Anaesthesia workstation

Dr John P George
Moderator-Dr Amiya
Objectives
•Machine vs workstation ​
•Features of workstation ​
•Components of workstation ​
•Pressure systems​
• High pressure​
• Intermediate pressure​
• Low pressure​
•Machine checkout
Machine vs
Workstation
• Pneumatic component only
• First machine- Boyle’s Machine-
1917: Continuous flow type
machine for delivering
inhalational anaesthetic agents
• Pneumatic +Electrical and
Electronic components
• Integrated ventilator and
monitors
• Equipped with safety features to
prevent delivery of hypoxic gas
mixtures
Features of Anaesthesia workstation

• Deliver volatile anesthetic gas at precise concentrations.

• Individually meter oxygen and two or more other breathing gases,
and continuously enrich the inhaled gas with anesthetic vapor.
• Allow the patient to be ventilated manually (“bag” ventilation) with
adjustable breathing circuit pressure.
• Ventilate the patient mechanically, with sophisticated ventilator
modes comparable to the intensive care unit (ICU).
• Allow rebreathing of the exhaled anesthetic gases after removing
carbon dioxide.
• Eliminate (“scavenge”) excess gas from the patient’s breathing circuit
and remove this gas from the room.
• Prevent hypoxic gas mixtures caused by operator error or gas supply
failure.
• Provide a breathing circuit manual oxygen flush feature.
• Possess a backup supply of oxygen.
• Display gas pipeline and backup tank supply pressures.
• Provide an integrated platform for continuously measuring and
displaying anesthetic, hemodynamic, and respiratory parameters and
for collecting this data into an electronic medical record.
Components of workstation
• Electrical system
• Data communication system
• Pneumatic system
Electrical system

1. Master Switch
2. Power failure indicator
3. Reserve Power
4. Electrical Outlets
5. Circuit breakers
Master Switch
• A master (main power) switch
activates both the pneumatic
and electrical functions.
• On most machines, when the
master switch is in the OFF
position, the only electrical
components that are active are
the backup battery charger and
the electrical outlets.
Power Failure Indicator:
• Most machines are equipped with a visual and/or
audible indicator to alert the anesthesia provider to
the loss of mains electrical power
Clinical Moments:
• If the power indicator shows loss of mains electrical
power or that the battery is in use, first check that
the power line has not become loose or
disconnected. Do what you can to conserve electrical
energy until the problem is fixed.
 Reserve Power:

• Since electricity is crucial for most anesthesia machines, a backup

source is provided. Generally, this will provide power for 30 minutes,
depending on usage.
• A non interruptible power source may be added to the anesthesia
machine to extend the backup period.
Electrical Outlets
• Most modern anesthesia machines have electrical outlets at the back
of the machine. These are intended to power monitors and other
anesthesia devices. They usually cannot supply electricity if there is a
power failure.

• These outlets should not be used to power anything other than

anesthesia devices and must not be used to power other devices such
as operating room tables, floor vacuums, or electrosurgical units.
Circuit breakers
• To protect from overcurrent or short circuit
Data communication system
• Function :To transfer Information from monitors to data
entry/management system (AIMS)
II. Pneumatic components
High
Pressure
System

Intermediate
Pressure
System

Low
Pressure
System
PRESSURE SYSTEMS

High
• - Confined to cylinders and cylinder primary pressure regulators
• O2 – 2200 psig 45psig
• N2O – 750 psig 45 psig
Intermediate
• - Begins at pressure regulated cylinder supply source at 45 psig, include the
pipeline source of 50-55 psig and extends to flow control valves
Low
• - Extends from the flow control valves to the common as outlet
• (5-8 Psig) Just above atmospheric pressure and variable
 50-60 Psig

O2 2200→ 45 Psig
N2O 750→45 Psig
1. High Pressure System –
Receives gases from cylinders at high, variable pressures and reduces those pressures to a lower, more
constant pressure suitable for use in the machine.

Cylinder Pressure
Check valves Gauge (Indicator)
Cylinder- Hanger
yoke assembly

Pressure
Regulator
 -Seamless (No Joints in cylinder)–
to Withstand high pressure inside.
Cylinders Initially made of forged steel (lower
tensile strength, therefore required
thicker walls and hence heavier and
carried less volume) now replaced
by

Molybdenum:
High Tensile strength
Light weight, 20% more volumeof
gas

- Aluminium cylinders for

MRI suites.

