Anesthesia machine basics_V1.0_EN讲 - Copy.pdf
- 1. Anesthesia machine basics PMLS Global technical support Service@mindray.com Version：V1.0 No：MMZ-22028
- 2. 2 Contents l Anesthesia Introduction l Structure of the anesthesia machine l Introduction of Mindray AM
- 3. 3 Subdirectory • Why we need anesthesia ？ What is an anesthesia machine?
- 4. 4 Fear Why anesthesia is needed Real Scenario Surgery in patient imagine
- 5. 5 Pain Why anesthesia is needed Normal trauma Surgical trauma
- 6. 6 Patient movement Why anesthesia is needed
- 7. 7 Why anesthesia is needed Three Elements of Anesthesia Analgesia Pain Sedation Fear Muscle relaxation Body movement
- 8. 8 Common anesthetics: Halothane Enflurane Isoflurane Sevoflurane Desflurane Red Orange Purple Yellow Blue
- 9. 9 Subdirectory Why we need anesthesia machine • What is an anesthesia machine?
- 10. 10 Transfer anesthetic (Fresh gas) to the patient What is the anesthesia machine?
- 11. 11 Drive gas system Keep patient breathing What is the anesthesia machine?
- 12. 12 What is the anesthesia machine? Anesthesia machine Give anesthetic to the patient Fresh gas system Ensuring the patient's breathing Drive gas system
- 13. Pipeline gas supply Ventilator O2 flush Flow meter Breathing circuit AGSSsystem Patient ACGO System switch Vaporizer bracket Vaporizer
- 16. 2. Structure of the anesthesia machine
- 17. • Pneumatic unit • Ventilator • Flowmeter • Breathing circuit • Vaporizer • Frame Basic Structure of Anesthesia Machine Light switch O2 Flush System switch Vaporizer Breathing circuit Flowmeter Screen Pressure gauges
- 18. 18 Gas inlet assembly Power cable Side rail DB9 connector(cali bration) AGSS connector Module slot Network port Basic Structure of Anesthesia Machine
- 19. Central gas supply system – Gas supply pressure has been adjusted – NIST – thread index safety system – DISS – diameter index safety system Backup cylinder ü The gas supply pressure is high, and the pressure relief valve is required.(Internal of the anesthesia machine) ü Backup cylinder hook York ü PISS – Axis Index Safety System ü Commonly used gas cylinder volume – E size ü Note: Do not open the backup gas cylinder in advance. Pneumatic unit supply
- 20. Main switch ON – Turn on the power – Turn on the O2 supply – Turn on the air supply Main switch Off – Power off – Turn off the pneumatic unit. – Do not turn off the auxiliary flowmeter. – Do not disable O2 flush. – Do not turn off the auxiliary power output. Pneumatic unit supply Main switch
- 21. Not controlled by the main power switch Provide high-flow pure oxygen(30-70 L/min) – Rapid correction of hypoxia – Lavage with drugs to speed up recovery. Mechanical – Inflatable bellows Manual – Rapid inflation of the bag – May be used during inspiration(Protected by the APL valve) Pneumatic unit supply O2 flush switch
- 22. Not controlled by the main power switch Separate O2 auxiliary flowmeter – The oxygen flow can be adjusted. – The O2 concentration cannot be adjusted. – For ordinary oxygen therapy(Nasal cannula oxygen inhalation) O2 + AIR assisted flowmeter – The oxygen flow can be adjusted. – The O2 concentration can be adjusted. – Used for MAC(Non-intubation anesthesia monitoring and nursing) – Reduce fire hazard Pneumatic unit supply Auxiliary flowmeter
- 23. Backlight illumination Respectively adjust the gas flow. High-flow and low-flow indicator tube (Glass) Mechanical knob(Rotate counterclockwise to increase flow) – Needle valve controls flow – Pneumatic connecting rod controls flow Flow display – Buoy(Rotary display) – Floater(Rotary display) Gas Types – Color differentiation – Thickness of knob threads mechanical flowmeter Gas Mixing Transmission
