Essentials of Equipment in Anaesthesia, Critical Care and Perioperative Medicine, 5th Edition

Front Cover
Inside Front Cover
Essentials of Equipment in Anaesthesia, Critical Care, and Peri-Operative Medicine
Copyright
Contents
Preface
Acknowledgements
Chapter 1: Medical gas supply
Gas supply
Cylinders
Components
Problems in practice and safety features
Cylinder valves
Components
Mechanism of action
Problems in practice and safety features
Piped gas supply
Components
Problems in practice and safety features
Sources of gas supply
Cylinder manifold
Components
Mechanism of action
Problems in practice and safety features
Liquid oxygen
Components
Mechanism of action
Problems in practice and safety features
Oxygen concentrators
Components
Mechanism of action (Fig. 1.25)
Problems in practice and safety features
Entonox
Problems in practice and safety features
Compressed air
Centralized vacuum or suction system (Fig. 1.28)
Components
Mechanism of action
Problems in practice and safety features
Self-assessment questions
MCQs
Suggested further reading
Chapter 2: The anaesthetic machine
Pressure gauge
Components
Mechanism of action
Problems in practice and safety features
Pressure regulator (reducing valve)
Components
Mechanism of action
Problems in practice and safety features
Second-stage regulators and flow restrictors
One-way valve or backflow check valves
Flow control (needle) valves
Components
Flowmeters
Components
Mechanism of action
Problems in practice and safety features
Vaporizers
Plenum vaporizer (Fig. 2.17)
Components
Mechanism of action
Problems in practice and safety features
Vaporizer filling devices
Non-return pressure relief safety valve
Emergency oxygen flush
Problems in practice and safety features
Compressed oxygen outlet(s)
Oxygen supply failure alarm
Common gas outlet (Fig. 2.29)
Other modifications and designs
Anaesthesia in remote areas
Components
Mechanism of action
Problems in practice and safety features
Suggested further reading
Chapter 3: Pollution in theatre and scavenging
Scavenging
Passive system
Components
Mechanism of action
Problems in practice and safety features
Active system
Components
Mechanism of action
Problems in practice and safety features
Charcoal canisters (Cardiff Aldasorber)
Components
Mechanism of action
Problems in practice and safety features
Suggested further reading
Chapter 4: Breathing systems
Properties of the ideal breathing system
Components of the breathing systems
Adjustable pressure limiting (APL) valve
Components
Mechanism of action
Problems in practice and safety features
Reservoir bag
Components
Mechanism of action
Problems in practice and safety features
Tubings
Mapleson classification
Magill system (Mapleson A)
Components
Mechanism of action
Problems in practice and safety features
Lack system (Mapleson A)
Components
Mechanism of action
Mapleson B and C systems (Figs 4.1 and 4.8)
Components
Mechanism of action
Bain system (Mapleson D)
Components
Mechanism of action
Problems in practice and safety features
T-piece system (Mapleson E and F)
Components
Mechanism of action
Problems in practice and safety features
The Humphrey ADE breathing system
Components
Mechanism of action
The circle breathing system and soda lime
Components
Mechanism of action
Use of vaporizers in the circle breathing system
Problems in practice and safety features
Waters canister (‘to-and-fro’) bidirectional flow breathing system
Suggested further reading
Chapter 5: Tracheal tubes, tracheostomy tubes and airways
Tracheal tubes
Features of tracheal tubes (Fig. 5.1)
Size
The bevel
The cuff
High-pressure/low-volume cuffs
Low-pressure/high-volume cuffs
Route of insertion
Connectors
Problems in practice and safety features
Specially designed tracheal tubes
Oxford tracheal tube
Armoured/reinforced tracheal tube
Polar and Ring, Adair and Elwyn (RAE) tracheal tubes
Laser-resistant tracheal tubes
Evoked potentials tracheal tubes (Fig. 5.16)
Microlaryngeal tube
Tracheostomy tracheal tubes
Components
Problems in practice and safety features
The fenestrated tracheostomy tube (Fig. 5.21)
Laryngectomy (Montandon) tube
Tracheostomy speaking valve (Fig. 5.23)
Tracheostomy button (Fig. 5.24)
Percutaneous tracheostomy tubes
Minitracheostomy tube
Components
Mechanism of action
Problems in practice and safety features
Cricothyrotomy tube (Fig. 5.28)
Components
Mechanism of action
Problems in practice and safety features
Double lumen endobronchial tubes
Components
Mechanism of action
Tube positioning
Endobronchial blocker
Components
Mechanism of action
Oropharyngeal airways
