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AP EXAM 2 LECTURE 3: ANESTHESIA MACHINE
AP EXAM 2 LECTURE 3: ANESTHESIA MACHINE
What are the three main components?
1. gas delivery
2. breathing circuit
3. scavenger
Who are the two manufacturers?
Datex-ohmeda

Drager
Gas supply
Cylinder
Inlets: PISS, pin index safety system

Pipeline (50 psi)
Inlets: DISS, diameter index safety system
Figuring out how long a tank will last formula:
X amount of contents L / Gauge pressure = capacity L / service pressure

Objective: figuring out X amount to give total Liters.

NOTE:
capacity = 660L
service pressure = 2200 psi
What's the Mapleson Circuit?
1. lightweight, inexpensive
2. no unidirectional valves
3. FGF equal to minute ventilation. Prevents rebreathing
Soda Lime
80% CaOH
4% NaOH

Carbonates, heat, and water formed.
Baralyme
CaOH 80%
BaOH 20%
Two main influences of CO2 absorption efficiency:
1. absorbent granule size: absorption increases with smaller granules.
2. channeling: path of least resistance.
a. loose packing
b. 1/2 vol canister granules
Toxic products of CO2 absorbent:
1. Nephrotoxin Compound A
a. FGF < 1L/min
b. baralyme >> soda lime
c. high absorbent temp
2. Carbon monoxide
What is the function of unidirectional valves?
1. function as check valves
2. horizontal disk
3. inspiratory valve closure prevents exhaled air from entering the circuit before CO2 is removed.
Where is the FG inlet located?
Btw absorber and inspiratory valve.
Where is the APL valve located?
Immediately before CO2 absorber.
Which limb is the reservoir bag located in?
Expiratory limb

At this location, it helps to reduce resistance to exhalation.
How do you check High Pressure system?
1. check O2 cylinder supply
2. check central pipeline supply.

NOTE: pipeline gauge ~50-55psig
... Low pressure system?
1. flow valve control
2. attempt to create hypoxic mixture.
3. fill level vaporizers.
How do you perform leak check?
1. turn flow control valve off
2. attach suction bulb to FG outlet.
3. squeeze (collapsed >10sec)
4. repeat with each vaporizer on.
How do you check for the scavenging system?
1. Open APL and occlude Y piece.
2. with low flow, bag collapses and pressure gauge ~0
3. actovate O2 flush and allow bag to fully distend. Verify P < 10cmH2O.
How do you perform the leak test on the Breathing Circuit?
1. close APL
2. occlude Y piece and pressurize > 30 cmH2O
3. ensure Pressure remains there > 10sec
How do you check for auto ventilation?
1. attach 2nd lung to Y-piece
2. fill bag with flush and turn on ventilator.
a. verfiy bellows deliver appropriate Vt
b. verify bellows/bag fill and empty appropriately.
c. check uni-directional valves.
Two uses of Lido
1. reduce pain on injection
2. blunt sympathetic reflex on DL.
What is the toxic dosage of Lido?
5 mg/kg
7 mg/kg with Epi
Neurotoxicity of lidocaine
1. tinnitus
2. lightheadedness
3. confusion
4. seizures
Cardiovascular toxicity of lidocaine
1. HTN
2. Myocaridal depression
3. hypotension
4. arrhythmias
Propofol dosage and peak effect
1-2.0mg/kg
60-120 sec
Thiopental
3-5mg/kg
45-120sec
Etomidate
0.2-0.6mg/kg
45-120sec
Ketamine
1-2mg/kg
Sedation dose for Fentanyl
25-50mcg
What's the reversal for benzodiazopines?
Flumazenil (0.2mg) every 5 mins.

Max 1mg
What are the uses for benzodiazopines?
1. anxiolysis
2. amnestic
Midazolam
Diazopam
Lorazapam
Midazolam: 1-5mg IV
Diazopam: 5-10mg PO
Lorazapam: 1-4mg IV
What are the appropriate ET tube sizes?
Adult: 7.5-8.0mm ID
Females: 7.0-7.5mm
Children: 4 + age/4 mm
What is the measurement of the OD of ETT?
15mm

NOTE: ETT is a low pressure high vol cuffs.
What are the purposes of preoxygenation?
1. increase duration of apnea without hypoxia
2. replace room air in FRC with O2.
3. O2 consumption: ~240ml/min
Fick's eqtn:
VO2 = CO * CaO2 - CvO2

CaO2 = 1.39 * Hb * SpO2 + .003*PaO2

NOTE:
Hb = 15, SaO2 96%, PaO2 90 mmHg

Hb = 15, SvO2 75%, PvO2 40mmHg

Arterial CaO2 = 20
Venous CaO2 = 15

VO2 = 5 *10 *5 = 250ml O2/min
Face mask ID connector measurement?
22 mm
Nasal Airway estimated length to use?
Distance nares to EAM (earlobe).

Should be lubricated.
Name a reason why a Miller blade is more indicated than a MAC.
Used in difficult airway due to large anatomical structure.

NOTE: MAC is used to facilitate maximal exposure.
Positioning of ET tube for male and female?
Male: 23cm
Female: 21cm
What could result if there was too much cuff volume?
Excessive cuff volume may indicate a tube above the cords or in the esophagus.
Does condensation in the tube guarantee a proper intubation?
NO. Esophageal intubation can still produce condensation in the tube.
Aspiration Prevention Drugs?
1. Na Bicitrate: an antacid
30cc 30 mins before induction of anesthesia.

Helps to raise pH.

2. H2 blockers: stimulates new fluids at higher pH to be secreted.

3. Reglan (metoclopramide): speeds up gastric emptying.
Aspiration prevention technique:
Rapid sequence induction (RSI) with cricoid pressure.

1. pre-oxygenate
2. put pt to sleep with hypnotics
3. succinylcholine, cricoid pressure, intubate.

NOTE: positive pressure mask ventilation is NOT performed! Why? To avoid increasing gastric volume.
What is the purpose of RSI?
To minimize the duration of impaired gag reflex prior to intubation.
How do you apply cricoid pressure?
Force of 10N (1 kg)

Occludes esophagus

Helps prevent passive regurgitation.
Monitored Anesthesia Care (MAC0
1. same room setup as GA
2. may not have access to airway.
ASA guidelines MAC
1. oxygenation
2. ventilation
3. circulation