Anesthesia Machine Evaluation and Breathing Circuits

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Questions and Answers

A patient's blood pressure is measured using a Doppler device. The reading is 130/80 mmHg. Which of the following is the correct interpretation?

  • The systolic blood pressure is within the normal range for an indirect measurement, and the diastolic blood pressure is within the normal range for an indirect measurement. (correct)
  • The systolic blood pressure is within the normal range for an indirect measurement, but the diastolic blood pressure is high.
  • The systolic blood pressure is within the normal range for a direct measurement, but the diastolic blood pressure is low.
  • The systolic blood pressure is within the normal range for a direct measurement, and the diastolic blood pressure is within the normal range for a direct measurement.

A patient's End Tidal CO2 reading is 32 mmHg. Which of the following is the most likely interpretation?

  • The patient's CO2 reading is too low to determine whether they are hyperventilating or hypoventilating.
  • The patient is hyperventilating. (correct)
  • The patient is hypoventilating.
  • The patient's ventilation is within the normal range.

An ECG shows a heart rate of 40 beats per minute. Which of the following is the most likely interpretation?

  • The patient is experiencing bradycardia, which could be a sign of excessive anesthetic depth. (correct)
  • The patient is experiencing a normal heart rate.
  • The patient is experiencing an arrhythmia, which could be a sign of excessive anesthetic depth.
  • The patient is experiencing tachycardia, which could be a sign of surgical stimulation.

A patient's Mean Arterial Pressure (MAP) is consistently below 90 mmHg. Which of the following is the most likely consequence?

<p>Decreased risk of tissue perfusion. (D)</p> Signup and view all the answers

During a surgical procedure, a patient experiences a sudden increase in their heart rate. What is the most likely reason for this increase?

<p>Surgical stimulation. (C)</p> Signup and view all the answers

What is the minimum acceptable SpO2 reading in a patient under anesthesia?

<p>95% (A)</p> Signup and view all the answers

What is the normal temperature range for a patient under anesthesia?

<p>99.5F-102.5F (B)</p> Signup and view all the answers

Why is hypothermia a common complication during anesthesia?

<p>A combination of factors including anesthesia, cold oxygen, room temperature, and drug-induced vasodilation (C)</p> Signup and view all the answers

What is the primary reason for monitoring blood pressure during anesthesia?

<p>To ensure adequate blood circulation and oxygen delivery (B)</p> Signup and view all the answers

Which of the following complications can occur if a patient is hypothermic during anesthesia?

<p>Cardiovascular issues and slower anesthetic recovery (A)</p> Signup and view all the answers

What is the MAC for SEVO for cats?

<p>2.62% (B)</p> Signup and view all the answers

What is the purpose of monitoring a patient's oxygen saturation (SpO2) during anesthesia?

<p>To determine if the patient is receiving enough oxygen (D)</p> Signup and view all the answers

What can happen if a patient is over-anesthetized with SEVO during a procedure?

<p>The patient may experience hypoventilation or hypotension. (B)</p> Signup and view all the answers

What is a significant advantage of the closed system over the semi-closed system for anesthetizing small patients?

<p>The closed system minimizes the risk of rebreathing carbon dioxide. (B)</p> Signup and view all the answers

Which of the following is NOT a disadvantage of the open system for anesthetizing small patients?

<p>It requires a CO2 absorbing canister for proper function. (B)</p> Signup and view all the answers

A veterinary technician notices that the anesthetic bag is too full during a procedure. Which of the following is NOT a possible cause?

<p>The CO2 absorbing canister may be malfunctioning, resulting in increased pressure. (B)</p> Signup and view all the answers

If a veterinary technician observes that the anesthetic bag is too flat during a procedure, what is the most likely cause?

<p>The flow rate might be set too low, restricting gas delivery. (D)</p> Signup and view all the answers

Which of the following is NOT a potential consequence of a closed system when not properly managed?

<p>Increased environmental pollution due to waste gas. (B)</p> Signup and view all the answers

What is a primary advantage of the semi-closed system over the open system when anesthetizing small patients?

