ANAESTHESIA MACHINE

Training module to be used for pre-service

(students at JiT and Tegbare id) and in-service
training.
Getachew Alemu ( MA)
A.A Tegbareid BMET Coordinator
Mar.2014
Course Objectives:- At the end of the training
the trainee will be able to:
• Define anesthesia machine.
• Identify the main components of anesthesia
machine.
• Explain how each component of anesthesia
machine work.
• Apply preventive maintenance procedure of
anesthesia machine
• Troubleshoot anesthesia machine
 What is anesthesia machine?
• Anesthesia machine is a medical device
designed to provide an accurate and
continuous supply of medical gases (such as
oxygen and nitrous oxide), mixed with an
accurate concentration of anesthetic vapor
(such as isoflurane) to a patient
• It delivers the medical gases to a patient at a
safe pressure and flow. Modern machines
incorporate a ventilator, suction unit, and
patient-monitoring devices.
The primary functions of an anesthesia system are
to:
• Supply set mixtures of gases and anesthetic agent
vapors to the patient. This is to make sure the
patient is unconscious and free from feeling pain.
• Deliver levels of oxygen necessary to sustain life.
•Provide basic patient monitoring such as
measuring breathing rate and volume and the
percent of oxygen delivered to the patient
• Safely remove waste gas from the machine.
 Anesthesia Machine Components

– Frame
– Regulator
– Flowmeter
– Oxygen Flush Assembly
– Vaporizer
– Anesthetic Supply System
– Scavenging System
 ventilator
Flow
meter

bellow
vaporizer

Pressure
Breathing Oxygen Flash gage
circuits
Corrugated APL valve
tube

Scavenging
Soda lime system
 Drager Anesthesia machine
ventilator
Flow
meter
Breathing
circuits bellow
Corrugated vaporizer
tube
Pressure
gage
Oxygen Flash
Soda lime

Scavenging
system
– Frame
• Supports the
components
of the
anesthetic
machine
• Several styles
available
Drager Anesthesia machine
– Regulator
• Placed on O2 tanks to
decrease pressure from tank
• 2 types of tanks
–“E” Tanks
»650L @ 1800PSI
–“H” Tanks
»7100L @ 2200PSI
• Output pressure
adjusted with knob
– Flowmeter
• Controls the amount o of
air released into the
anesthetic circuit
• Calculation:
(Tidal volume - mL) x
(Breathes per minute) /
(1000mL/Liter)=
Liters Resp. per Minute
– Vaporizer
• Changes liquid agent to
a vapor
• Delivers the vapor into the moving
steam of oxygen in controlled amounts
• Must b e serviced to maintain accuracy
of delivery and safety
• Caution with refurbished models
Oxygen Flush Assembly
• High flow oxygen straight from O2
supply (45-50psi)
• Do not use while connected to
patient through tracheal tube
• Use to flush anesthetic gases from
circuit and minimize exposure
 Anesthesia machine systems
• High-Pressure system
• Intermediate system
• Low-Pressure system
• Scavenging system
• Breathing system
• Manual and automatic ventilation system
• Monitors
High, intermediate, and low pressure systems

Intermediat Low Pressure Circuit

High
e
 High Pressure System
• Receives gasses from the high pressure E
cylinders attached to the back of the
anesthesia machine. (2200 psig for O2,
745 psig for N2O)
• Consists of:
– Hanger Yolk (reserve gas cylinder
holder)
– Check valve (prevent reverse flow of
gas)
– Cylinder Pressure Indicator (Gauge)
– Pressure Reducing Device (Regulator)
• Usually not used, unless pipeline gas
supply is off
 E Size Compressed Gas Cylinders
Cylinder Oxygen Nitrous Oxide Carbon Dioxide Air
Characteristics

Color White Blue Gray Black/White

(green) (yellow)

State Gas Liquid and gas Liquid and gas Gas

Contents (L) 625 1590 1590 625

Empty Weight 5.90 5.90 5.90 5.90

(kg)

Full Weight (kg) 6.76 8.80 8.90

Pressure Full 2000 750 838 1800

(psig)
 Hanger Yolk: orients Hanger Yolk
and supports the
cylinder, providing a
gas-tight seal and
ensuring a
unidirectional gas
flow into the machine
 Index pins: Pin Index
Safety System (PISS)
is gas
specificprevents
accidental
rearrangement of
cylinders (e.g..
switching O2 and
N2O)
 Pressure Reducing Device
• Reduces the high and variable pressures found
in a cylinder to a lower and more constant
pressure found in the anesthesia machine (45
psig)
• Reducing devices are preset so that the
machine uses only gas from the pipeline (wall
gas), when the pipeline inlet pressure is 50
psig.
• This prevents gas use from the cylinder even if
the cylinder is left open (i.e. saves the cylinder
for backup if the wall gas pipeline fails)
 Pressure Reducing Device

• Cylinders should be kept closed routinely.

