1. Breathing systems and the anaesthetic machine Zsolt Molnár SZTE, AITI

2. Introduction „Auld” definitions „New”: Mapleson systems 1954
Open-, semi open-
Semi-closed, closed-systems
„New”: Mapleson systems 1954
Rebreathing
Non-rebreathing 10 10

3. Physiolgy refreshment courseVT
4-7 ml/kg VD
2-3 ml/kg
Peak inspiratory flow (PIF)
At rest: l/min
Breathing cycle
Inspiration – expiration – expiratory pause 10 10

4. Mapleson systems Parts Efficacy FG inlet Rezervoire balloon
Pop-off valve
Efficacy
FGF – to prevent CO2 rebreathing 10 10

5. Pressure relieving valve
Parts
Disc
Sharp edge
Spring
Safety opening P
60-70 cmH2O 10 10

6. Mapleson A – spont. breathing
„Magill attachment”
>110 cm
FGF = 1 x VA (70ml/kg/m)
VA = ?
PIF = ?
Monitoring: capnograph 10 10

7. Capnography A: normal B: rebreathing C: diaphragm movements
pCO2
A: normal
B: rebreathing
C: diaphragm movements
D: cardiac oscillation
E: sampling error
F: bronchospasm A B C D
Sebészeink…, anamnesis...
Általános szabály, hogy a viszgán legyen egy algoritmususnk, ami alapján válaszolunk a kérdésekre. Tehát egy ilyen beteg ellátása preop…..problémát egyaránt jelent. Mielőttt azonban ennek nekiállnánk, frissítsünk fel néhány elengedhetetenül fontos élettani fogalmat.
Molnár ‘99 E F

8. Mapleson A – IPPV „Close” pop-off valve Rebreathing may occur
FGF = 2.5 x VA 10 10

9. Coaxial systems Mapleson D or Bain Mapleson B or Lack
IPPV: FGF = 1 x VA
Spont: FGF = 2.5 x VA
Mapleson B or Lack
„A” better 10 10

10. Mapleson C Water’s circiut „To-and-fro”: IPPV: FGF >3 x VA
Spont: FGF > 2 x VA
„To-and-fro”: 10 10

11. Water’s circuit O2 Rezervoire balloon Mask, ET tube Valve Molnár ‘99
A hipovolémia során a keringő vérmennyiség csökkenése a …
Valve
Molnár ‘99

12. Mapleson E and F E: Ayre’s T-piece F: Jackson-Rees
Spont: FGF = 1.5 x VA
IPPV: FGF = 3 x VA
F: Jackson-Rees
Monitoring
PEEP 10 10

13. T-piece
T-piece
Outlet
Inlet
Molnár ‘99

14. Bernoulli’s law Molnár ‘99 8 LPM 50% O2 100*8 + X*21 = (8+X)*50
FGF = = 21 L/p
Molnár ‘99

15. T-piece parts: Venturi injector + humidification
Physiology
PIF~20-30 l/min
Bernoulli’s effect
FiO2
60-30 L/min
Active humidification
Hot water bath
Heating coil
Levegő
Molnár ‘99

16. A happy chapy on T-piece
Molnár ‘99

17. The anaesthetic machine
Cylinders (O2, N2O, Air)
Rotameters
Vaporizers
Breathing circuit
CO2 absorber
Safety:
FiO2 + alarm
O2 bypass
Pressure relieving valve 10 10

18. Rebreathing system (circuit)10 10

19. CO2 absorber CaOH2, NaOH, sylicate CO2 + 2NaOH Na2CO3 + H2O + heat
Na2CO3 + CaOH2 2NaOH + CaCO3 10 10

20. Rotameters 10 10

21. Rotameters Gas specific Safety features: Min FiO2 = 0.3 FiO2 alarm 10

22. Vaporisers ages ago… Inside the circuit Small vaporizing surface
Quick cooling 10 10

23. …and today
Outside the circiut
Well insulated containers 10 10

24. …and today Outside the circiut Well insulated containers Agent safe 10

25. …and today Outside the circiut Well insulated containers Agent safe
Heat compensation 10 10

26. Summary Mapleson systems: advantages Mapleson systems: disadvantages
Simple, cheap, safe
Low resistance
Good for practice
Mapleson systems: disadvantages
Non-economic
Not environment friendly
High heat and humid loss 10 10