3AA- Steel
3AL or 3ALM - Aluminium
OXYGEN CYLINDER NITROUS CYLINDER
1949

New International
Color coding from
2010- Not followed
in India yet
Safety Feature of Cylinders
• 1. Made of Molybdenum steel – high tensile strength
• 2. Colour coding
• 3. Seamless body
• 4. Safety relief valve
• 5. Pin index safety system
Pin Index Safety System- Philip Woodbridge
(1952)
Pressure relief device
• For venting of high pressure gases from inside the cylinder (safety
system).
• Types:
• -Rupture disc – copper
• -Fusible plug not reusable
• -Combination of both
• -Pressure relief valve(spring loaded)-reusable
Fusible Plug
• Made of Woods Alloy-
• - Cadmium
• - Bismuth
• - Lead
• - Tin
• - (Melts at 150-170 deg)
 Hanger Yoke Assembly:

• The hanger yoke orients and supports the cylinder, provides a gas-tight seal, and
ensures a unidirectional gas flow.
• It is composed of several parts:
• The body, which is the principal framework and supporting structure;
• A retaining screw, which tightens the cylinder in the yoke;
• A nipple, through which gas enters the machine;
• Pin Index Safety System pins which prevent an incorrect cylinder from being
attached;
• A washer, which helps to form a seal between the cylinder and the yoke also
known as Gasket or Bodock seal;
• A filter to remove particulate matter that could come from the cylinder.
Bodock Seal
• Made of neoprene rubber and
aluminum rim
• Provides air tight seal between
cylinder and yoke assembly
• Only one to be used –more than
one nullifies Pin index safety
system
Hanger Yoke Assembly
Functions of Hanger Yoke Assembly
• Supports and orients the cylinder to this machine.
• Maintains leak proof connection between cylinder and the machine.
• Maintains unidirectional flow of gases towards the machine.(check
valve)
Mounting a cylinder
Cylinders
Should be
opened
Slowly.
Why?
Check Valve

• The check valve allows gas from a cylinder to enter the machine but
prevents gas from exiting the machine when there is no cylinder in
the yoke.
• It allows an empty cylinder to be replaced with a full one, without
losing gas from other cylinders of the same gas that are open or from
the intermediate pressure system.
• The check valve also prevents gas from being transferred from a
cylinder with a higher pressure to another one with a lower pressure
when both are connected to a double yoke and opened at the same
time.
• A yoke should not be left vacant. As soon as a cylinder is exhausted, it
should be replaced by a full one. If a full cylinder is not available, a
yoke plug (dummy cylinder block or plug, blanking cap or plug) should
be placed in the empty yoke.
• The yoke plug is a solid piece of metal which fits over the nipple.
• When in place, the plug forms a seal to prevent the gas from escaping
from the machine. Manufacturers often chain yoke plugs to the
machine.
• Cylinder valve and yoke not be contaminated with oil or grease, because this
could cause a fire .

• The yoke should be checked for the two Pin Index Safety System pins are
present. A missing pin could allow the safety system to be bypassed.

• After the cylinder has been tightened onto the yoke, it should be opened to
make certain that the cylinder is full and that there is no leak (as evidenced
by a hissing sound). The most common cause of a leak is a defective or
missing washer. If the cylinder valve leaks or is difficult to operate, the
cylinder should be returned to the supplier.
• After the cylinder has been attached to the yoke, the valve should be
closed unless it is to be the primary gas supply for the machine.
• If the pipeline is the primary supply and the valve remains open,
fluctuations in the gas pressure in the machine could allow some or
all of the gas to exit the cylinder.
• In the event that pipeline pressure is lost, gas could be used from the
cylinder without the user being aware of the change. The first time
that the user becomes aware of the lost pipeline pressure could be
when the cylinder becomes empty.
 iii) Cylinder Pressure Gauge (Indicator):

