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Principles I Test 2

Breathing Systems

What is the purpose of an anesthesia breathing system? links the patient to the anesthesia machine by delivering O2 and anesthetic gases and eliminating CO2
What are 6 types of breathing systems (circuits)? insufflation, open-drop, draw-over, maplesons, circles, resuscitation
Which types of breathing circuits are open? insufflation and open-drop
What types of breathing circuits are semi-open? draw-over and maplesons
Which type of breathing circuit is semi-closed or closed? circle systems
How can you decrease resistance in a circuit? decrease circuit length, increase circuit diameter, avoid sharp bends, maintain laminar flow, eliminate valves (NOT possible)
Which breathing system that is no longer used today used chloroform or ether dripped onto gauze over mask? open-drop anesthesia
Which breathing system's vaporizer is dependent on flow and on temperature? draw over anesthesia
Describe draw over anesthesia ambient air is inhaled (drawn over) liquid anesthesia agent; most of these systems do not have a ventilator
What are the advantages of draw over anesthesia? simple, portable, can be used without compressed gas or ventilators (war zones)
What is insufflation? blowing gas across the face; it is more a technique than a circuit
When is insufflation used? inhalation induction (peds), under drapes during sedation (not safe = flammable & trapped CO2), apneic techniques (oxygenation without ventilation to keep survivable O2 sat during airway surgery)
What components were added to a breathing circuit to make it a mapleson? breathing tube, fresh gas inlet, APL valve, reservoir bag
Absolute and total non rebreathing occurs with which type of breathing circuit? maplesons
Maplesons are expensive and require a special adapter on the machine. Are they associated with high flows or low flows? Why does this matter? high flows; high flows are associated with gas wasting, contamination of OR, losing moisture, losing heat
What determines the classification of mapleson? location of components
What makes a breathing circuit a mapleson? the components
Why does a mapleson not have a CO2 absorber as one of its components? exhaled gases go straight to scavenging (absolute non rebreathing), so it is not needed
With spontaneous ventilation in a mapleson system, fresh gas flow must equal what? minute ventilation
With controlled positive pressure ventilation in a mapleson system, ____ the minute ventilation is required 3 times
What is a bain circuit? the "tube in a tube" version of the Mapleson D; they require an adaptor
Bain circuits help conserve what? expired heat and moisture
What are the components of a circle system? CO2 absorber & absorbent, fresh gas inlet, unidirectional valves, y piece, APL valve, reservoir bag, breathing tubes
Why are breathing tubes large (22 inches in diameter)? larger diameter means decreased resistance
The longer the breathing tube, the greater the __________ resistance
As the volume of the reservoir bag increases, so does the __________. This is a safety feature that prevents excess pressure from going to patient & causing ____________ compliance; barotrauma
Why are rebreathing systems beneficial? they conserve heat, humidity, and costly medical gases
The cycle system allows for rebreathing of _______ ________ without rebreathing of _______ medical gases, CO2
Unlike anesthesia machine reservoir bags, AMBU bags are ______-________ self-refilling
Unlike anesthesia machine reservoir bags, AMBU bags need ______ flows for high FiO2's high
With anesthesia machine reservoir bags, you must have a _____ _____ in order for the bag to fill good seal
What is the definition of dead space? tidal volume that does not move into alveoli
Where does dead space end? where inspiratory and expiratory flows divide
Because of the valves, dead space is distal to the __-_______ in a circle system Y-piece
True or False: breathing system tube length does not affect dead space True
In what 3 situations are high gas flows beneficial? induction, emergencies, and compensating for leaks
In a circle system, heat and humidity of inspired gas depends on what? proportion of rebreathed gas vs. fresh gas
What two things does the CO2 absorbent add to the system? heat and humidity
What are the 4 disadvantages of circle systems? less portability, greater risk of malfunction, complications related to absorbent, less predictability of inspired gas concentrations at low flows
What 3 things does rebreathing conserve? heat, humidity, and volatile agent
Soda lime (CO2 absorbents) neutralizes carbonic acid (H2CO3) into what two products? water and heat (energy)
What are the ingredients of soda lime? Ca(OH)2, NaOH, H2O
Why is silica added to soda lime? to decrease dust and resistance
How much CO2 is soda lime capable of absorbing? up to 23 L of CO2 per 100 grams of absorbent
Why is barium lime no longer used? it is a fire hazard
pH indicator turns white absorbent one of two colors, what are these colors? purple or pink
At what percentage of color change should the CO2 absorbent be replaced? 50 - 70%
True or False: absorbent can revert back to original color with rest true; however, this does NOT mean that absorbency is restored
The higher the flows, the _____ the patient rebreathes less
Fresh gas flows of 0.3 - 0.5 L/min means what in terms of rebreathing and CO2 absorbent? almost total rebreathing and fully reliant on absorbent to eliminate CO2
Fresh gas flows of 5 - 8 L/min means what in terms of rebreathing and CO2 absorbent? little rebreathing with almost all CO2 being eliminated via scavenging
What is exhaustion? occurs when absorbent has absorbed all the CO2 of which it is capable of
What is mesh? the number of holes per linear inch of a screen; most absorbents are 4 - 8 mesh
What is desiccation? when absorbent becomes dry
What does desiccation lead to? higher volatile gas degradation
What is degradation? it occurs when volatile agents are broken down by absorbent
The degradation of desflurane produces what? carbon monoxide
The degradation of sevoflurane produces what? Compound A
What is Amsorb? a newer CO2 absorbent with less degradation; allows you to run Sevoflurane at lower flows and not risk Compound A development
Without Amsorb, if you are running sevoflurane how many liters of flow do you have to have to prevent a Compound A problem? 2L
What 3 things contribute to Compound A formation? high concentration of sevoflurane, long anesthesia time (>2 MAC hours), low flow technique (< 2 L/min)
What is channeling? absorbent exhaustion in areas where gas enters the absorber; baffle system in absorber directs gas flow thru center to minimize channeling
How can you detect rebreathing of CO2 through monitoring? CO2 > 3 mmHg noted on the capnograph during inspiratory phase
What are 3 possible causes of increased inspired CO2 (> 3 mmHg)? exhausted absorbent, patient stacking breaths, unidirectional valve incompetency
Created by: Mary Beth