Different types of anesthetic equipment and their use. Anaesthetic machine, Cylinders, Breathing systems, Ventilator, Air ways, Laryngoscope, Endotracheal tubes, Tracheostomy tube, I.V.Cannula, Syringe pumps, Magill’s forceps, Central Venous Pressure, Nasogastric tube, ect.

1. Anaesthesia
Anaesthetic Equipments & use
Clinical appointment
2002/03 A
Devdas 2002 / 03 A

2. Anaesthetic machine
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Cylinders / pipe line gas supply
Reducing valves
Vaporisers
Flow meters
Sodalime canister
Breathing circuits
Accessories – face masks, laryngoscopes,
ET tubes, metal stylets, air ways

3. Anaesthesia machine
Pipe line
supply
Vaporizers
Reducing
valves
Flow meters
Sodalime
canister
Cylinders
Breathing
circuit

4. Cylinders
• Constructed from Molybdenum
• Colour coded according to gas supplied
• Safety – Pin index system
– Oxygen
– Nitrous oxide
– Pipe line gas supply

5. Inhalational Anaesthetic Machine

6. Oxygen
• In the form of gas – 130 bars
• Pressure gauge is there
• Outlet valve can only connect the O 2
cylinder to the machine
• Alarm – when O2 is depleting

7. Nitrous oxide
• Liquid form – pressure 51 bars until the
liquid vaporizes
• Heat vaporization
• Pressure gauge – doesn’t indicate the
measure of contents
• Blue color cylinder

8. Pipe line gas supply
• All gases in liquid form – economical
• Pressure 4 bars
• Identification – gas name, color code,
shape
• Convenient

9. Catheter - mount

10. Flow meters
• Tapered glass tubes contains Spinning bobbins
• Calibrated for a specific gas
Vaporizers
• Vaporizes inhalational anesthetics in liquid form
at room T
• Calibrated for a specific inhalational agent

11. Breathing systems
• Delivers anaesthetic gases & oxygen to
the patient & removes CO2
– Magill circuit
– T-piece (Paediatric circuit)
– Bain circuit
– Circle circuit – commonly used

12. Mapleson classification
• Mapleson system A
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– Magill system – most
satisfactory with
spontaneous respiration
Mapleson system B – not
common
Mapleson system C – not
common
– Water’s system
• Mapleson system D
– Bain co-axial system
• Mapleson system E
– Ayre’s T piece – paediatric
use
• Efficiency of systems with
spontaneous respiration
A > D, E > C > B
• Efficiency of systems with
IPPV
D, E > B > C > A
• Most important closed
circle or low flow system
– Rebreathing system
Refer more on Circle system

13. Ventilator circuit – circle circuit
Re breathing system
Sodalime is needed to
absorb CO2 from exhaled
gas
Low fresh gas flows
Economical
Less theater pollution
Humidification is better
Valves – not ideal for
pediatric use
Heavy

14. Bain circuit
Coaxial system –
inspiratory limb inside
& outer expiratory limb
Used both in
spontaneous &
controlled ventilation
Scavenging gases is
easy
Reservoir bag – 2 L

15. Pediatric – T-Piece
No valves no resistance
to respiration
Fresh gas flow should be
twice the minute volume
Reservoir bag fixed on
the open end – for
controlled ventilation
See different breathing circuits identify according to MAPLESON classification

16. Sodalime
• Used with circle circuit – re-breathing systems
• Calcium hydroxide(94%)Na(5%) & K(1%)
hydroxides
• Absorbs CO2 – color change when it becomes
inactive
Facemasks
• Rubber or plastic
• Transparent ones show vomitus &
secretions

17. Ventilator

18. Setting up a simple ventilator
• Connect the gas supply – usually N2O(66%)
O2(33%) air…
• Connect the outlet to the breathing circuit
• Select the,
– Tidal volume – 7-10ml/kg
– Respiratory rate -12-16/min
– Inspiration : expiration ratio (usually 1:2)
• Keep upper airway pressure 10-20 cmH2O
• Negative upper airway pressure means patient
is voluntarily breathing

19. Oxygen mask
Look how this is connected to gas supply & to
ambu bag
What happens if
connection to ambu
bag is lost?

20. Ambu bag
Ideal valve should have
No foreward leak
No backward leak
Low resistance
Minimal dead space
Self inflating bag
Light weight
Reservoir bag – 100% O2
Minimal opening pressure without
sticking
Valves –
Transparency
1.Prevent forward leak
Reliability & durability
2.Prevent backward leak
3.Expiratory
4.Inspiratory
5. Pressure releasing >40mmHg

