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ANESTHESIA MACHINE AND CIRCUIT

Portal to the Respiratory System
  • Author Footnotes
    * Department of Anesthesiology, University of California–Irvine, UCI Medical Center, Orange, California
    Randall L. Goode
    Footnotes
    * Department of Anesthesiology, University of California–Irvine, UCI Medical Center, Orange, California
    Search for articles by this author
  • Author Footnotes
    * Department of Anesthesiology, University of California–Irvine, UCI Medical Center, Orange, California
    Peter H. Breen
    Footnotes
    * Department of Anesthesiology, University of California–Irvine, UCI Medical Center, Orange, California
    Search for articles by this author
  • Author Footnotes
    * Department of Anesthesiology, University of California–Irvine, UCI Medical Center, Orange, California
      The first practitioners of modern anesthesia needed a machine to deliver accurate volumes of anesthetic gases, including O2, N2O, cyclopropane, ether, chloroform, and volatile inhalational agents. The first such machine appeared in 1905.
      • Dorsch J.A.
      • Dorsch S.E.
      Since then, the anesthesia machine has become more complicated, with greater attention to safety. There are many reports of malfunctioning components of the anesthesia machine leading to potential patient morbidity.
      • Berman L.S.
      • Pyles S.T.
      Capnographic detection of anaesthesia valve malfunctions.
      • Dean H.N.
      • Parsons D.E.
      • Raphaely R.C.
      Case report: Bilateral tension pneumothorax from mechanical failure of anesthesia machine due to misplaced expiratory valve.
      • Eger E.I.
      • Hylton R.R.
      • Irwin R.H.
      • Guadagni N.
      Anesthetic flow meter sequence—a cause for hypoxia.
      • Gordon P.C.
      • James M.F.
      • Lapham H.
      • Carboni M.
      Failure of the proportioning system to prevent hypoxic mixture on a Modulus II Plus anesthesia machine.
      • Karis J.H.
      • Menzel D.B.
      Inadvertent change of volatile anesthetics in anesthesia machines.
      • Kumar A.Y.
      • Bhavani-Shankar K.
      • Moseley H.S.L.
      • Delph Y.
      Inspiratory valve malfunction in a circle system: Pitfalls in capnography.
      • Pyles S.T.
      • Berman L.S.
      • Modell J.H.
      Expiratory valve dysfunction in a semiclosed circle anesthesia circuit—verification by analysis of carbon dioxide waveform.
      • Rosewarne F.A.
      • Wells D.
      Three cases of valve incompetence in a circle system.
      In 1984, Buffington et al
      • Buffington C.W.
      • Ramanathan S.
      • Turndorf H.
      Detection of anesthesia machine faults.
      asked 190 anesthesia meeting attendees to identify five intentional faults in a standard anesthesia machine. Only 3.4% of participants found all five faults, and 7.3% found no faults. In a rigorous attempt to standardize the design and construction of anesthesia machines in order to decrease morbidity and mortality, the American National Standards Institute (ANSI) published a standard for anesthesia machines in 1979.
      • American National Standards Institute
      The ANSI standard directed the design of specific features of the anesthesia machine that decrease the likelihood of misconnections or other misuse. In 1988, the ANSI standard was superseded by the American Society for Testing and Materials (ASTM) standard,
      • American Society for Testing and Materials
      which has become the design reference for anesthesia machines in the 1990s.
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      References

        • Albrecht W.H.
        • Dryden G.E.
        Five-year experience with the development of an individually clean anesthesia system.
        Anesth Analg. 1974; 53: 24-28
        • American National Standards Institute
        Minimum Performance and Safety Requirement for Components and Systems of Continuous Flow Anesthesia Machines for Human Use (ANSI Z-79.8.). ANSI, New York1979
        • American Society for Testing and Materials
        Specification for Minimum Performance and Safety Requirements for Components and Systems of Anesthesia Gas Machines (ASTM F-1161-88). ASTM, Philadelphia1988
        • Andrews J.J.
        Anesthesia systems.
        in: Barash P.G. Cullen B.F. Stoelting R.K. Clinical Anesthesia. ed 2. JB Lippincott, Philadelphia1992
        • Andrews J.J.