Components
Mechanism of action
Problems in practice and safety features
Nasopharyngeal airway
Components
Mechanism of action
Problems in practice and safety features
Supraglottic airway devices
Laryngeal mask airway
Components
Mechanism of action
The intubating laryngeal mask airway (ILMA)
Problems in practice and safety features
i-gel airway
Components
Mechanism of action
Problems in practice and safety features
AuraGain airway
COBRA perilaryngeal airway (PLA)
Suggested further reading
Chapter 6: Masks and oxygen delivery devices
Face masks and angle pieces
Components
Mechanism of action
Problems in practice and safety features
Nasal masks (inhalers)
Catheter mount
Components
Mechanism of action
Problems in practice and safety features
Oxygen delivery devices
Variable performance masks (medium concentration; MC)
Components
Mechanism of action
Problems in practice and safety features
Nasal cannulae
Components
Mechanism of action
Problems in practice and safety features
Nasal catheters
Open oxygen delivery systems
Fixed performance devices
Venturi mask
Components
Mechanism of action
Problems in practice and safety features
Humidified high-flow nasal oxygenation (Fig. 6.16)
Components
Mechanism of action
Problems in practice and safety features
Suggested further reading
Chapter 7: Laryngoscopes and tracheal intubation equipment
Laryngoscopes
Components
Mechanism of action
Problems in practice and safety features
Fibreoptic intubating laryngoscope
Components
Mechanism of action
Problems in practice and safety features
Videolaryngoscopes (rigid indirect laryngoscopes)
Magill forceps
Introducer, bougie, bite guard, local anaesthetic spray, Endotrol tube and Nosworthy airway
Retrograde intubation set (Fig. 7.17)
Components
Mechanism of action
Problems in practice and safety features
Suggested further reading
Chapter 8: Ventilators
Classification of ventilators
Characteristics of the ideal ventilator
Manley MP3 ventilator
Components
Mechanism of action
Problems in practice and safety features
Penlon Anaesthesia Nuffield Ventilator Series 200
Components
Mechanism of action
Problems in practice and safety features
Bag in bottle ventilator
Components
Mechanism of action
Problems in practice and safety features
Servo-U ventilator
Components (Fig. 8.6)
Mechanism of action
Problems in practice and safety features
High-frequency jet ventilator
Components
Mechanism of action
Problems in practice and safety features
VentiPAC
Components
Mechanism of action
Problems in practice and safety features
Pneupac VR1 Emergency Ventilator (Fig. 8.11)
Components
Mechanism of action
Problems in practice and safety features
Venturi injector device
Components
Mechanism of action
Problems in practice and safety features
Self-inflating bag and mask
Components
Mechanism of action
PEEP valve
SUggested further reading
Chapter 9: Humidification and filtration
Heat and moisture exchanger (HME) humidifiers
Components
Mechanism of action
Problems in practice and safety features
Hot water bath humidifier
Components
Mechanism of action
Problems in practice and safety features
Nebulizers (Fig. 9.6)
Gas-driven (jet) nebulizer
Components
Mechanism of action
Spinning disc nebulizer
Ultrasonic nebulizer
Bacterial and viral filters
Components
Mechanism of action
Electrostatic filters (Fig. 9.8)
Pleated hydrophobic filters (Fig. 9.9)
Vapor-Clean filters
Suggested further reading
Chapter 10: Non-invasive monitoring
Integrated monitoring
Electrocardiogram (ECG)
Components
Mechanism of action
Problems in practice and safety features
Arterial blood pressure
Components
Mechanism of action
Problems in practice and safety features
The Von Recklinghausen oscillotonometer
Components
Mechanism of action
Problems in practice and safety features
Pulse oximetry
Components
Mechanism of action
Problems in practice and safety features
End-tidal carbon dioxide analysers (capnographs)
Components
Mechanism of action
Side-stream analysers
Main-stream analyser
Uses (Table 10.5)
Problems in practice and safety features
Oxygen concentration analysers
Paramagnetic (Pauling) oxygen analysers
Components
Mechanism of action (Fig. 10.24)
The galvanic oxygen analyser (Hersch fuel cell)
Polarographic (Clark electrode) oxygen analysers
Problems in practice and safety features
Nitrous oxide and inhalational agent concentration analysers
Components
Mechanism of action
Piezoelectric quartz crystal oscillation
Problems in practice and safety features
Mass spectrometer
Wright respirometer
Components
Mechanism of action
Problems in practice and safety features