21. Face mask
Triple manure
1. Head tilt
2. Extended to straiten the airway &
prevent tongue falling back
3. Jaw thrust
Why DENITRATION is important?
To increase the % of O2 in alveoli before
intubation
This enables enough time to intubate

22. Face Masks
NOTE : How face mask is
held preventing air leak
Practice Triple Maneuver

23. Air ways
• Air way maintenance by displacing the
tongue from posterior pharynx
• Oro-pharygeal airway
• Nasal airway – when unable to open the
mouth & in oral surgeries
• Paediatric & adult types
Dotted
Color coding

24. Adult Guedel airways
Look for the dotted coding in pediatric airway

25. Nasal airway
What are the contraindications for nasal intubation?
What are the complications of nasal intubation?
Note : Why gauze
pack is put into the
oral cavity in nasal
intubation?

26. Laryngeal mask airways
• Short tube with a elliptical cuff
• Placed in the laryngopharynx behind the inlet
• Can avoid muscle relaxants no haemodynamic
response like in ET tube
• Relieves hypoxia in failed intubation
• Blind intubation through mask is possible
• Risk of regurgitation is there
• Alternative to face mask
• Needs minimum skills
Learn the procedure of putting
laryngeal mask

27. Laryngoscope
Curved blade – Macintosh
Straight blade – Magill (for children)
Battery in the handle – check
whether the bulb is working before
use
Use with the left hand
Put it in from the right side
Groove in the left side of the blade is
for to keep the tongue apart & lifted
What are the uses of
laryngoscope?
Macintosh laryngoscope – curved blade

28. Endotracheal tube - cuffed
How to describe a
endotracheal tube?
Cuffed or not
Internal diameter
Main parts – from above
downwards
1.Universal airway
connector
2.Tube
3. Radio opaque line
7.Murfy’s eye
8. Black lines 2
Use of each part &
there importance
4. Pilot tube
5.Pilot inflator bag
6.Cuff type – high P/ low
V or low P / high V
What are the uses of flexible &
reinforced tubes?
What is RAE tube?

29. Importance
• Universal airway
connector
– external diameter is same
in every tube (15mm)
• Tube- internal diameter
– female – 7.0 to 8.0 mm
– male 8.0 to 10.0 mm
• Radio opaque line
– identify it radiologically
• Pilot tube
– to inflate the cuff
• Inflating bag – 5ml
• Cuff
– High pressure / low volume
– high risk of aspiration &
pressure necrosis
– Low pressure / high volume
– vise versa
• Two black lines
– vocal cords should be in
between – risk of damage
is reduced
• Murfy’s eye
– to keep patancy when
secretions block the tube
– To keep the patancy of the
upper right bronchus

30. Endotracheal tube – plain/non
cuffed
Indications for ET tubes
1.When muscle relaxants given
2.In patients with risk of aspiration
3.To provide controlled ventilation
4.For prolong operations
Why non-cuffed is preferred in children?
Their narrowest place is at cricoid. tube fits nicely.

31. Endotracheal tubes
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What is I.T. on tube?
– Implantation test for allergies has been done.
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What is the importance of reinforced tube?
– It is not liable to kink – in oral surgeries
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What are the indications of Proper Intubation?
1. Feels expired air touching the dorsal surface of hand
when it is neared to the airway connector
2. See vapor in the tube
3. Hold a piece of thread near the opening – it will
move
4. Positive capnogram on monitor

32. Tracheostomy tube
Sized according to the internal
diameter
Cuffed or uncuffed
Introducer is available
Winged flange to secured to
skin
Indications
1.In ICU patients who needs
prolong intubation
2.Vocal cord palsy
3.OP poisoning
4.Oropharyngeal laryngeal
carcinomas
5. Chemical burns
6. Gillian Bare syndrome .. etc

33. Complications of tracheostomy
1. Early :
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2. Late :
Haemorrhage
• Infection
Displacement or
• Tracheal ulceration
obstruction
• Tracheal dilatation
Injury to trachea
• Tracheal stenosis
Tracheitis
• Cardiovascular
Crust formation
collapse
Surgical emphysema
Difficult insertion
pneumothorax

34. After care of tracheostomy
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Position the patient
– Adults – propped up
– Children – chin should not occlude
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Suction – clean catheter used
– Deep suction + physiotherapy or ventilation – in unconcious
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Humidification
– Prevent drying & formation of crusts
– Wet guaze in the opening
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Tube changing
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2-3 days
Silver tubes – remove inner tube & clean
Cuffed tubes – regular deflation to prevent pressure necrosis
Air – minimum to prevent air leak
Pain management
Management of hemorrhage