- 24. Virtual flow tube – The O2 and balance gas flow can be displayed respectively. – The total flow and O2 concentration can be displayed respectively. – Optimal flow indicator Backup flowmeter(Used in case of power failure) Electronically controlled flow(Improve accuracy) Gas Types – Color differentiation Flow setting data – Output to the anesthesia electronic medical record EFCS O2 flow Balance Gas Flow Total flow O2 concentration Gas Mixing Transmission
- 25. Type – Chain drive(O2 N2O knob side-by-side) – Gear drive(O2 N2O knob side-by-side) Function(The proportion of guaranteed oxygen is not less than 25%.) – The decrease of oxygen flow drives the decrease of N2O flow. – The O2 flow increases, but the N2O flow does not increase. – The N2O flow decreases, but the O2 flow does not decreases. – Increasing N2O flow can drive the increase of O2 flow. Mechanical N2O linkage safety protection * No linkage protection for air. If air is used at the same time, it cannot be guaranteed that the oxygen ratio is not less than 25%. Gas Mixing Transmission
- 26. Oxygen: Essential anesthetic gas Other anesthesia gases: Balance gas – Prevent inspiration Oxygen Concentration Too High – Anesthesia effect(N2O) – Arousal(CO2) – If balance gas is used, monitor the inspired oxygen concentration. O2: The last mixed gas – Prevent the decrease of oxygen concentration caused by leakage of other flowmeters Volatile anesthetic can be added. Anesthetic Mixture(Fresh gas generated) Composition of fresh gas: Oxygen, mixed with other anesthetic gases, or added with volatile anesthetic agents Gas Mixing Transmission
- 27. Definition: – High flow: Total fresh gas flow > 1L – Low flow: Total fresh gas flow < 1L – Micro flow: The total fresh gas flow is less than 500 ml. – Metabolic flow: Total fresh gas flow ≤ 250 mL Low flow anesthesia Advantages: ü Save anesthetics and costs ü Reduce environmental pollution ü Powerful for airway humidification and heating Conditions: ü Fully closed circuit ü Oxygen concentration monitoring ü AG monitoring ü Small volume circuit ü To replace the soda lime during the operation. Built-in bypass switch Gas Mixing Transmission
- 28. Dosing Method of Vaporizer Vaporizer 1. PULL fill 2. QUICK fill 3. KEY filler 1 3 2
- 29. • Only one vaporizer can be opened at a time. • Selectatec (Auto Interlock) – Mindray – GE(DO) – Delg – BAYS – Penlon • Plug-in(Manual Interlock) – Delg – BAYS – Penlon Vaporizer interlocking device Vaporizer
- 30. • No leakage • Convenient for realizing mechanical control, manual control, and spontaneous breathing. • Safe control of fresh gas input • Small volume and compact structure • Convenient to realize waste gas emission • Convenient sterilization and maintenance Clinical requirements for breathing circuit Breathing circuit
- 31. • Repeated inspiration of anesthetic, cost saving • It is conducive to humidification and heating of the airway. • Effectively reduce environmental pollution • Applicable to mechanical, manual, and spontaneous breathing. Benefits of Circulation circuit Breathing circuit
- 32. • Connecting ACGO or CGO • Effective in reducing dead space • Effective in reducing expiratory resistance • Quick Clear CO2 • Applicable to manual ventilation and spontaneous breathing. • Commonly used for pediatric anesthesia Advantages of Open Circuit Breathing circuit
- 33. • Double breathing tube(For circulation circuit) – 1.5 m long – Suction end – Expiratory end – Y-shape connector • Single breathing tube(For open circuit) – Manual breathing bag – Fresh gas inlet – Check valve Patient circuit(Threaded tube) Breathing circuit
- 34. • CO2 absorbent – Ingredients: Active NaOH – Keep wet – Bulk and independent packaging • CO2 absorption principle(Soda lime) – CO2 + H2O = H2CO3 – H2CO3 + 2NaOH = Na2CO3 + 2H2O + Heat • Determination of Sodium Lime Failure – The particles become hard. – The granules become dry. – Indicator discoloration – CO2 concentration increased CO2 absorbent Breathing circuit