• Many cylinder pressure gauges (indicators) are the Bourdon tube (Bourdon spring, elastic
element) type.
• A hollow metal tube is bent into a curve and then sealed and linked to a clocklike mechanism.
The other end is connected to the gas source.
• An increase in gas pressure inside the tube causes it to straighten. As the pressure falls, the
tube resumes its curved shape. These motions are transmitted to the indicator, which moves
over a calibrated scale.
• A drawback of these mechanical pressure gauges is that their readings cannot be transferred
to a data management system.
• Most new anesthesia machines indicate cylinder pressure digitally.
• Light-emitting diodes may also be used to indicate adequate pressure in the cylinder.
Bourdon’s Pressure Gauge
Led indicators for cylinder pressure
Cylinder valve
open and
pressure
adequate- green

Valve open and

pressure
inadequate- red
iv) Pressure Regulator:

• A pressure regulator reduces the high and variable pressure delivered from a cylinder to a
lower, more constant pressure suitable for use in an anesthesia machine.
• Without a regulator, it would be necessary for the anesthesia provider to constantly alter
the flow control valve to maintain a constant flow through the flowmeter as the pressure in
the cylinder decreases.

• The pressure at the regulator outlet is set lower than the pipeline pressure.
• This ensures that pipeline gas is used preferentially to the cylinder supply if the cylinder
valve is open while oxygen from the piping system is being used. This differential pressure
may not always prevent the cylinder from becoming exhausted since pressure fluctuations
in the pipeline may cause the pressure in the machine to drop below the pressure from the
pressure regulator.
• Principle- Pc x A1 = Pr x A2
• High pressure(Pc) over a small area(A1) is balanced by a
low pressure(Pr) over a large area(A2)
DIRECT PRESSURE REGULATOR

• Cylinder pressure tends to open valve seat A1

Forces acting to push down diaphragm-
• Pressure from cylinder(Pc x A1)
• Force exerted by spring S1 varied by adjusting
screw(FS1)
Forces acting to resist this
• Pr x A2
Sealing spring S2 resists opening of valve seat A1
At equilibrium,
Pc x A1 + (FS1-FS2) = Pr x A2
• As adjustable screw is screwed in, valve seat A1 opens and gas enters
from cylinder C to chamber R and a new equilibrium is attained
• Pressure at outlet is given by
Pr=Pc xA1/A2 + (FS1- FS2)/A2
• FS1>>Pc and The value of Fs2 is considerably smaller than Fs1 so
that (Fs1 – Fs2) is large compared with Pc, and Pr will
remain relatively constant despite variations in Pc.
Indirect pressure regulator
• Cylinder pressure tends to close
valve seat A1- so Pc tends to
decrease force on diaphragm
Forces acting down on diaphragm
• FS1-FS2
Forces resisting this
• Pc x A1 + Pr x A2
• As adjustable screw is screwed in, valve seat area A1 opens and
gas enters from cylinder C to R and a new equilibrium is attained
• Pressure at outlet is given by
• Pr= (FS1- FS2)/A2 - (Pc x A1/A2)
 INTERMEDIATE PRESSURE SYSTEM
• The Intermediate –pressure system extend from the pipelines or from stepped –down input from
the E-cylinders and extends up to the flow control valves.
• It receives gases from the pressure regulator or the pipeline inlet at 40-55 psig
• Includes:
• Pneumatic component of master switch
• Pipeline inlet connections
• Pipeline pressure indicators
• Piping
• Oxygen pressure failure devices
• Oxygen flush
• Additional pressure regulator(second stage pressure regulator)
• Flow control valves
• Alternative(Auxiliary) oxygen source
• .
 Master
switch(pneumatic)
• The pneumatic portion of the master switch is
located in the intermediate pressure system
downstream of the inlets for the cylinder and
pipeline supplies.
• The Oxygen flush is usually independent of this
switch .
• When the master switch is turned off , the
pressure in the intermediate pressure system
will drop to zero.
Quick couplers
Pipelines have couplers to
connect to the source.
These are color coded and
have pins in different
configurations.
Quick couplers utilize pins and
corresponding slots on the
male & female ends,
respectively.
Quick couplers
PIPELINE INLET CONNECTIONS
 PIPELINE INLET CONNECTIONS