Otherwise, if the wall gas fails, the machine
will automatically switch to the cylinder
supply without the anesthetist being aware
that the wall supply has failed (until the
cylinder is empty too).
 Intermediate Pressure System
 Receives gasses from the
regulator or the hospital
pipeline at pressures of 40-55
psig
 Consists of:
– Pipeline inlet connections
– Pipeline pressure
indicators
– Piping
– Gas power outlet
– Master switch
– Oxygen pressure failure
devices
– Oxygen flush
– Additional reducing
devices
– Flow control valves
 Pipeline Inlet Connections

• Mandatory N2O and O2,

usually have air and
suction too
• Inlets are non-
interchangeable due to
specific threading as per
the Diameter Index
Safety System (DISS)
• Each inlet must contain
a check valve to prevent
reverse flow (similar to
the cylinder yolk)
 Oxygen Pressure Failure Devices
• Machine standard requires that an anesthesia
machine be designed so that whenever the
oxygen supply pressure is reduced below
normal, the oxygen concentration at the
common gas outlet does not fall below 19%
 Oxygen Pressure Failure Devices
• A Fail-Safe valve is present in the gas line
supplying each of the flow meters except O2.
This valve is controlled by the O2 supply
pressure and shuts off or proportionately
decreases the supply pressure of all other
gasses as the O2 supply pressure decreases
• Historically there are 2 kinds of fail-safe valves
– Pressure sensor shut-off valve (Ohmeda)
– Oxygen failure protection device (Drager)
 Pressure Sensor Shut-Off Valve
• Oxygen supply pressure opens the valve as long
as it is above a pre-set minimum value (e.g.. 20
psig).
• If the oxygen supply pressure falls below the
threshold value the valve closes and the gas in
that limb (e.g.. N2O), does not advance to its
flow-control valve.
Pressure Sensor Shut-Off Valve
 Oxygen Failure Protection Device (OFPD)
• Based on a proportioning principle rather than a shut-
off principle
• The pressure of all gases controlled by the OFPD will
decrease proportionately with the oxygen pressure
 Oxygen Supply Failure Alarm
• The machine standard specifies that whenever
the oxygen supply pressure falls below a
manufacturer-specified threshold (usually 30
psig) a medium priority alarm shall blow
within 5 seconds.
 Limitations of Fail-Safe Devices/Alarms

• Fail-safe valves do not prevent administration of a

hypoxic mixture because they depend on pressure
and not flow.

• These devices do not prevent hypoxia from accidents

such as pipeline crossovers or a cylinder containing
the wrong gas
 Oxygen Flush Valve (O2+)
• Receives O2 from pipeline inlet or cylinder
reducing device and directs high, unmetered
flow directly to the common gas outlet
(downstream of the vaporizer)
• Machine standard requires that the flow be
between 35 and 75 L/min
• The ability to provide jet ventilation
• Hazards
– May cause barotraumas
– Dilution of inhaled anesthetic
Oxygen Flush Valve (O2+)
 Second-Stage Reducing Device
• Located just upstream of the flow control
valves
• Receives gas from the pipeline inlet or the
cylinder reducing device and reduces it further
to 26 psig for N2O and 14 psig for O2
• Purpose is to eliminate fluctuations in
pressure supplied to the flow indicators
caused by fluctuations in pipeline pressure
 Low Pressure System

• Extends from the flow control valves to the

common gas outlet
• Consists of:
– Flow meters
– Vaporizer mounting device
– Check valve
– Common gas outlet
 Flowmeter assembly
 When the flow
control valve is
opened the gas
enters at the bottom
and flows up the tube
elevating the
indicator

 The indicator floats

freely at a point
where the downward
force on it (gravity)
equals the upward
force caused by gas
molecules hitting the
 Arrangement of the Flow-Indicator Tubes
• In the presence of a
flowmeter leak (either at the
“O” ring or the glass of the
flow tube) a hypoxic mixture
is less likely to occur if the O2
flowmeter is downstream of
all other flowmeters
• In A and B a hypoxic mixture
can result because a
substantial portion of oxygen
flow passes through the leak,
and all nitrous oxide is
directed to the common gas
outlet
• * Note that a leak in the
oxygen flowmeter tube can
cause a hypoxic mixture,
even when oxygen is located
in the downstream position
 Proportioning Systems