<p>It conserves anesthetic gases and reduces waste compared to the open system. (A)</p> Signup and view all the answers

Why is minimal breathing resistance considered crucial for anesthetizing small patients weighing less than 7 kg?

<p>Smaller patients have a greater risk of airway obstruction, requiring a system with minimal resistance. (A)</p> Signup and view all the answers

Which of the following options is NOT a potential reason for a flat anesthetic bag during an anesthesia procedure?

<p>The CO2 absorbing canister might be malfunctioning, leading to decreased pressure in the system. (A)</p> Signup and view all the answers

What is the primary advantage of using non-rebreathing circuits over rebreathing circuits in anesthesia?

<p>They eliminate the need for a CO2 absorber canister. (A)</p> Signup and view all the answers

Which component of the anesthesia machine is bypassed when using a non-rebreathing circuit?

<p>The CO2 absorber canister (C)</p> Signup and view all the answers

What is the recommended flow rate for rebreathing circuits in anesthesia?

<p>20-40 ml/kg/min (A)</p> Signup and view all the answers

In which scenario is a rebreathing circuit most appropriately used?

<p>For patients weighing more than 7kg with slow changes in anesthetic depth. (A)</p> Signup and view all the answers

What is a consequence of mechanical dead space in the context of anesthesia?

<p>Increased arterial and end expired carbon dioxide levels. (A)</p> Signup and view all the answers

What is the primary function of the soda lime in a rebreathing system?

<p>To absorb CO2 from exhaled gases (B)</p> Signup and view all the answers

In a nonrebreathing system, which component is typically bypassed?

<p>CO2 absorber canister (B)</p> Signup and view all the answers

Which of the following best describes how to calculate the size of the reservoir bag?

<p>kg x 10-20 mL/kg x 6 / 1000 (C)</p> Signup and view all the answers

What is a key difference between the Jackson Rees system and the Norman elbow in nonrebreathing setups?

<p>Norman elbow has the fresh gas inlet located in the patient connection (B)</p> Signup and view all the answers

What could potentially happen if the reservoir bag is too small for the patient?

<p>Hypoventilation and inadequate oxygenation may occur (C)</p> Signup and view all the answers

How does a bag coupled with an O2 flush valve enhance the functionality of a nonrebreather system?

<p>By allowing the user to manually ventilate when necessary (B)</p> Signup and view all the answers

What is the primary risk associated with a reservoir bag that is too large?

<p>Difficulty in observing the patient's breathing patterns (D)</p> Signup and view all the answers

What type of scavenging system is mentioned as being utilized at Banfield for waste anesthetic gases?

<p>Active scavenging system (D)</p> Signup and view all the answers

What is the most likely cause of a leak in the anesthesia system AFTER induction?

<p>An improperly placed or sized endotracheal tube (C)</p> Signup and view all the answers

What is the primary reason why sevoflurane is preferred over isoflurane for general anesthesia?

<p>Sevoflurane has a lower blood gas partition coefficient, leading to faster induction and recovery. (B)</p> Signup and view all the answers

Calculate the minute volume for a patient with a tidal volume of 500 ml and a respiratory rate of 12 breaths per minute.

<p>6 L/min (A)</p> Signup and view all the answers

What does MAC refer to in the context of inhalant anesthetics?

<p>Minimum Alveolar Concentration (A)</p> Signup and view all the answers

What is the significance of a lower MAC value for an inhalant anesthetic?

<p>It indicates a more potent anesthetic, requiring lower concentrations for desired effects. (B)</p> Signup and view all the answers

Why are precision vaporizers preferred for delivering anesthetic gases?

<p>They allow for more precise control over the concentration of anesthetic gas delivered to the patient. (B)</p> Signup and view all the answers

What is the typical tidal volume range for an adult patient?

<p>10-20 ml/kg (A)</p> Signup and view all the answers

If a patient wakes up during a procedure, what are the possible causes? (Select all that apply)

<p>The anesthetic gas concentration is too low. (A), The procedure is painful. (C), There is a leak in the anesthesia system. (D), The endotracheal tube is not correctly placed. (E), The patient is experiencing a side effect of the anesthetic. (F)</p> Signup and view all the answers

Flashcards

Rebreathing Circuit

A breathing system for patients >7kg using low flow rates and CO2 absorbent.