- 35. Manual Position Manual/Auto switch Mechanical position Breathing circuit
- 36. Used for monitoring the concentration of inspired oxygen Chemical fuel cell – The service life about 1 year in general. – Frequent calibration required(Air calibration, pure oxygen calibration) O2 cell Breathing circuit
- 37. • Passitive blowdown system PGSS – The pressure of the breathing circuit drives the exhaust gas to be discharged. – Connected to sewage pipes • Active blowdown system AGSS – Use the negative-pressure suction system of the hospital to discharge waste gas. – A large enough pneumatic tank is required to buffer the pressure. – A adjust valve is required to prevent excessive vacuum. – Adjustable exhaust gas flow Waste gas blowdown * Exhaust gas source: Drive gas of the ventilator, gas released from the Pop-off valve and Pop-off valve, and sampled gas for sidestream gas monitoring. Breathing circuit
- 38. • As a pneumatic valve, the weight of the membrane of the Pop-off valve generates extraneous PEEP.(2-4 cmH2O) • During inspiration, the drive gas forces the Pop-off valve to close and the bellows to descend, generating positive pressure ventilation. • The bellows rise during expiration. If the bellows rise to the top and the patient continues expiration, the Pop-off valve opens to release too high pressure (when the pressure is greater than 2.5cmH2O). The excess expired air enters the sewage system and is drained. Pop-off valve During inspiration Start Expiration End- expiratory Ventilator
- 39. 39 Operation training-VCV VCV： Tidal volume=constant flow*inspiration time Pressure related parameters: Tidal volume、compliance、resistance
- 41. 41 Operation training-VCV Ti Te Flow PEEP Paw Ppeak TV=Flow*time TV range：20~1500ml Steps：20~100ml : 5ml 100~300ml : 10ml 300~1500ml : 25ml
- 42. 42 Operation training-VCV Ti Te Flow PEEP Ppeak Paw Set Rate=15， Respiration time= 60/Rate = 4secs I:E =1：2 Inspiration time：1.33 sec Expiration time：2.66 sec
- 43. 43 Operation training-VCV Ti Flow Pplat Paw Te TIP:TI range： 5-60% Set Ti=4s，TIP:TI=25% TIP=1s
- 44. 44 Operation training-VCV Flow PEEP Paw Plimit Plimit range: 10~100ml Peep range：OFF,4~30cmH2O Plimit
- 45. 45 Under PCV mode, machine deliver gas to target pressure till inspiration time end. Tidal volume differs from patient’s lung compliance and resistance. No Tpause under PCV mode Operation training-PCV
- 48. 3. Introduction to Mindray AM
- 49. ü10.4 Touch Screen üPlug-in gas module ü… üOptimal flow indication(65 Optional) ü12.1 Touch screen üPCV-VG, SIMV-VG, CPAP/PSV üCO2+AG üBIS(65 Optional) ü… ü15.1 Touch screen üLung recruitment tool üNMT ü… üEFCS üOptimal flow indication üLung recruitment tool üNMT ü… ü15.1 Touch screen üOptimal flow indication üEFCS üPCV-VG, SIMV-VG, CPAP/PS ü… WATO EX-20 WATO EX-35 WATO EX-55/65 A5 A7 WATO EX-55Pro/65Pro Product Introduction of Mindray AM
- 50. WATO series: EX-20/25/30/35 EX-20/25 EX-30/35 Process Code 0615, 0616 0617, 0618 Screen 7 "LCD 8.4 inch LCD Patient circuit Transparent circuit Ventilation mode VCV,PCV,SIMV Module rack None Common upgrade items Monitoring bracket, O2 cell, negative-pressure suction AGSS, one-year/three-year maintenance kit EX-20/25/30/35 Product Introduction of Mindray AM
- 51. WATO series: EX-50/60 EX-50 EX-60 Process Code 0612(Old) 0614(New) 0611(Old) 0613(New) Screen 8.4 inch LCD 10.4-inch LCD screen, with touchscreen Patient circuit Metal circuit (old), transparent circuit (new) Ventilati on mode VCV,PCV,SIMV Module rack None Commo n upgrade items Monitoring bracket, O2 cell, one-year/three- year maintenance kit EX-50/60 Product Introduction of Mindray AM