– Mechanical
integration of the
N2O and O2 flow-
control valves
– Automatically
intercedes to
maintain a minimum
25% concentration
of oxygen with a
maximum N2O:O2
ratio of 3:1
 Vaporizers
• A vaporizer is an instrument designed to
change a liquid anesthetic agent into its vapor
and add a controlled amount of this vapor to
the fresh gas flow

Ex. Of Anesthetic Agents

 Isoflurane
 Halothane
 Enflurane
 Sevoflurane
 Generic Bypass Vaporizer
• Flow from the
flowmeters enters the
inlet of the vaporizer
• The function of the
concentration control
valve is to regulate the
amount of flow through
the bypass and
vaporizing chambers
Splitting Ratio = flow
though vaporizing
chamber/flow through
bypass chamber
 Factors That Influence Vaporizer Output
• Flow Rate: The output of the vaporizer is
generally less than the dial setting at very low
(< 200 ml/min) or very high (> 15 L/min) flows
• Temperature: Automatic temperature
compensating mechanisms in bypass chambers
maintain a constant vaporizer output with
varying temperatures
• Back Pressure: Intermittent back pressure (e.g.
positive pressure ventilation causes a higher
vaporizer output than the dial setting)
 Cont…
• Atmospheric Pressure: Changes in
atmospheric pressure affect variable bypass
vaporizer output as measured by volume %
concentration, but not (or very little) as
measured by partial pressure (lowering
atmospheric pressure increases volume %
concentration and vice versa)
• Carrier Gas: Vaporizers are calibrated for 100%
oxygen. Carrier gases other than this result in
decreased vaporizer output.
 Oxygen Pressure Failure Devices
• A Fail-Safe valve is present in the gas line
supplying each of the flow meters except O2.
This valve is controlled by the O2 supply
pressure and shuts off or proportionately
decreases the supply pressure of all other
gasses as the O2 supply pressure decreases
• Historically there are 2 kinds of fail-safe valves
– Pressure sensor shut-off valve (Ohmeda)
– Oxygen failure protection device (Drager)
 Breathing system
A breathing system is defined as an assembly of
components which connects the patient’s airway to the
anaesthetic machine creating an artificial atmosphere,
from and into which the patient breathes.
It primarily consists of,
• A fresh gas entry port/delivery tube through which the
gases are delivered from the machine to the systems;
• A port to connect it to the patient’s airway;
• A reservoir for gas, in the form of a bag or a corrugated
tube to meet the peak inspiratory flow requirements;
• An expiratory port/valve through which the expired gas
is vented to the atmosphere;
• A carbon dioxide absorber if total rebreathing is to be
allowed and
• Corrugated tubes for connecting these components
 Requirements of a breathing system:
• The components when assembled should
satisfy certain requirements, some essential
and others desirable.
Essential:
• The breathing system must
• a) deliver the gases from the machine to the
alveoli in the same concentration as set and in
the shortest possible time;
• b) effectively eliminate carbon-dioxide;
• c) have minimal apparatus dead space; and
• d) have low resistance.
Breathing System
 Rebreating circuits
• Here the same gases are re-used, and CO2 is
removed by passage of the gas through soda
lime.
• A circle rebreathing circuit is composed of
– Carbon dioxide absorbing canister
– Y-piece
– Inhalation and exhalation breathing tubes
– Inhalation and exhalation unidirectional (one way)
valves
– Fresh gas inlet
– Pressure manometer
– pop-off valve
– A reservoir bag
 Non-rebreathing circuits
• With these, the patient breathes in from the
reservoir and out to atmosphere. The gases
are not re-used.
• However, in practical sense, this terminology
is incorrect because some rebreathing of
exhaled gases occurs in most of these systems,
especially with lower recommended flow
rates.
• Satisfactory elimination of CO2 is dependent
on adequate gas flow, and on minimal dead
space in the circuit.
 Scavenging Systems
• Protects the breathing
circuit or ventilator
from excessive positive
or negative pressure.
 Scavenging Systems
Consists:
• Anesthetic Gas
• Evacuating Gases
• Filtering Gases
– Anesthetic Supply System
• Breathing circuits
• Rebreathing
–Exhaled air is cleaned and reused with the
patient
• Non-rebreathing
–Exhaled air is taken by scavenging system
• Operational flow of typical anesthesia system:
 TROUBLESHOOTING ANESTHESIA MACHINE