        Inhaled anesthetic delivery system.
        in: Miller R.D. Cucchiara R.F. Miller Jr, E.D. Anesthesia. Churchill Livingstone, New York1994
        • Andrews J.J.
        • Johnston Jr, R.V.
        • Bee D.E.
        • et al.
        Photodeactivation of ethyl violet: A potential hazard of sodasorb.
        Anesthesiology. 1990; 72: 59
        • Ayres P.
        Endotracheal anesthesia for babies. Special reference to hare-lip and cleft palate operations.
        Anesth Analg. 1937; 16: 330-333
        • Ayres P.
        The T-piece technique.
        Br J Anaesth. 1956; 28: 520
        • Berman L.S.
        • Pyles S.T.
        Capnographic detection of anaesthesia valve malfunctions.
        Can J Anaesth. 1988; 35: 473-475
        • Bonsu A.K.
        • Stead A.L.
        Accidental cross-connection of oxygen and nitrous oxide in an anaesthetic machine.
        Anaesthesia. 1983; 38: 767-769
        • Bowie E.
        • Huffman L.M.
        The Anesthesia Machine: Essentials for Understanding. Ohmeda, Madison, WI1985
        • Breen P.H.
        • Jacobsen B.P.
        co2 spirogram (but not capnogram) detects leaking inspiratory valve in circle circuit.
        Anesth Analg. 1997; 85: 1372-1376
        • Brown E.S.
        • Bakamjian V.
        • Seniff A.M.
        Performance of absorbents: Effect of moisture.
        Anesthesiology. 1959; 20: 613-617
        • Buffington C.W.
        • Ramanathan S.
        • Turndorf H.
        Detection of anesthesia machine faults.
        Anesth Analg. 1984; 63: 79-82
        • Calverley R.K.
        A safety feature for anaesthetic machines—touch identification of oxygen flow control.
        Can Anaesth Soc J. 1971; 18: 225-229
        • Cicman J.
        • Himmelwright C.
        • Skibo V.
        • Yoder J.
        Operating Principles of Narkomed Anesthesia Systems. North American Drager, Telford, PA1993
        • Conway C.M.
        Anaesthetic breathing systems.
        Br J Anaesth. 1985; 57: 649-657
        • Cote C.J.
        Pediatric breathing circuits and anesthesia machines.
        Int Anesthesiol Clin. 1992; 30: 51-61
        • Cotter S.M.
        • Petros A.J.
        • Barber N.D.
        • White D.C.
        Cost of low flow anaesthesia.
        Br J Anaesth. 1991; 66: 408P-409P
        • Davis R.
        Soda lime dust.
        Anaesth Intensive Care. 1979; 7: 390
        • Dean H.N.
        • Parsons D.E.
        • Raphaely R.C.
        Case report: Bilateral tension pneumothorax from mechanical failure of anesthesia machine due to misplaced expiratory valve.
        Anesth Analg. 1971; 50: 195-198
        • Dorsch J.A.
        • Dorsch S.E.
        Understanding Anesthesia Equipment: Construction, Care and Complications, ed 3. Williams & Wilkins, Baltimore1994
        • Eger E.I.
        • Hylton R.R.
        • Irwin R.H.
        • Guadagni N.
        Anesthetic flow meter sequence—a cause for hypoxia.
        Anesthesiology. 1963; 24: 396
        • Gaughan S.D.
        • Benumof J.L.
        • Ozaki G.T.
        Can an anesthesia machine flush valve provide for effective jet ventilation?.
        Anesth Analg. 1993; 76: 800-808
        • Gilmour I.J.
        • Boyle M.J.
        • Rozenberg A.
        • Palahniuk R.J.
        The effect of heated wire circuits on humidification of inspired gases.
        Anesth Analg. 1994; 79: 160-164
        • Gordon P.C.
        • James M.F.
        • Lapham H.
        • Carboni M.
        Failure of the proportioning system to prevent hypoxic mixture on a Modulus II Plus anesthesia machine.
        Anesthesiology. 1995; 82: 598-599
        • Hertz G.E.
        • Anderson M.T.
        Anesthesia machine safety and the FDA checklist.
        in: Morell R.C. Eichhorn J.E. Patient Safety in Anesthetic Practice. Churchill Livingstone, New York1997
      1. Johnson JL, Jacobsen BP, Breen PH: Can a small inspiratory limb CO2 absorber add significant humidity and heat to inspired gas in the circle system? [abstract] Anesthesiology 87(3A): 1998, in press

        • Karis J.H.
