Anesthetic Delivery Systems

Prodigy Anesthesia Quick Review
Anesthetic Delivery Systems
On an anesthesia machine, what components are The low pressure system on an anesthesia machine contains
found in the low pressure system? the flowmeters, hypoxia prevention devices, unidirectional
valves, pressure relief devices, and the common gas outlet.
Dorsch JA, Dorsch SE. Understanding Anesthesia Equipment.
5th ed. Philadelphia, PA: Lippincott Williams and Wilkins, 2008:
103.
On an anesthesia machine, what components are The intermediate pressure system of an anesthesia machine
found in the intermediate pressure system? contains the pneumatic part of the master switch, pipeline inlet
connections and pressure indicators, the gas power outlet,
oxygen flush valve, oxygen pressure failure devices, and flow
control valves.
97.
Where does the oxygen flush receive its gas supply? The oxygen flush receives an unmetered oxygen supply from
the cylinder pressure regulator or the pipeline inlet at a flow rate
between 35 and 75 liters/minute.
100.
When is use of the oxygen flush control valve The oxygen flush control valve delivers oxygen at a rate of 35-
contraindicated in a mechanically ventilated patient? 75 L/min and a pressure of 50 psig. To avoid barotrauma, it
should never be used when there is no outlet for excess gas
pressure to escape. This situation exists when the patient is in
the inspiratory phase of mechanical ventilation when the
inspiratory valve is open to the patient but there is no vent for
gases to escape.
Longnecker DE. Anesthesiology. New York: McGraw-Hill;
2008: 771.
What are the three functions of the hanger-yoke The hanger yoke assembly orients the gas cylinder, supports
assembly on the anesthesia machine? the weight of the cylinder, provides for uni-directional gas flow,
and provides an air-tight seal.
86.
How does a variable-bypass vaporizer work? A variable-bypass vaporizer splits the fresh gas flow into two
parts. One portion enters the vaporizing chamber where it
becomes saturated with anesthetic agent. The other portion
enters the bypass chamber and does not come into contact with
the anesthetic agent. By controlling the amount of gas that
enters the vaporizing chamber, the amount of anesthetic agent
delivered to the patient can be controlled.
Miller RD, Pardo MC. Basics of Anesthesia. 6th ed.
Philadelphia, PA: Elsevier Saunders; 2011: 202.
Copyright 2012 Prodigy Anesthesia, Inc. Unlawful to duplicate, distribute, or sell this document. Page 1 of 10
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Is the Tex-6 vaporizer a variable-bypass vaporizer? The Tec 6 vaporizer is heated to 39 degrees Celsius and
Why or why not? pressurized to 2 atmospheres. It is not a variable bypass
vaporizer and unlike these devices, no fresh gas flows through
the sump.
Morgan GE, Mikhail MS, Murray MJ. Clinical Anesthesiology.
4th ed. New York, NY: McGraw-Hill; 2006: 66-68.
What is the 'pumping effect' and when might it occur? The 'pumping effect', an intermittent back pressure caused by
positive pressure ventilation or use of the oxygen flush valve
results in elevated vaporizer output. It is more prominent with
low flows, low vaporizer dial settings, low levels of anesthetic in
the vaporizer chamber, high respiratory rates, and high peak
inspiratory pressures.
Barash PG, Cullen BF, Stoelting RK. Clinical Anesthesia. 5th
ed. Philadelphia, PA: Lippincott Williams and Wilkins: 2006:
572.
Why should you avoid using a dessicated CO2 Prolonged exposure of desflurane or isoflurane to dessicated
absorbent with desflurane? CO2 absorbent can result in the degradation of the anesthetic
with the resulting production of carbon monoxide. Increased
temperature and higher doses of anesthetic agent both increase
the amount of carbon monoxide produced. The inhaled
anesthetic that produces the greatest amount of carbon
monoxide is desflurane.
2008: 796.