• Anesthesia machines have evolved from simple,

pneumatic devices to sophisticated, computer-
based, fully integrated anesthesia systems.
• An anesthesia system consists of the various
components that communicate with each other
during the administration of inhalation
anesthesia.
 Troubleshooting…
• System components include the anesthesia
machine, the vaporizers, the anesthetic circuit,
the ventilator, and the scavenging system
• The flow control valves are an important
anatomical landmark because they divide the
anesthesia machine into two parts.
• The high-pressure circuit is that part of the
machine which is upstream from the flow control
valves, and the low-pressure circuit is that part of
the machine which is downstream from the flow
control valves.
 Troubleshooting…
• The operator regulates flow entering the low-pressure
circuit by adjusting the flow control valves.
• The oxygen and nitrous oxide flow control valves are
linked mechanically or pneumatically by a
proportioning system to help prevent delivery of a
hypoxic mixture.
• The flow travels through a common manifold and may
be directed to a calibrated variable-bypass vaporizer.
• Precise amounts of inhaled anesthetic can be added,
depending on the vaporizer setting.
• The total fresh gas flow travels toward the common gas
outlet
 Troubleshooting…
• The presence or absence of a check valve
profoundly influences which preoperative leak
test is indicated.
• The oxygen flush connection joins the mixed-
gas pipeline between the one-way check valve
and the machine outlet.
• Thus, the oxygen flush, when activated, has a
"straight shot" to the common outlet.
• The heart of the system is the mechanical
integration of the nitrous oxide and oxygen
flow control valves
 Troubleshooting …
8 Categories of check:
• Emergency ventilation equipment
• High-Pressure system
• Low-Pressure system
• Scavenging system
• Breathing system
• Manual and automatic ventilation system
• Monitors
 Troubleshooting…
• The best time to troubleshoot an anesthesia
machine is preoperatively, using appropriate
preoperative checks.
How to Perform a Leak Test
• A leak test is the basic troubleshooting
technique for diagnosing anesthesia systems.
Each time you use your anesthesia system, we
recommend you check for pressure leaks in the
machine and ensure that your waste-gas
evacuation system is working properly.
 Troubleshooting…
How to perform a basic 10-second leak test:
• Connect a rebreathing circuit and bag to your
machine as if you were about to perform a surgery.
• Close the Pop-Off Valve and cover the end of the
rebreathing circuit—where the E/T tube
connects—with your palm or finger.
• Push the oxygen flush button or turn the
flowmeter ON until the pressure gauge reads at
least 20 cmH2O.
• Turn the oxygen OFF and watch the pressure
gauge. If the reading drops rapidly (faster than 1
cmH2O per second), you have a leak.
 Troubleshooting…
• Check hoses, rebreathing bag, vaporizer inlet
and outlet, any mechanical fittings, and the
seals of the canister for leaks.
• When the pressure remains fairly constant,
with the flow meter turned OFF, your machine
can be considered leak free.
• With your thumb still over the y-piece, open
the Pop-Off Valve to ensure the gases have an
unobstructed path out of the evacuation
system.
 Troubleshooting …
• If you are unable to find a leak and your
patients continue to be light, there may be
issues with your vaporizer or scavenger
system.
• IMPORTANT: Never spray petroleum products
on your oxygen system.
• Solution: If you find a crack in CO2 absorbing
canister or the black tubing, change canister
or the black tubing
 Troubleshooting…
• If the leak is coming from the dome o-ring area,
check to see whether the o-rings are seated
incorrectly or cracked.
• Unscrew dome counterclockwise and slip o-ring
off dome. Inspect for cracks.
• If you don’t see any cracks, place o-ring on top
of dome and slide down evenly until it “snaps”
into place.
• Screw dome back into place clockwise until
tight. Perform leak test again.
 Troubleshooting …
• If the leak is coming from the inlet and outlet vaporizer
adaptors, they may not be seated properly.
• If the leak is coming from around the base of the Pop-Off
Valve, remove the valve, wrap Teflon tape on the
threads, and reinstall.
• If the leak is coming from around the rebreathing liter
bag, a common problem, check to see whether the bag
is cracked or has holes, if so, remove and replace.
• If the leak is coming from the rebreathing hoses, check
for cracks and if needed, replace.
• Retest to ensure no leaks persist.
• Problem: “I am unable to keep a patient down. I set the