        • Menzel D.B.
        Inadvertent change of volatile anesthetics in anesthesia machines.
        Anesth Analg. 1982; 61: 53-55
        • Kumar A.Y.
        • Bhavani-Shankar K.
        • Moseley H.S.L.
        • Delph Y.
        Inspiratory valve malfunction in a circle system: Pitfalls in capnography.
        Can J Anaesth. 1992; 39: 997-999
        • Lanier W.L.
        • Weeks D.B.
        Portable semiclosed circuit for prolonged oxygen administration in aircraft [letter].
        Anesthesiology. 1985; 63: 116-118
        • Lin C.
        Enflurane vaporizer accuracy with nitrous oxide mixtures.
        Anesth Analg. 1979; 58: 440-441
        • Lin C.Y.
        Assessment of vaporizer performance in low-flow and closed-circuit anesthesia.
        Anesth Analg. 1980; 59: 359-366
        • Mapleson W.W.
        The elimination of rebreathing in various semi-closed anaesthetic systems.
        Br J Anaesth. 1954; 26: 323-332
        • Matjasko J.
        Economic impact of low-flow anesthesia.
        Anesthesiology. 1987; 67: 863-864
        • McMahon D.J.
        A synopsis of current anesthesia machine design.
        Biomed Instrum Technol. 1991; 25: 190-199
        • Mosca P.J.
        • Loyd G.E.
        • Tsueda K.
        Effects of ThermH2Osorb carbon dioxide absorber on temperature and humidity in the anesthetic circuit [letter].
        Anesth Analg. 1997; 84: 1164-1165
        • Nakae Y.
        • Miyabe M.
        • Sonoda H.
        • et al.
        Comparison of the Jackson-Ress circuit, the pediatric circle, and the MERA F breathing system for pediatric anesthesia.
        Anesth Analg. 1996; 83: 488-492
      2. Ohmeda 7900 Ventilator, Operation and Maintenance Manuel. Ohmeda, The BOC Group, Madison, WI1996
        • Powell J.
        Leak from an oxygen flowmeter.
        Br J Anaesth. 1981; 53: 671
        • Pyles S.T.
        • Berman L.S.
        • Modell J.H.
        Expiratory valve dysfunction in a semiclosed circle anesthesia circuit—verification by analysis of carbon dioxide waveform.
        Anesth Analg. 1984; 63: 536-537
        • Rees G.J.
        Anaesthesia in the newborn.
        Br Med J. 1950; 2: 1419-1422
        • Rice J.
        • Kolek B.
        Ohmeda Explore! The Anesthesia System. Ohmeda, The BOC Group, Madison, WI1996
        • Rosewarne F.A.
        Capnography and sticking valves in the circle system.
        Anaesthesia. 1991; 46: 599
        • Rosewarne F.A.
        • Wells D.
        Three cases of valve incompetence in a circle system.
        Anaesth Intensive Care. 1988; 16: 376-377
        • Sprague D.H.
        • Archer G.W.
        Interoperative hypoxia from an erroneously filled liquid oxygen reservoir.
        Anesthesiology. 1975; 42: 360-362
        • Sword B.C.
        The closed method of administration of gas anaesthetics.
        Anesth Analg. 1930; 9: 198
        • Sykes M.K.
        Rebreathing circuits: A review.
        Br J Anaesth. 1968; 40: 666-675
        • Synnott A.
        • Wren W.S.
        Effect of nitrous oxide on the output of three halothane vaporizers.
        Br J Anaesth. 1986; 58: 1055-1058
        • Weeks D.B.
        Higher humidity, an additional benefit of a disposable anesthesia circle.
        Anesthesiology. 1975; 43: 375-377
        • Westhorpe R.N.
        Equipment review: The anesthetic machine in the 1990s.
        Anesthesiol Rev. 1992; 19: 46-55
        • White C.D.
        Vaporization and vaporizers.
        Br J Anaesth. 1985; 57: 658-671
        • Wu W.H.
        • Turndorf H.
        PEEP valve for an anesthesia machine.
        Anesthesiology. 1975; 43: 677-678