When an anesthesia machine is connected to a When connected to a pipeline gas source, the cylinders should
pipeline gas supply, should the backup cylinder be kept closed so that a pipeline pressure failure would be
valves be open or closed? Why? detected earlier and to prevent pressure variations in the
pipeline from draining oxygen from the cylinders.
98.
What safety mechanisms are built into the pipeline The pipeline inlet connections on an anesthesia machine are
inlet connections on the anesthesia machine? fitted with diameter index safety system fittings to prevent
connection of a gas line to the wrong connector on the
machine. They also have 100 micron (or less) filters and a
unidirectional check valve.
97-98.
How does the oxygen supply failure alarm work? The oxygen supply failure alarm sets off an alarm if the oxygen
pressure falls below a standard set by the manufacturer (which
is typically 30 psig). It must engage within 5 seconds of the
disconnect and cannot be disabled by the anesthetist. It is
designed to help prevent hypoxia from lack of oxygen flow, but
does not prevent the flow of anesthesia gases (and therefore
could still possibly allow a hypoxic mixture of gases to be
delivered).
99.
In the event your oxygen supply fails and you must Most anesthesia machines utilize oxygen as the driving gas to
switch indefinitely to your backup oxygen tanks, what power the ventilator. By reducing fresh oxygen flow rates and
are appropriate measures to reduce the amount of eliminating the use of the ventilator by allowing the patient to
oxygen consumed and prolong the duration of your breathe spontaneously or ventilating via the reservoir bag, you
backup oxygen supply? will prolong the backup oxygen supply.
2008: 771.
What is the function of the diameter index safety The diameter index safety system connects the wall outlet gas
system? supply to the anesthesia machine and has a line pressure of 45-
55 psi. It is designed for medical gas lines at pressures of 1380
kPa (200 psi) or less
4th ed. New York, NY: McGraw-Hill; 2006: 48.
What is the function of the fail-safe device on the The fail safe device triggers an alarm and closes the supply of
anesthesia machine? nitrous oxide and other gases when the oxygen pressure falls
below 25 psi.
Which gas should be positioned last in the flowmeter Oxygen should be placed last in the sequence of flowmeters to
sequence on an anesthesia machine? reduce the risk of delivery of a hypoxic mixture of gases if a leak
develops in one of the upstream flowmeters.
Why is the flowmeter tube (also called a Thorpe The diameter of the flowtube is tapered such that it is smaller at
tube) tapered? the bottom than at the top. At lower gas flows, it takes less
pressure to support the bobbin and the diameter is smaller. At
higher gas flows, the diameter is larger and more gas is allowed
to pass around the bobbin.
How do you calculate the inspired oxygen The formula to calculate the inspired oxygen concentration if
concentration if you are administering air and oxygen you are administering both air and oxygen together is: 100 X
simultaneously? (1.0 X O2 L/min) + (0.21 X Air L/min)/(O2 L/min + Air L/min)
Sandberg W, Urman RD, and Ehrenfield JM. The MGH
Textbook of Anesthetic Equipment. Philadelphia, PA: Elsevier;
2011: 25.
You are testing your anesthesia machine in the If you have verified that the backup oxygen cylinder is full,
morning before cases begin. You disconnect the connected properly, and opened and the anesthesia machine
pipeline supply and turn on the backup oxygen still does not pressurize, then there is a problem in the high or
cylinder to make sure it functions correctly. The intermediate pressure system in the anesthesia machine.
oxygen cylinder is full and connectly correctly but the
anesthesia machine still does not pressurize. What
could be the cause?
407.
What is the only machine safety device that detect The oxygen monitor
problems downstream from the flowmeters?
When the BAG/VENT selector on the anesthesia When the BAG/VENT selector is switched to VENT, controlled
machine is set to VENT, which components are ventilation is instituted and the gas reservoir bag and APL valve
eliminated from the circle anesthetic system? are eliminated from the circle system.
What is the result of closing the APL valve off when Closing the APL valve while a patient is breathing
the patient is breathing spontaneously? spontaneously will result in an increase in the breathing circuit
pressure. The breathing bag can become distended and the
patient can be exposed to CPAP.
