Anesthesia Machine

Compiled and Presented by:

Dr. Judith Justin [Link]., Ph.D.,

Prof. & Head,
Department of Biomedical Instrumentation Engineering
Faculty of Engineering
Avinashilingam University
Coimbatore - 641 108
 Introduction

⚫ Anaesthesia machine or Boyle's machine is used by

anaesthesiologists to support administration of anaesthesia
⚫ The most common type of anaesthetic machine is designed to
provide an accurate and continuous supply of medical gases
(such as oxygen and nitrous oxide) mixed with an accurate
concentration of anaesthetic vapour (such as isoflurane), and
deliver this to the patient at a safe pressure and flow.
⚫ Modern machines incorporate a ventilator, suction unit,
and patient monitoring devices.
⚫ The original concept of Boyle's machine was invented by the
British anesthetist Henry Boyle (1875–1941) in 1917.
machine
 Components of an Anesthesia machine
⚫ A modern anaesthesia machine includes the following components:
⚫ Connections to piped hospital oxygen, medical air, and nitrous oxide.
⚫ Reserve gas cylinders of oxygen, air, and nitrous oxide attached via a
specific yoke with a Bodok seal.
⚫ A high-flow oxygen flush which provides pure oxygen at 30-75
litres/minute
⚫ Pressure gauges, regulators and 'pop-off' valves, to protect the
machine components and patient from high-pressure gases
⚫ Flow meters (rota meters) for oxygen, air, and nitrous oxide, low Flow
meters for oxygen nitrous oxide
⚫ Updated vaporizers to provide accurate dosage control when using volatile
anaesthetics
⚫ An integrated ventilator to properly ventilate the patient during administration
of anaesthesia
⚫ A manual ventilation bag in combination with an Adjustable Pressure
Limiting (APL) valve
⚫ Systems for monitoring the gases being administered to, and exhaled by
the patient
 Need for Anesthesia
⚫ Anesthesia serves the following two functions:
⚫ It ensures that the patient does not feel pain and minimizes
patient discomfort;
⚫ It provides the surgeon with favorable conditions for the surgery.
⚫ When anesthesia is given so that the patient loses consciousness,
it is called general anesthesia. In ‘general anesthesia’, the
anesthetic agent is administered to the body so that it reaches the
brain via the blood stream.
⚫ The usual method is 'inhalation anesthesia' in which gaseous
anesthetic agents are introduced via the lungs. Examples of such
agents are diethyl ether, chloroform, halothane, cyclopropane and
nitrous oxide (N20, laughing gas).
⚫ During anesthesia, not only is the anesthetic administered in the
required amount with oxygen. Any excess carbon dioxide is also
eliminated. In the superficial stages of anesthesia, the patient can
breathe for himself spontaneous ventilation.
 Delivery of Anesthesia

The anesthetic delivery system consists of an anesthesia

machine, a patient breathing circuit, a ventilator and airway
equipment.
⚫ The anesthesia machine comprises a gas supply—delivery
unit and an anesthetic vaporizer.
⚫ The patient breathing circuit consists of a closed loop of
breathing tubing, containing two uni-directional breathing
valves and an Adjustable Pressure Limiting (APL) valve, a
C02 absorber, a means for venting excess gases
(scavenging), a humidifier and a collapsible reservoir bag.
⚫ A mechanical ventilator is used for positive pressure
ventilation.
⚫ The airway management equipment includes the mask and
endo-tracheal tube, which interface the patient with the
 Anesthesia Machine
⚫ An anesthesia machine is a device which is used to deliver
a precisely known but variable gas mixture including
anesthetic and life-sustaining gases to the patient's
respiratory system
⚫ Generally, a variable concentration gas mixture of oxygen,
nitrous oxide and anesthetic vapor like ether or halothane
is obtained from the machine and is made to flow through
the breathing circuit to the patient.

⚫ Anesthesia machine is composed of two subsystems:

(i) The gas supply-delivery unit, which consists of tubing
and flow
meters interconnected in parallel; and
(ii) The anesthetic vaporizers, which is used to produce an
 Gas Supply System
⚫ Gases are provided to the anesthesia machine from either a
pressurized hospital central supply or small storage cylinders attached
to the machine.
⚫ Centralized Supply: Centralized supply systems consist of bulk or
cylinder storage for main and reserve supply, control equipment
including valves and pressure regulators, a distribution pipeline, and
numerous supply outlets.
⚫ The system is so designed that the necessary supply of gases (oxygen
and nitrous oxide) is always available. The gas supplied by the
hospital is regulated and maintained at 275-345 kPa (40-50 psi) at the
wall outlet.
⚫ Gases are supplied to the anesthesia machine inlet from the central
system via a flexible hose connected to the operating room wall outlet.