- 52. WATO series: EX-55/65 EX-55 EX-65 Process Code 0622 old, 0624 new 0621 (old), 0623 (new) Screen 8.4 inch LCD(Old) 10.4 "LCD(Old) Patient circuit Transparent circuit (old), opaque nylon circuit (new), Support Pre-pak circuit Ventilation mode VCV,PCV,SIMV,PSV Module rack Yes Common upgrade items Ventilation mode, monitoring bracket, O2 cell, negative-pressure suction module, AGSS, CO2/AG/BIS (only 65 s) One-year/three-year maintenance kit EX-55/65 Product Introduction of Mindray AM
- 53. Basic Product Configuration Differences New EX-55 New EX- 65(0625) New EX- 55(0626) Screen size 12.1 12.1 Brake Central brake Independent brake Modular monitorin g(Optional) CO2 AG BIS CO2 AG Respiratio n Mode VCV PCV PS(Optional) PCV- VG(Optional) SIMV- VG(Optional) CPAP/PS(Opt ional) VCV PCV PS(Optional) New EX-65 Product Introduction of Mindray AM
- 54. Model A5 A7 Touch screen Yes Yes Screen size 15 " 15 " Pull table No Yes(Standard) Touch panel Yes Yes Breathing circuit type Prepak Prepak Anesthesia calculation(Optional) Yes Yes Quick release APL valve(Standard) No Yes Negative-pressure suction system(Optional) External Built-in Return of sampled gas No Yes ACGO Mechanical Mechanical and electrical control(Standard) EFCS No Yes Satellite Module Rack Yes Yes Hanging tower bracket Supported Supported Product Introduction of Mindray AM
- 55. 55 Product Line Introduction Model Process Code Equipment Condition Online Status MET-610 0610 Agent DAMECA anesthesia machine Stop Agent MET-810 0810 Agent DAMECA anesthesia machine Stop Agent MET-910 0910 Agent DAMECA anesthesia machine Stop Agent WATO EX-60(Old) 0611 Anesthesia machine SN: CH- YMxxxxxx Discontinued WATO EX-50(Old) 0612 Anesthesia machine SN: CJ- YMxxxxxx Discontinued WATO EX-60(New) 0613 Anesthesia machine SN: DE- YMxxxxxx Discontinued WATO EX-50(New) 0614 Anesthesia machine SN: DF- YMxxxxxx Discontinued
- 56. 56 Product Line Introduction Model Process Code Equipment Condition Online Status WATO EX-65-GI 0621 Anesthesia machine SN: DA-YMxxxxxx Discontinued WATO EX-5-GI 0622 Anesthesia machine SN: DB-YMxxxxxx Discontinued WATO EX-65-GII 0623 Anesthesia machine SN: ER-YMxxxxxx Discontinued WATO EX-55-GII 0624 Anesthesia machine SN: ES-YMxxxxxx Discontinued WATO EX-20 0615 Anesthesia machine SN: DW-YMxxxxxx Domestic and international WATO EX-25 0616 Anesthesia machine SN: DX-YMxxxxxx Domestic and international WATO EX-30 0617 Anesthesia machine SN: DY-YMxxxxxx Domestic and international WATO EX-35 0618 Anesthesia machine SN: EA-YMxxxxxx Discontinued
- 57. 57 Product Line Introduction Model Process Code Equipment Condition Online Status A5 0634 Anesthesia machine SN: FY-YMxxxxxx Launched internationally in 2011 A7 0635 Anesthesia machine SN: GC-YMxxxxxx Listed domestically and internationally in April 2013 A3 0633 Anesthesia machine SN: FA-YMxxxxxx Launched in USA in 2011 V60 0602 Mindray volatile tank Domestic and international OR-charting 0521 Standalone version SN FTA YYYY-MM xxxxxx Server SN FTB yyyy-mm xxxxxx 2013 Domestic and International WATO EX-65-GIII 0625 Anesthesia machine SN: KT-YMxxxxxx/ HX-YMxxxxxx Released in 2015 WATO EX-55-GIII 0626 Anesthesia machine SN: KU-YMxxxxxx HY-YMxxxxxx Released in 2015 New WATO EX-35 0619 Anesthesia machine SN: KG-YMxxxxxx Released in 2015 New WATO EX-25 0629 Anesthesia machine SN: X9-YMxxxxxx Released in 2015
- 58. 58 Product Line Introduction Model Process Code Equipment Condition Online Status WATO EX-65 PRO 0627 Anesthesia machine SN: KY-YMxxxxxx Released in 2016 WATO EX-55 PRO 0628 Anesthesia machine SN: F1-YMxxxxxx Released in 2016 A8/9 0646/0648 Released in 2020 WATO EX-65 2525 Released in 2021 WATO EX-55 2526 Released in 2021 WATO EX-65 PRO 2527 Released in 2021 WATO EX-55 PRO 2528 Released in 2021
- 59. THANKS！