198-199.
A patient is being mechanically ventilated with a The ventilator is driven by oxygen and requires an amount
respiratory rate of 8/minute, a tidal volume of 700 equal to the minute ventilation, which in this case is 5.6 L/min.
mL, the oxygen flow rate is 1L/minute and nitrous The oxygen flow is 1 L/min and therefore, the total flow
oxide is being delivered at 1L/minute. How much consumed is 6.6 L/min.
oxygen is being consumed per minute?
Which mechanical ventilation modes allows for Ventilation modes that allow spontaneous ventilation include:
spontaneous ventilation? IMV, SIMV, MMV, PSV, and HFJV. CMV, AC, and PCV do not.
What are the regulations concerning the amount of According to the standards set by the ASTM, 3-liter reservoir
pressure a breathing bag can exert? Who sets bags (also called breathing bags) that are distended to four
these regulations? times their normal size should not exert a pressure less than 35
cm H2O or greater than 60 cm H2O. Bags that are 1.5 L in size
or smaller shall not exert a pressure less than 30 cm H2O or
greater than 50 cm H2O when distended to this extent. The
lowest pressure to be exerted is to ensure that the bag is
capable of exerting enough minimum pressure to ventilate a
patient and the highest pressure is to limit the amount of
barotrauma that a patient may be exposed to when using the
breathing bag.
196.
What is wasted ventilation? Name three factors that Wasted ventilation is a reduction in the tidal volume delivered to
will increase the amount of tidal volume lost during the patient due to distention of the breathing system
inspiration due to wasted ventilation. components. The tidal volume lost increases with increased
airway pressures, increased tidal volume, increased compliance
of the breathing system components, and increased breathing
system volume.
194.
What factors result in higher tidal volumes than are Unless you are using an anesthesia machine that is designed to
set for the patient when the anesthesia machine compensate for it, when the ventilator is being used a portion of
ventilator is in use? the fresh gas flow will contribute to the tidal volume. This effect
increases if the fresh gas flow rates are high, if the I:E ratio is
high, and if the patient has a slower respiratory rate.
194.
What are the potential complications of overfilling a Possible complications from overfilling a vaporizer include:
vaporizer? liquid agent entering the fresh gas line and potentially delivering
a lethal dose of agent to the patient or complete failure of the
vaporizer. Some vaporizers have the filling port positioned so
that overfilling cannot occur, but if the vaporizer is tipped
overfilling is still a possibility.
185.
Describe the steps of the chemical reaction that The reaction that occurs within the CO2 absorber between soda
occur in the soda lime-based CO2 absorber lime and carbon dioxide occurs in two steps. The first is CO2 +
cannister. H2O --> H2CO3. The second portion of the reaction is H2CO3
+ 2NaOH --> Na2CO3 + 2H2O + heat. Therefore, H2CO3 is an
intermediate product of the reaction, but not a final product as it
is degraded by the secondary reaction. The final products are
Na2CO3, H2O, and heat.
What is channeling in a CO2 absorber cannister? Channeling occurs when gases flow through passages of lower
resistance in the CO2 cannister. When this occurs, most of the
CO2 absorbent granules are bypassed and the efficiency of the
absorber decreases. It can be minimized by gently shaking the
cannister prior to use.
What are the advantages/disadvantages of a single- A single canister CO2 absorber system is easier to change, but
cannister CO2 absorber system over a double- double canister systems provide more complete CO2
cannister system? absorption, less frequent canister changes, and lower
resistance to gas flow.
What are the three classifications of a circle system Semi-open, semi-closed, and closed. Semi-open requires high
type of anesthetic breathing apparatus? How do fresh gas flow rates to prevent rebreathing. Semiclosed
they differ? involves rebreathing of anesthetic and respiratory gases and is
the most commonly used system in the U.S. A closed system
requires matching the inflow of gas precisely to the amount of
gas consumed by the patient.