35. Intravenous fluid set
Priming an IV line
1.Take out from the pack – mark
to scratch in the packet
2.Clamp it
3.Never touch the connector
4.Open the cap of fluid bottle &
connect the line
5.Open the line till half of the
syringe fills
6.Open fully & allow fluid to come
out – to assure no air bubbles
inside
Risks
7.Connect to the cannula
Septicemia
Air embolism

36. I.V.Cannula
Gauges – color code
Orange 14G
Ash 16G
White 17G
Green 18G
Pink 20G
Blue 22G
Yellow 24G
(Spinal needle – 25Gfrench grading)
Demonstrate how IV cannulation is done discuss importance of each step

37. Control syringe
Learn the use of syringe

38. Syringe pumps
• Electrically driven – battery back-up is there
• Alerts provided for
– Power failure
– Empty syringe
– Occlusion of delivery pipe
• Applications
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Pain relief
Total IV anaesthesia
Sedation in intensive care
CVS support
Relaxants
Control of diabetes

39. Dose calculation for syringe pump
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Dobutamine solution – 200mg in 500ml
Dose – eg: 2.0μg / kg / min
Body weight of the patient – eg: 50kg
So, amount of mg per hour
= 2.0 μg × 50kg × 60 = 6mg
1000
• Amount of solution needed per hour
= 500ml × 6mg = 15ml / hour
200mg
• So the infusion rate = 3.8 per minute

40. Magill’s forceps
Guide the ET tube into larynx –
in nasal intubation
Guide the nasogastric tube into
oesophagus
See how this is held?

41. Blood transfusion set
Normal blood amount
Adult male – 70ml / kg
Adult female – 60ml / kg
Child – 80ml / kg
Discuss how blood loss is
assessed in theatre?
Discuss management of
hemorrhagic shock?
Learn the appropriate use of three way tap

42. Transfusion bags
List the blood components & their indications

43. Haemodialysis - tubings

44. CVP Manometer
Measure,
Adequacy of blood or fluid
replacement
Easy & rapid transfusion of blood
Normal – 3 to 10 cmH2O
Low CVP
1.Hypovolemia
2.Septic shock
High CVP
1.Heart failure
2.Increased intra thoracic pressure
– IPPV, PEEP pneumothorax
3.Ovetransfusion
4.Constrictive pericarditis
5.Pulmonary vasoconstriction

45. Central Venous Pressure
• >50% of the total blood volume is in venous
system – alteration in venous tone play a large
part in regulation of hemodynamics
• Zero at mid axillary line
• Normal – 3 to 10 cmH2O
• Complications
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Thromboplebitis, infection, septicemia
Pneumothorax, haemothorax, hydrothorax
Bracheal plexus injury
Air embolus
Pericardial effusion
Lymphatic leakage
Arrhythmias
Catheter breaking

46. Peritoneal dialysis - set

47. Peritoneal dialysis - catheter

48. Double lumen dialysis

49. Epidural set
Spinal set

50. Spinal needle
Whitacre spinal needle - 25G
Commonly used
Subarachnoid anaesthesia
1. Take the consent
2. Look for contraindications
1. CNS lesions – ideally full CNS examination
should be done
2. Sepsis around the area of pricking
3. Any coagulopathies
3. Sterile procedure

51. Spinal needles
Spinal introducer for Sprotte cannula
Spinal sprotte cannula
Spinal sprotte cannula

52. Foley’s catheter
Learn the aseptic procedure of catheterization

53. Guide wire – External Pace Maker

54. Suction catheters
Twin bore nasal

55. Nasogastric tube
Indications
1. Aspiration of gastric juices for
the diagnostic & therapeutic
purposes
2. Confirmation of gastroduodenal
hemorrhage
3. Feeding
Confirmation of it’s presence in
the stomach
1.Syringing the air down the tube
while listening over epigastrium
2.Suck the tube to see juices are
coming
3.Vapour inside in accidental
tracheal intubation

56. Identify?

57. Identify?

59. I.V.Cannula
Why do you tap to find
appropriate vein for
canulation?
Why veins in the periphery
are selected first?
What should be done if
peripheral veins are not
visible?
When do you use low
grade cannulae for adults?
What are the
complications?
Why anti-cubital fossa is
not selected as a good site
for cannulation?