Non-Rebreathing Circuit

A breathing system for patients <7kg that provides fresh gas with each breath.

Flow Rates in Rebreathing

Utilizes flow rates of ~20-40ml/kg/min for rebreathing systems.

Flow Rates in Non-Rebreathing

Uses high flow rates of ~300-500ml/kg/min, ensuring fresh gas delivery.

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CO2 Absorber Canister

A component used in rebreathing circuits to eliminate carbon dioxide from fresh gas.

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Rebreathing System

A system where exhaled gases are reintroduced to the patient, utilizing CO2 absorbers.

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Nonrebreathing System

A system that only allows fresh gases to enter, without reintroducing exhaled gases.

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Reservoir Bag Size Calculation

Size is determined by the formula: kg x 10-20mL/kg (Tidal volume) x 6 / 1000.

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Function of Soda Lime

Absorbs CO2 from exhaled gases in a rebreathing system.

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Jackson vs. Norman Systems

Jackson has a fresh gas inlet away, Norman has it inside patient connection.

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Active Scavenging System

A system that actively collects and removes waste anesthetic gases from the environment.

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Parts of Anesthesia Machine in Rebreathing

All parts are utilized including CO2 absorbers and valves.

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Parts of Anesthesia Machine in Nonrebreathing

Bypasses CO2 absorbers and uses limited parts; relies on scavenging system.

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Leak Test

A test to check for leaks in the anesthesia machine or bag before usage.

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Breathing System Check

Inspect the breathing system for leaks or issues with the reservoir bag.

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Tidal Volume

The volume of air a patient inhales in one breath, usually 10-20ml/kg.

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Minute Volume

The total volume of air a patient inhales in one minute, calculated as tidal volume times respiratory rate.

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Sevoflurane vs Isoflurane

Sevoflurane is preferred over Isoflurane for its faster onset and recovery due to lower blood gas partition coefficient.

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Precision Vaporizer

A device that delivers a specific percentage of anesthetic gas to the patient, ensuring accurate dosages.

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MAC (Minimum Alveolar Concentration)

Measurement of anesthetic potency, defined as the concentration that prevents movement in 50% of patients during surgery.

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Patient Waking Assessment

Evaluate the patient’s vital signs and anesthetic gas levels upon waking.

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Closed System Anesthesia

An anesthesia system that conserves gases and minimizes waste, maintaining stable anesthetic depth.

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Pros of Closed System

Conserves anesthetic gas, has minimal waste, preserves heat & humidity, and stable depth.

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Cons of Closed System

Requires precise control, risk of pressure build-up, complex management, and needs adjustments.

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Semi Closed System Anesthesia

An anesthesia system that adjusts depth faster than a closed system but wastes more gas.

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Pros of Semi Closed System

Faster depth adjustments, reduces waste gas, and retains some heat & humidity.

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Cons of Semi Closed System

More gas waste than closed system, more breathing resistance, and requires CO2 absorber.

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Open System Anesthesia

An anesthesia option with minimal resistance, simple setup, and faster induction for small patients.

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Pros of Open System

Minimal resistance, quick induction, simple without CO2 absorber, and low rebreathing risk.

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Direct Blood Pressure Measurement

Obtained through an arterial catheter directly into the bloodstream.

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Indirect Blood Pressure Measurement

Measured using a doppler or oscillometric device, not directly into the blood.

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Mean Arterial Pressure (MAP)

Average pressure in arteries during one cardiac cycle; indicates tissue perfusion.

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End Tidal CO2

Amount of carbon dioxide released at the end of exhalation; indicates ventilation efficiency.

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Bradycardia

Abnormally low heart rate; may indicate deep anesthesia and may require intervention.

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Minimum Alveolar Concentration (MAC)

The MAC is the anesthetic concentration needed to prevent movement in 50% of patients in response to surgery.