Which preserves circuit humidity more effectively, a A single-limbed circuit will improve humidification to a slightly
single-limbed circuit or a two-limbed circuit? greater degree than a two-limbed circuit.
299.
In a circle anesthesia circuit, what determines the In a circle anesthesia circuit, the fresh gas flow rate determines
amount of gas that is rebreathed by the patient? the amount of gas the returns to the patient and is rebreathed.
2011: 26.
Can you use both an HME and a heated humidifier No. The combination of an HME and a heated humidifier can
at the same time to preserve circuit humidity? produce a dangerous resistance to airflow.
301.
How much carbon dioxide will a patient inhale using None. A circle circuit incorporates the carbon dioxide absorbers
a normal circle anesthesia circuit? which will absorb any exhaled CO2.
2011:
You are using a circle anesthetic circuit and realize An 'open' circuit implies that the patient is not rebreathing any of
that the carbon dioxide absorbent has become the exhaled gases. Although this is wasteful, it can also be
exhausted. You decide to convert the circuit to an useful in the event the CO2 absorbent becomes exhausted
'open circuit'. What is the easiest way to do this during a case and you need to prevent the patient from
during the case? rebreathing exhaled carbon dioxide. All that's necessary to
convert a circle circuit to 'open' is to increase the fresh gas flow
rate to above the patient's minute ventilation.
2011: 26.
How will a PEEP valve affect the patient's work of A PEEP valve will increase the amount of work the patient has
breathing? to exert during the exhalation phase.
200-201.
What is the Bain circuit? The Bain circuit is a modification of the Mapleson D circuit
utilizing a coaxial system in which the fresh gas hose lies within
the corrugated tubing through which exhaled gas flows. The
exhaled gas passes in the opposite direction of the fresh gas,
establishing a countercurrent, which helps warm the inspired
gas. It requires a fresh gas flow of 1-2 times that of the minute
ventilation to prevent rebreathing.
The Bain circuit is a modification of what other The Bain circuit is a coaxial version of the Mapleson D system.
anesthetic breathing system? The fresh gas supply tube passes inside the corrugated
expiratory tubing. The Bain circuit may be used for controlled or
spontaneously breathing patients.
Which anesthetic breathing circuit does not have a The Mapleson E does not have a gas reservoir bag. The Bain
gas reservoir bag? circuit and all of the Mapleson circuits except for the Mapleson
E have a gas reservoir bag.
How can pain affect oxygen saturation during low- During low-flow anesthesia, the amount of oxygen delivered
flow anesthesia? must be higher than the patient's metabolic demand regardless
of the FiO2. For example, if your oxygen flow rate is 300
mL/min and the patient's metabolic demand is 300 mL/min, then
the oxygen supply meets the demand. If however, the patient
experiences pain, it is likely that his heart rate, blood pressure,
and metabolic demand for oxygen will increase. As his oxygen
consumption increases above 300 mL/min the supply no longer
meets the demand and the oxygen saturation will begin to fall.
2011: 29.
What is a heat and moisture exchanger (HME)? Heat and moisture exchangers (HME) are inexpensive, silent,
What are three disadvantages of using an HME? easy-to-use devices that help retain heat and moisture within
the anesthesia circuit. Advantages of HMEs include: no need
for water or electrical power source and no risk of:
hyperthermia, overhydration, burns, or electrical shock. They all
act as large particle filters and many serve as effective bacterial
and viral filters.
The primary disadvantages of HMEs are that they are not
nearly as effective at warming and humidifying the patient's
airway as water-based, electrical devices. They also increase
deadspace and can increase the work of breathing.
Airway obstruction can occur if the HME becomes blocked
with fluid, blood, secretions, nebulized drugs, or if a mechanical
defect is present in the device. If increased airway resistance is
experienced during an anesthetic, the peak pressure should be
measured both with and without the HME in place.
301.
