SECTION  II Equipment

6
CHAPTER

Vaporizers
Jerry A. Dorsch, MD

The vapor pressures of most modern inhalation anesthetic agents at room are calibrated using O2 as the carrier gas. Usually, little change in output
temperature are much greater than the partial pressure required to pro- occurs if air is substituted for O2. Addition of N2O to the carrier gas typi-
duce anesthesia (Table 6-1). To produce clinically useful concentrations, a cally results in both temporary and long-lasting effects on vaporizer output.
vaporizer must bring about dilution of the saturated vapor. The total gas The temporary effect is usually reduced vapor concentration. The duration
flow from the flowmeters goes through the vaporizer, picks up a predict- depends on the gas flow rate and on the volume of liquid in the vaporizer.
able amount of vapor, and then flows to the common gas outlet. A single The longer-term effect may be increased or decreased output concentration,
calibrated knob or dial is used to control the concentration of the agent. depending on the construction of the vaporizer.
At low barometric pressure (higher altitudes), variable-bypass
concentration-calibrated vaporizers will deliver approximately the same
Concentration-Calibrated Vaporizers anesthetic partial pressure but increased concentrations measured in vol-
All vaporizers in common use today in developed countries are calibrated ume percent. At high barometric pressure (as in a hyperbaric chamber),
by the output concentration, expressed in volume percent. This is known these vaporizers deliver decreased output measured in volume percent
as a concentration-calibrated (variable bypass, direct-reading) vaporizer. because the vapor pressure of the agent is affected only by temperature
The American Society for Testing and Materials anesthesia workstation
standard requires that all vaporizers on the anesthesia workstation be
concentration calibrated. In addition, all vaporizer control dials must turn
counterclockwise to increase the output concentration. These vaporizers
must be placed between the flowmeters and the outlet on the anesthesia
machine.
Concentration calibration may be accomplished by splitting the flow of
gas that passes through the vaporizer. Some gas passes through the vapor-
izing chamber (the part of the vaporizer containing the liquid anesthetic
agent), and the remainder goes through a bypass to the vaporizer outlet
(Figure 6-1). The ratio of bypass gas to the gas flowing to the vaporizing
chamber is called the splitting ratio and depends on the resistances in the two
pathways. It also depends on the setting of the concentration dial that
allows more gas to pass through the vaporizing chamber as higher output
concentrations are set. The splitting ratio may also depend on the total
gas flow through the vaporizer. Another method of controlling the outlet
concentration is to direct enough carrier gas to flow through the vaporizing
chamber to achieve the concentration set on the vaporizer. This is deter-
mined by a computer.
In many concentration-calibrated vaporizers, the composition of the
carrier gas affects vaporizer output (vaporizer aberrance). Most vaporizers

Figure 6-1  A schematic of a variable bypass vaporizer. Oxygen, air, or both

O2 and air flow into the inlet, and a small amount is diverted into the vaporiz-
ing chamber—the concentration valve and a temperature compensation valve
Table 6-1  Vapor Pressure of Inhaled Anesthetic Agents at 20° C
control the amount that is diverted. As the gas flowing through the vaporizing
Anesthetic Agent Vapor Pressure, mm Hg chamber absorbs the inhalation agent, the temperature of the liquid drops.
To maintain a constant output of the inhalation agent, the temperature
Isoflurane 239
compensation valve diverts more gas into the vaporizing chamber. Conversely,
Sevoflurane 160 if the room temperature were to rise—and, therefore, the temperature of the
entire vaporizer, the valve would move to the left, and less gas would be
Desflurane 664
diverted into the vaporizing chamber.

11
7  Vaporizers
and not by ambient pressure. The partial pressure and clinical effects
remain relatively unchanged.
Vaporization Methods
Flow Over
In a flow-over vaporizer, carrier gas passes over the surface of the liquid.
Increasing the area of the carrier gas-liquid interface can enhance the
efficiency of vaporization. This can be done using baffles or spiral tracks
to lengthen the pathway of the gas exposed to the liquid. Another method
is to use wicks with their bases in the liquid. The liquid moves up the
wicks by capillary action.
Bubble Through
Another way to increase contact between the carrier gas and the volatile
liquid is to bubble the gas through the liquid. The gas may break up into
small bubbles, further increasing the gas-liquid interface.
Injection
Some vaporizers control the vapor concentration by injecting a known
amount of liquid anesthetic agent (from a reservoir in the vaporizer or from
the bottle of agent) into a known volume of gas.
Temperature Compensation
When a liquid is vaporized, energy, in the form of heat, is lost. The vapor
pressure decreases as the temperature of the liquid drops. Three methods
have been employed to maintain a constant vapor output with fluctuations
in liquid anesthetic temperature.
Thermostatic Compensation
Most concentration-calibrated vaporizers compensate for changes in vapor
pressure with temperature by altering the flow of carrier gas through the
12
vaporizing chamber. This is accomplished by changing the splitting ratio.
In mechanical vaporizers, a thermostatic element performs this function
by increasing resistance to the bypass gas flow, allowing more gas to
flow through the vaporizing chamber when the vaporizer cools.
Computer Controlled
In electronic vaporizers, gas flow is controlled by a computer that alters
the flow of carrier gas through the vaporizing chamber to maintain the
set output concentration.
Supplied Heat
An electric heater can be used to supply heat to a vaporizer and maintain
it at a constant temperature. Desflurane vaporizers (Tec 6, Datex-Ohmeda,
GE Healthcare, Helsinki, Finland; Dräger Vapor-D, Telford, PA; and
Penlon Sigma Alpha, Abingdon, UK) present unique problems for vapor-
izer design. The low boiling point (22.8° C) of desflurane makes the volume
of gas delivered by either a measured-flow or a variable-bypass vaporizer
unpredictable. The Ohmeda Tec 6 vaporizer pressurizes the liquid desflu-
rane to 1500 mm Hg and warms it to around 40° C. It delivers a flow of
pure saturated gas to the bypass gas. The amount of vapor that is delivered
to the bypass gas will depend on the concentration selected on the concen-
tration dial and the fresh gas flow.
Suggested Readings
Andrews JJ. Delivery systems for inhaled anesthetics. In: Barash PG, Cullen BF,
Stoelting RK, eds. Clinical Anesthesia. 3rd ed. Philadelphia: Lippincott-Raven;
1997:535-572.
Dorsch JA, Dorsch SE. Vaporizers (anesthetic agent delivery devices). In: Dorsch JA,
Dorsch SE, eds. Understanding Anesthesia Equipment. 5th ed. Baltimore:
Williams & Wilkins; 2008:121-190.
Sezdi M, Akan A, Tank F. Anesthetic gas concentration changes related to the
temperature and humidity in high and low flow anesthesia. Conf Proc IEEE
Eng Med Biol Soc. 2009;2009:877-880.