vaporizer setting to 5% and my patient still begins to
wake up.”
 Troubleshooting…
• Troubleshoot by performing a leak test as above. If you
find no leaks, check your evacuation system. If there is an
imbalance between the positive and negative pressures in
your anesthesia system, the anesthetic agent may be
effectively removed from your system due to the vacuum
effect of the evacuation device.
• Check the vaporizer. It may not be outputting the
percentage indicated. When vaporizers fail, they usually
fail on the low side and rarely on the high side. But before
sending the vaporizer in for service, please check:
• Is the vaporizer is full of anesthetic?
• Are the manifold inlet and outlet adapters pressed snugly
onto vaporizer manifold?
• Is the vaporizer’s drain tightened down?
• Is the vaporizer fill cap tightened down?
• Solution: If your leak test shows bubbling, check for leak
sources as above.
 Troubleshooting…
• If you find the evacuation system is a problem,
you may need a waste-gas interface device to
balance the pressures, ensuring the anesthetic
agent is delivered to the patient and not sucked
out by the evacuation system.
• Problem: “ there is a leak somewhere between
oxygen tank and the flowmeter on the
anesthesia system, the high-pressure side of
the anesthesia system.”
• Troubleshoot by spraying Windex on the
fittings where you hear the sound. If you have a
leak, it will bubble.
 Troubleshoot …
• Here’s how:
• Turn flowmeter off.
• Turn oxygen tank on so you can watch the
pressure regulator rise.
• Turn oxygen tank off.
The pressure regulator should hold steady. If the
pressure begins to fall, you have a leak.
• Solution: Check the oxygen hose nut. If it is not
fully tightened, use a crescent wrench to fully
tighten.
 Troubleshooting…
• Check the oxygen flowmeter flow control
assembly to ensure it is not stuck in an open
position.
• If the ball floats and will not fall to zero, the meter
is stuck. Under normal circumstances, this requires
replacement of the flow control assembly.
• Problem: “The oxygen doesn’t seem to be flowing
or I cannot turn my oxygen off on my anesthesia
machine.”
• Troubleshoot by: Checking to make sure the
oxygen tank is on pushing on the oxygen flush to
ensure oxygen is flowing to the machine.
 Troubleshoot…
• Turning mechanical stop flow control and see if
ball moves up and down the flowmeter. See if ball
hovers above zero in the flowmeter. If not,
• Solution: If the oxygen flush and oxygen flowmeter
are not working and the oxygen tank has been
turned on and does have oxygen in it, the regulator
or the oxygen tank may need to be replaced.
• If the ball hovers above zero and does not come
to rest at the bottom of the flow tube, you will
need to replace the mechanical stop flow control
assembly. Contact us for further assistance.
 Troubleshoot…
• Problem: “My oxygen system is not working
correctly.”
• Troubleshoot by checking:
 The oxygen quick disconnects
The oxygen check valves in dual gas supply
The black tubing
The oxygen flush
For an oxygen leak from regulator
For improper or insufficient oxygen flush
For improper or insufficient metabolic oxygen
delivered to patient
 Troubleshoot…
• Solution: If no problem is apparent in any of
the above, yet you are getting either pressure
that is too high or too low, you may need to
replace the regulator. The oxygen regulator is
a medical grade, preset, non-adjustable
regulator designed to reduce oxygen tank
pressure from approximately 2100 psi (when
full) to approximately 50 psi. If pressure is
either too high or too low, your regulator may
have failed.
 Troubleshoot…
• Problem: “The needle on my monometer gauge
is not at zero.”
• Solution: The re-zero screw is located at the 12
o’clock position (top, dead-center) under the
crystal manometer cover.
• Remove cover by turning counterclockwise.
Adjust screw mechanism with small screwdriver
until needle is zeroed. Replace manometer cover.
• If manometer will not re-zero, or if needle will
not indicate proper pressure, manometer should
be replaced. Contact us for further assistance.
 Troubleshoot. . .
• Problem: “Low/High FiO2 concentration”
• Solutions:
 Check Air & Oxygen Supply if sufficient
 Look for possible leaks
 Perform two-point O2 sensor calibration
 Replace O2 cell with new one
 Acceptable variance – (+/- 5%
concentration)
 Troubleshoot. . .
• Problem: “High/Low Tidal Volume as per the
preset values”
• Solutions:
 Check medical gas if sufficient
 Look for possible leaks
 Clean the flow valves (Ins. & Exp. Valves)
 Perform flow sensor calibration
 Replace flow sensors
Thank You!!!