DISS is a threaded connection

in which the diameter and
shape of each thread is
specific for each gas.
NIST(NON INTERCHANGABLE SCREW
THREADS) CONNECTORS
• Followed in UK
Pipeline Pressure Indicators
Oxygen Failure Safety Devices
 Oxygen Failure Safety Devices
Pressure Sensor Shut Off Valve
• Based on threshold principle
• Cuts off N2O supply when O2
pressure falls below 25 psi.
• MOA-O₂ pressurises and holds
open shut off valve . It interrupts
the supply of N2O and other
gases if O2 pressure < threshold
setting.
Oxygen supply Failure Protection
Device
 Based on proportioning
principle
 Gas loaded regulator
 When O₂ pressure
decreases there is a
proportional decrease
in N2O supply and
complete cut off seen
at<12psi.
 MOA-O₂ pressure
regulator(primary
regulator) controls
secondary(slave)
regulator located in
N₂O line
Oxygen Supply Failure Alarm
Oxygen Flush valve (O2+)
Oxygen Flush valve (O2+)
Alternative Oxygen Control
Second stage pressure regulator
• Present only in ge machines
• Upstream of failsafe valve
• Maintain more constant flow to flow meters esp when there are
fluctuations in pipeline/cylinder pressures
• Differential pressure reduction-
O2-14psi
N20- 26psi
• In drager machines ,no SSPG –only flow restrictors- based on Bernoulli's
theorem- as gas passes through a narrower tube velocity increase is
assosciated with a decrease in static pressure
 Flow control valves

• The mechanical flow control

valves utilizes a stem with fine
threads that when turned
clockwise will move inward to
decrease or stop gas flow
• When turned counterclockwise
the stem will move outward to
increase the gas flow .
Flow control valves
 LOW
PRESSURE
SYSTEM
 LOW PRESSURE SYSTEM
• Extends from the flow control valves to the
common gas outlet
• Consists of:
• - Flow meters
• - Hypoxia prevention safety devices
• - Unidirectional valve
• - Pressure relief devices
• - Common gas outlet
• - Vaporizers and their mounting devices
 FLOW CONTROL ASSEMBLIES
MECHANICAL
 When the flow control valve is opened the gas
enters at the bottom and flows up the tube
elevating the indicator
 Transparent flow tube known as a variable
orifice flowmeter or Thorpe tube.
 Thorpe Tube is made up of Pyrex glass,
transparent, nonconducting material .
 It is conical in shape ,tapered vertically with
smallest diameter at the bottom

 INDICATOR ( FLOAT OR BOBBIN)

 It is light weight , made up of aluminium .It
contains antistatic material to prevent sticking to
wall of flowmeter .
 The indicator floats freely at a point where the
downward force on it (gravity) equals the
upward force caused by gas molecules hitting
the bottom of the float
FLOW CONTROL ASSEMBLIES
 High flow- annular space behaves like
orifice-turbulent flow- flow
Low flow vs high flow predominantly depends on gas
density (Grahams Law)

The space between tube and

head float can be considered
equivalent to a annular space
having same cross sectional
area
Clinical implication?
Low flow –annular
space behaves like
tubular opening-
laminar flow-flow
depends on gas
viscosity(Hegan-
Poiseuille Law)
 FLOW CONTROL ASSEMBLIES

The knobs are specifically

designed for each gas.
This is a safety feature to
assist in low light
conditions.
ELECTRICAL FLOW
SENSORS
• Based on hotwire anemometers,
differential pressure transducer ,
mass flow sensors etc.
• As gas flows through a heated
chamber of known volume, a specific
amount of electricity is required to
maintain the chamber temperature.
The amount of energy required to
maintain the temperature is
proportional to the flow and specific
heat of the gas.
Digital representation
of electronic
flowmeters
 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
AUXILLARY OXYGEN FLOWMETER
ANTI HYPOXIA DEVICES
Hypoxia Prevention Safety Devices
Hypoxia Prevention Safety Devices
Hypoxia Prevention Safety Devices
 Hypoxia Prevention Safety Devices
PNEUMATIC [ ORMC ( DRAGER ) /
SORC]

• Oxygen ratio monitor controller

• Sensitive oxygen ratio controller
• Linear resistors (3:1 ratio for N₂O & O₂)between O₂ and N₂O flow
control valves.

• Ensure 25% O₂ by limiting N₂O flow.

• ORMC shuts off N₂O if ratio of O₂ flow falls below 30%.