⚫ In order to prevent interchanging the gas supply wall outlet with the
incorrect anesthesia machine inlet, for example, nitrous oxide for
oxygen, non- interchangeable connectors are used at each end of the
hose.
⚫ The two types of non-interchangeable connections used are the
Diameter Index Safety System (DISS) and non-inter- changeable
quick couplers.
 …..contd.
⚫ Gas Cylinders: A second gas supply source is the cylinders located
in yokes attached to the anesthesia machine. This supply can be
utilized as either the main source when a central gas supply does
not exist, or a reserve when central gas supply is available.
⚫ Yoke: Each anesthesia machine has at least one yoke for an oxygen
cylinder but most are provided with two. In addition to oxygen,
most machine designs include a nitrous oxide yoke. In order to
prevent incorrect placement of a tank into the wrong yoke, two pins
located in the yoke must fit into corresponding holes drilled into the
tank neck. The placement of these pins and corresponding holes is
unique for each gas. This identification system, which is referred to
as the 'Pin Index Safety System', has been standardized to prevent
the accidental fitting of a wrong cylinder to the yoke.
⚫ Pressure Regulator: Machine pressure regulators reduce cylinder
gas pressures to 275 kPa (40 psi) before the gas flows through the
machine. The regulator has one high-pressure inlet, one high-
pressure outlet and two-low pressure outlets. The high pressure
inlet is connected with the cylinder through a non-return valve. The
non-return valve prevents the flow into an empty cylinder or back
into the central piping system and also enables its removal and
 Gas Supply System
⚫ Pressure Gauge: Pressure gauges are attached to the cylinders to indicate the
contents of the gases in the cylinders. For oxygen, the operating range of the
gauge is 0 to 150 kg/cm2.
⚫ Whenever the new oxygen cylinder is hooked up and taken in line, the indicator
should be above this mark. With the gradual usage of the gas, the reading would
drop gradually.
⚫ When the indicator shows that the pressure has fallen below the minimum level of
acceptance, the cylinder should be refilled. If for any reason, the pressure gauge
shows a reading above
150 kg/cm2 during use, the cylinder should be disconnected immediately and
replaced.

⚫ Fail Safe System: From the supply, the gas flows into the inlet of the anesthesia
machine and is directed through the pressure safety system (fail-safe system)
towards the flow delivery unit.
⚫ The pressure safety system will not allow nitrous oxide to flow without an oxygen
supply pressure in the machine.

⚫ The fail-safe system consists of a master pressure regulator valve located in the
oxygen supply line. From the master regulator, a reference pressure is provided to
 Gas Delivery System (Gas
proportioning)
⚫ Regulations now require oxygen-nitrous oxide ratio safeguards,
which need a minimum continuous low flow of oxygen varying
from 200 to 300 mL/min, as indicated by the low-flow rotameter.
In newly designed machines, ingenious mechanical devices
prevent the delivery of gas mixtures with an oxygen concentration
below a low limit. Oxygen-nitrous oxide ratios vary from 25:75 to
30:70.
⚫ Gas Delivery Units: From the fail-safe system, the gas is directed
to the flow delivery unit. Two methods have been used to
accomplish delivery and control of the gas mixture: gas
proportioning and gas mixing.
⚫ In a gas proportioning system, the delivered concentration of each
gas constituent is the function of a pre-determined, precisely
controlled ratio of proportionality which is independent of the total
gas flow. For example, for a desired mixture of 70% nitrous oxide
and 30% oxygen, the metered ratio of mass delivery will always be
7:3, regardless of the total flow rate. Concentration is only a
function of the proportional relationship between constituents. It
does not rely on setting individual gas flows. An oxygen-nitrous
oxide bleeder used in a manner similar to the oxygen— air
 Gas Delivery System (Gas mixing)
⚫ Current anesthesia machines use gas mixing. In this technique,
the flow rate of each constituent is independently controlled and
measured by a delivery unit consisting of a needle valve and a
rotameter. The needle valve functions as a flow controller and a
means of turning the gas on and off. The rotameter is a variable
orifice flow meter and consists of a transparent tube with a
tapered internal diameter and a floating bobbin flow indicator.
⚫ During the administration of anesthesia, it may be necessary to
fill the patient breathing circuit with oxygen at a rate higher than
what the gas delivery unit can supply. For example, such a
situation exists any time the patient is disconnected to the
breathing circuit. This higher flow of oxygen is supplied via the
oxygen flush valve and line. The oxygen flush system provides a
high flow ranging from 35 to 75 L/min at a high pressure (20-45
psi, 270-590 kPa) directly into the patient breathing circuit.
⚫ Each gas has a specific delivery unit. These units are connected
in parallel and exhaust into a common manifold prior to leaving
the machine. The final concentration and total flow determined
by mixing the component flows are dependent functions and
subject to the accuracy of the control and measurement
 Vapour delivery
⚫ Liquids that possess anesthetic properties are too potent
(strong) to be used as pure vapours. They are diluted in a
carrier gas such as air and/or oxygen, or nitrous oxide and
oxygen. The device that allows vaporization of the liquid
anesthetic agent and its subsequent admixture with a carrier gas
for administration to a patient is called a 'vaporizer'. Vaporizers
produce an accurate gaseous concentration from a volatile
liquid anesthetic. The anaesthetic vapour can then be safely
added to the previously metered oxygen and nitrous oxide as
the mixture leaves the mixing manifold.

