (Oxygen, Nitrous & Air) in the fresh gas (L/min)

Main parts

AGSS (In the back)

Anesthetic Gas Scavenging System

Exhaled gas does contain anesthetic agent.

Inhalation Exhalation

Doctors and nurses surrounding the patient will be subjected to anesthetic gases as well. How to prevent this? Suck the exhaled gas outside the operating room.

AGSS topology

Discharge at the hospital roof AGSS wall outlet AGSS Hospital pipeline system

CO2 removal

CO2 removal

Open / Closed / Semi-Closed systems

Anesthetic gases: 1) Expensive 2) Unwelcome to the surrounding area
Inhalation
Exhalation

Solution: Return exhalation back to patient! The exhaled gas will be returned back to patient after being passed through Soda lime for CO2 removal

Soda lime

CO2 Anesthetic agent O2 + N2O

Soda lime

Soda lime principle

The main components of soda lime are - Calcium hydroxide, Ca(OH)2 (about 75%) - Water, H2O (about 20%) - Sodium hydroxide, NaOH (about 3%) - Potassium hydroxide, KOH (about 1%) Chemical reaction:

CO2 + H2O H2CO3

H2CO3 + 2NaOH Na2CO3 + 2H2O + Heat Na2CO3 + Ca(OH)2 CaCO3 + 2NaOH

Ca(OH)2 (heat) CaO + H2O

Open / Closed / Semi-Closed systems

Systems: 1) Open: no gas is returned to patient

Inhalation Exhalation

2) Closed: no gas is released from patient 3) Semi-Closed: part of the gas will be released from patient.

Monitored parameters during anesthesia

ECG Cardiac system function NIBP / IBP Vascular system function

SpO2 O2 concentration
etCO2 CO2 concentration

Agents Anesthetic agent concentration

BIS level of consciousness

Safer anesthesia / BIS monitoring

Provides a direct measure of the effects of anesthetics and sedatives on the brain EEG signal processing numerical number to show the level of sedation

Anaesthesia / Fabius plus

Anaesthesia / Fabius plus

Anaesthesia / Fabius plus

One of latest equipment data sheet overview

Anaesthesia / Fabius plus

Anaesthesia

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