 Hypoxia Prevention Safety Devices

ELECTRONIC

 Electronic devices e.g.PENLON use a paramagnetic

oxygen analyser to continuously sample the gas mixtures
from the flowmeters .
 In this the nitrous oxide gets temporarily shut off when
the inspired fraction of oxygen (FiO2 ) decreases below
0.25, while a increase in the FiO2 will temporarily start
the nitrous oxide flow .
UNIDIRECTIONAL (CHECK) VALVE
PRESSURE RELIEF VALVE
COMMON (FRESH) GAS OUTLET

101
COMMON GAS OUTLET
• Some new anesthesia machines provide two common
gas outlets.
• The anesthesia workstation standard states that there shall
be only one functional common gas outlet at a time (7).
• An interlock prevents both outlets from being inadvertently
operative at the same time
• The common gas outlet should not be used to administer
supplemental oxygen to a patient
PRE-ANESTHESIA CHECKOUT PROCEDURES
 Workstation checkout procedure

• 1. Verify Auxiliary Oxygen Cylinder and Self- Inflating Manual

Ventilation Device Are Available and Functioning

 2. Verify Patient Suction Is Adequate to Clear the Airway

3.Turn on Anesthesia Delivery System and Confirm That AC

Power Is Available.
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• 4.Verify Availability of Required Monitors and Check Alarms
• Monitoring supplies ( BP cuffs of appropriate sizes, pulse oximetry probes, ECG and capnography )

 5.Verify That Pressure Is Adequate on the Spare Oxygen Cylinder Mounted on the
Anesthesia Machine

 6.Verify That Pipeline Gas Pressures Are 50 psig or Higher

106
• 7.Verify That Vaporizers Are Adequately Filled and, If Applicable, That
the Filler Ports Are Tightly Closed
• Check of their machine’s vaporizer interlock system ,which , if
present , prevent more than one vaporizer from being activated
simultaneously.

107
• 8.Verify That No Leaks Are Present in the Gas Supply Lines Between
the Flowmeters and the Common Gas Outlet
• Universal Leak Test- Negative pressure relief test
• It is Highly sensitive, detecting leaks as small as 30 mL/min

108
• Positive pressure relief test cannot be used to detect leaks in
machines with outlet check valve as it can only detect leaks upto the
check valve and may miss any leaks upstream i.e from vaporisers
• Flow control valves fully closed- suction bulb repeatedly squeezed
until it is fully collapsed- It should remain deflated in a system without
leak
• If leak+, it will draw in air through the leak to the bulb
 9. Test Scavenging System Function

 Evaluation of scavenging system is a manual maneuver.

 No automated checks are conducted.
 A test of the scavenging system begins by checking the proper assembly and integrity
of each component and connection within the system

111
• 10. Calibrate, or Verify Calibration of, the Oxygen Monitor and
Check the Low Oxygen Alarm
Manually setting the low oxygen concentration alarm limit to
more than 21% while exposing the analyzer to room air,
generating the alarm condition

• 11. Verify Carbon Dioxide Absorbent Is Not Exhausted- Using

Capnography(Inspired CO2 fraction) and not colour change of
absorbant

112
 • 12. Breathing System Pressure and Leak Testing
• Machine switched to bag mode- Gas flows set to zero- APL valve
fully closed Occlude patient end(Y-piece) and O2 flush used
to pressurise system upto 30 cm water-Circuit passes the leak test if it
holds this pressure for atleast 10 s
• M/C location of leak- Absorber canister

• APL Valve function can also be assessed during this time-Opening it

widely after pressure test would cause system pressure to decrease
rapidly to zero
12. Breathing System Pressure and Leak Testing

114
13. Verify That Gas Flows Properly Through the
Breathing Circuit During Both Inspiration and Exhalation
• Test of circuit flow is accomplished by placing a “test lung” or an extra
breathing bag at the patient Y-piece.
• In the “bag” or a manual mode of ventilation, the operator ventilates
the artificial “lung” with the breathing bag, then actively “exhales”
(squeezes) the test lung back to the breathing bag in a to-and-fro
motion. This is the so-called flow test.

115
14. Document Completion of Checkout
Procedures

117
15.Confirm ventilator settings and evaluate readiness to deliver
anaesthesia care

• Monitors functional?
• Capnogram present?
• Oxygen saturation by pulsoximetry measured?
• Flowmeter ventilator settings proper?
• Manual/ventilator switch set to manual?
• Vaporizers adequately filled?
The MS MAIDS checklist

119