⚫ Vaporizers are available in one of the two basic designs: the

flow meter controlled or the concentration-calibrated. In either
device, the anesthetic vapours are picked up from the vaporizer
by a carrier gas consisting either of pure oxygen or an
oxygen-nitrous oxide mixture that bubbles through or passes
over the liquid. The liquid surface area to gas interface is
 …contd.
⚫ Vapourization produces a drop in liquid temperature.
⚫ As liquid temperature decreases, a thermal gradient is established between the
liquid and the surroundings.
⚫ This results in a decrease in the quantity of the vapour produced. In order to
maintain the performance of the vapourizer, the temperature drop is minimized
or prevented by the incorporation of a thermal source.
⚫ This is achieved by using a water bath or surrounding the vapourizing liquid
with a heating element.
⚫ These devices may also control the temperature of the carrier gas entering the
vapourizer.
⚫ The materials selected for vapourizer construction require both a high specific
heat and high thermal conductivity.
⚫ Materials with high specific heats will change temperature more slowly and
maintain an appropriate thermal inertia.
⚫ The higher the thermal conductivity, the higher the conduction of heat from the
surroundings.
⚫ Because of its availability and lower cost, copper is one of the most common
materials used.
⚫ Copper has a moderate specific heat and a high thermal conductivity.
⚫ Earlier vapourizers were called “copper kettles".
⚫ In order to provide a stable and predictable concentration of
anaesthetic vapour, the vaporizers include a suitable method of
obtaining calibrated dilution of vapour to avoid administration
of too powerful volatile anaesthetic agents to the patient.
⚫ This can be done by several means and the vaporizers are
accordingly classified into two categories:
Variable Bypass Vaporizer
Measured flow vaporizer
 Variable bypass vaporizer
⚫ Variable Bypass Vaporizer: Here the carrier gas flow from the
flowmeter is split into two streams in a known ratio: one stream
which is called 'chamber flow', flows over the liquid agent while the
other stream goes through the bypass path and does not enter the
vaporizing chamber. The final concentration can be controlled by
varying the splitting ratio between the vapourizer gas and the bypass
gas using an adjustable valve.
⚫ The splitting ratio of the two flows depends on the ratio of
resistances to their flow, which is controlled by the concentration
control dial and the
automatic temperature compensation valve.
⚫ Less than 20% of the gas becomes enriched-saturated with
vapour and more than 80% is bypassed, to rejoin at the
vapourizer outlet.
⚫ The output of current variable
A flow splitting
bypassvalve that can be rotated
vapourizers to alter
is relatively
the
 Variable bypass vaporizer ….contd.
⚫ The output of vapourizers is linear at the ambient
temperature (2°-35°C) due to automatic temperature
compensating devices that increase carrier gas flow as the
liquid volatile agent temperature decreases.
⚫ Also, they are composed of metals with high specific heat
and thermal conductivity.
⚫ Check valves are provided to prevent back pressure effect
on the vapourizer from the breathing circuit due to
positive pressure ventilation.
 Measured flow Vaporizer
⚫ The anaesthetic agent is heated to a temperature above the
boiling point (so that it behaves as a gas) and is then metered
into the fresh gas flow.
⚫ Various anaesthetic agents have widely different potencies
and physical properties and hence require vaporizers
constructed specifically for each agent. They are thus
'agent-specific'.
⚫ They are only calibrated for a single gas, usually with keyed
filters that decrease the likelihood of filling the vaporizers
with the wrong agent.
 Measured flow Vaporizer
⚫ Vaporizers are provided with various safety related
inter-locks which ensure that:
Only one vaporizer is turned on;
Gas enters only through the one which is on;
Trace vapour output is minimized when the
vaporizer is off;
Vaporizers are locked into the gas circuit, thus
ensuring that they
are seated correctly; and
Other important safety features are followed
including keyed
filters and secured mounting to minimize tipping
(tilting) which
may obstruct the working of the valves.
 Delivery System
⚫ Patient Breathing System: The function of a patient
breathing system is to deliver anesthetic and respiratory gases
to and from the patient. It describes both the mode of
operation and the apparatus by which inhalation agents are
delivered to the patient. The breathing system may be
⚫ Rebreathing Type: This refers to re-breathing of some or all
of the previously exhaled gases, including carbon dioxide
and water vapour.
 Delivery System
⚫ Non-rebreathing Type: In this a fresh gas supply is delivered
to the patient and re-breathing of previously exhaled gases
is prevented. Usually, non-rebreathing type systems are
applied in practice. This is achieved by using:
⚫ Non-rebreathing uni-directional valve;
⚫ Carbon dioxide absorption system; involving;
⚫ Uni-directional (circle) system; and
⚫ Bi-directional (to-and-fro) system.