What are the two types of heat and moisture There are two primary types of HMEs: hydrophobic and
exchangers (HMEs) and how are they different? hygroscopic. Hydrophobic HMEs have a hydrophobic
membrane with small pores that is pleated to provide a greater
surface area. Hygroscopic HMEs contain a wool, foam, or
paperlike material that is coated with a chemical that helps it to
retain moisture. High ambient temperature may decrease the
effectiveness of hydrophobic HMEs compared to hygroscopic
HMEs. Hydrophobic HMEs may also be more effective at
preventing the transmission of the hepatitis C virus than
hygroscopic HMEs. Also, if hygroscopic HMEs become wet,
they may lose their ability to filter airborne pathogens and
airway resistance may increase substantially. The airway
resistance of hydrophobic HMEs increases only slightly if wet.
Hygroscopic HMEs are considered more effective at preserving
heat and humidity than hydrophobic HMEs.
299.
What driving pressure is required to deliver adequate When performing transtracheal jet ventilation through a 12 or 14
oxygen flow through a 14 or 16 gauge catheter used gauge catheter, a driving pressure of 50 psi is required to
for an emergency cricothyrotomy? ensure sufficient gas flow into the lungs.
In what cases should an HME be avoided? An HME should be avoided when a patient exhibits thick,
copious secretions which could enter the circuit and occlude the
HME. They should also not be used when there is a leak that
prevents the exhalation of gas through the HME such as a
bronchopleuralcutaneous fistula or when an uncuffed
endotracheal tube is used.
299.
Can you use two HME's in a series to improve Yes. Using two HME's in a series can improve humidification,
humidification in an anesthesia circuit? but care must be taken to monitor for the effects of increased
deadspace or work of breathing.
299.
How does the color of a gas cylinder correspond with Oxygen cylinders are green, nitrous oxide cylinders are blue,
its contents in the US? carbon dioxide cylinders are gray, air cylinders are yellow,
nitrogen cylinders are black, and helium cylinders are brown.
These colors can vary outside of the United States.
10.
How many liters of oxygen will an E-cylinder hold? An E-cylinder will hold about 660 liters of oxygen, 1590 liters or
Nitrous oxide? Carbon dioxide? Air? either nitrous oxide or carbon dioxide, or 625 liters of air.
8.
An E-cylinder oxygen tank pressure gauge reads A full E-cylinder oxygen tank holds 660 liters at a pressure of
1000 psig. How much oxygen is left in the tank? 2000 psig. Because an oxygen tank's pressure is proportional
to its contents, if the pressure falls by half, then the number of
liters falls by half as well. Using this ratio, the tank would have
330 liters left in it.
What is the critical temperature of nitrous oxide in The critical temperature of nitrous oxide is 36.5 degrees
degrees Celsius? What is the significance of this? Celsius. This means that because its critical temperature is
above room temperature, it will remain in liquid form without a
refridgeration system.
When the pressure gauge drops below 745 psig on a Because E-cylinder nitrous oxide tanks contain nitrous oxide in
nitrous oxide E-cylinder at room temperature, how both the liquid and gas state, the only accurate way to
much nitrous oxide is left in the tank? determine the amount of gas left in the tank is by weighing it. A
full E-cylinder tank will hold 1590 liters of nitrous oxide. When
the liquid form is consumed and the tank pressure drops below
745 psig, however, the amount of nitrous oxide in the gas phase
is about 400 liters.
What is Entonox? Entonox is a 50:50 mixture of oxygen and nitrous oxide. It is

most commonly used for dental procedures, dressing changes,
and obstetric anesthesia.
2011: 13-14.
What is heliox? Heliox is a mixture of helium and oxygen. Helium is less dense
than oxygen and improves respiratory mechanics by increasing
laminar flow (a reduction in Reynolds number) through the
airways and decreasing the work of breathing. Heliox can
alleviate the symptoms of increased airway resistance, but
doesn't dilate the airways like a bronchodilator.
2011: 14.

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Prodigy Anesthesia Quick Review

Anesthetic Delivery Systems

What is Entonox? Entonox is a 50:50 mixture of oxygen and nitrous oxide. It is

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