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MAC for SEVO in Dogs

The MAC for SEVO (sevoflurane) for dogs is 2.36%.

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MAC for SEVO in Cats

The MAC for SEVO (sevoflurane) for cats is 2.62%.

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SpO2 Monitoring

SpO2 measures the percentage of oxygen saturation in hemoglobin using a pulse oximeter.

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Normal SpO2 Value

The normal SpO2 value should be greater than 95% for adequate oxygenation.

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Temperature Monitoring

Temperature is monitored to prevent hypothermia, which affects metabolism and cardiovascular function.

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Effects of Hypothermia

Hypothermia during anesthesia can slow heart rate, impair clotting, and prolong recovery.

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Blood Pressure Monitoring

Blood pressure can be measured directly or indirectly to assess cardiovascular stability during anesthesia.

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Study Notes

Anesthesia Machine Evaluation

  • Oxygen Flow: Oxygen flows from the oxygen tank to the flowmeter, then to the vaporizer. The flow continues through fresh gas inlet/outlet ports, into the reservoir bag, and through the inhalation valve to the patient. Exhaled gas moves through the expiratory valve, CO2 absorber canister, and then the scavenging system. For non-rebreathing systems, exhaled gas flows through an overflow valve to the scavenging system after passing through the patient.

Breathing Circuits

  • Rebreathing: Used for patients over 7 kg; uses low flow rates (20-40 mL/kg/min). Anesthetic depth changes more slowly, using all parts of the anesthesia machine, including the CO2 absorber canister.

  • Non-rebreathing: Used for patients under 7 kg; employs high flow rates (300-500 mL/kg/min). Anesthetic depth changes rapidly. This circuit does not utilize the CO2 absorber canister. It offers less resistance to breathing.

Anesthesia Machine Components

  • Rebreathing vs. Non-rebreathing: Rebreathing uses all machine components, while non-rebreathing bypasses the CO2 absorber canister. Non-rebreathing circuits are suited for active scavenging systems, removing waste anesthetic gases.

Reservoir Bag Size

  • Calculation: Reservoir bag size is determined by the patient's weight (kg) multiplied by 10-20 mL/kg (tidal volume) and divided by 1000.

Soda Lime

  • Function: Soda lime absorbs exhaled CO2, enabling recirculation of anesthetic gases and reducing CO2 buildup in a rebreathing system.

  • Viability: Assess soda lime viability by checking its physical state (hard/brittle vs. soft). Change when it reaches 50g over its initial weight, or after 8 hours/1 month of use, depending on the institution.

Excess Anesthetic Gases (WAGS)

  • Capture: An active scavenging system captures WAGS, which are exhausted through an outlet in the ceiling. A passive system utilizes gravity to direct gases into a canister.

Breathing Systems (Closed, Semi-Open, Open)

  • Determining Factor: The fresh gas flow rate relative to the patient's oxygen consumption. A closed system matches the patient's metabolic oxygen consumption. A semi-closed system has a higher fresh gas flow than the patient's need. An open system has a fresh gas flow rate exceeding the patient's consumption.

Monitoring Equipment

  • SpO2: Monitors oxygen saturation (goal: >95%)

  • Temperature: Normal range is 99.5-102.5°F (37.5-39.2°C). Hypothermia can impact anesthetic recovery.

  • Blood Pressure: Monitored via direct arterial catheter or indirect oscillometric methods.

  • End-tidal CO2: Measures the CO2 concentration at the end of exhalation (normal: 35-45 mmHg).

  • ECG: Tracks the electrical activity of the heart; shows rhythm and rate (rate too slow or high may necessitate adjustments to anesthetic levels or intervention with drugs).

Vaporizer

  • Sevoflurane: Preferred due to faster onset and recovery time due to lower blood gas partition coefficient.

  • Precision Vaporizer: Enables precise control of anesthetic gas delivery to the patient.

  • MAC (Minimum Alveolar Concentration): Measures the potency of inhalant anesthetics. Lower MAC indicates a more potent anesthetic.

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