Pneumotachograph
Components
Mechanism of action
Problems in practice and safety features
Combined pneumotachograph and Pitot tube
The Pitot tube
Components
Mechanism of action
Problems in practice and safety features
Ventilator alarms
Pressure monitoring alarm
Components
Mechanism of action
Problems in practice and safety features
Volume monitoring alarm
Peripheral nerve stimulators and neuromuscular blockade monitoring
Components
Mechanism of action
Neuromuscular transmission monitoring
Problems in practice and safety features
Bispectral index (BIS) analysis
Components
Mechanism of action
Problems and safety features
Entropy of the EEG
Suggested further reading
Chapter 11: Invasive monitoring
Invasive arterial pressure monitoring
Components
Mechanism of action
The arterial pressure waveform (Fig. 11.7)
The natural frequency
Problems in practice and safety features
Central venous catheterization and pressure
Pressure transducer
Fluid manometer (Fig. 11.13)
Catheters
Multilumen catheter
Long central catheters/peripherally inserted central catheters (PICC)
Hickman catheters
Dialysis catheters
Problems in practice and safety features
Invasive electrocardiogram (ECG)
Cardiac output
Balloon-tipped flow-guided PA catheter
Components
Mechanism of action
Information gained from PA catheter
Problems in practice and safety features
Oesophageal Doppler haemodynamic measurement
Components
Mechanism of action
Problems in practice and safety features
LiDCOrapid
Components
Mechanism of action
Problems in practice and safety features
Masimo
Temperature probes
Thermistor
Components
Mechanism of action
Problems in practice and safety features
Infrared tympanic thermometer
Components
Mechanism of action
Problems in practice and safety features
Thermocouples
Components
Mechanism of action
Suggested Further Reading
Chapter 12: Pumps, pain management and regional anaesthesia
Patient-controlled analgesia (PCA)
Components
Mechanism of action
Problems in practice and safety features
Syringe pumps
Volumetric pumps
Target-controlled infusion pumps
Elastomeric pumps
Components
Mechanism of action
Problems in practice and safety features
Epidural needles
Components
Mechanism of action
Problems in practice and safety features
Epidural catheter, filter and loss of resistance device (Fig. 12.9)
The catheter
Components
Mechanism of action
Problems in practice and safety features
The filter (see Fig. 12.10)
Loss of resistance device or syringe
Spinal needles
Components
Mechanism of action
Problems in practice and safety features
Dural headache
Spinal microcatheters
Nerve block needles
Components
Mechanism of action
Insulated needles
Non-insulated needles
Percutaneous localization of nerves
Nerve stimulator for nerve blocks
Components
Mechanism of action
Problems in practice and safety features
Ultrasound guidance in regional anaesthesia
Suggested Further Reading
Chapter 13: Additional equipment used in anaesthesia and intensive care
Continuous positive airway pressure (CPAP)
Components
Mechanism of action
Problems in practice and safety features
Haemofiltration
Components
Mechanism of action
Problems in practice and safety features
Arterial blood gas analyser (Fig. 13.5)
Polarographic (Clark) oxygen electrode
Components
Mechanism of action
Problems in practice and safety features
pH electrode
Components
Mechanism of action
Problems in practice and safety features
Carbon dioxide electrode (Severinghaus electrode)
Components
Mechanism of action
Problems in practice and safety features
Intra-aortic balloon pump (IABP)
Components
Mechanism of action
Problems in practice and safety features
Intravenous giving sets
Components
Intravenous cannulae
Blood warmers
Forced-air warmers (Fig. 13.18)
Defibrillator
Components
Mechanism of action
Problems in practice and safety features
Chest drain
Components
Mechanism of action
Problems in practice and safety features
The ultrasound machine (Fig. 13.27)
Components
Mechanism of action
Problems in practice and safety features
Suggested Further Reading
Chapter 14: Point-of-care testing
Introduction
HemoCue
Components
Mechanism of action
Problems in practice and safety features
Hemochron Junior
Components
Mechanism of action
Problems in practice and safety features
Original TEG/ROTEM
Background
How it works
TEG 6s
Components
Mechanism of action
Problems in practice and safety features
Suggested further reading
Chapter 15: Electrical safety
Principles of electricity (Fig. 15.1)
Electric current (I)
Potential difference or voltage (V)
Electrical resistance (R)
Impedance (Z)
Ohm’s law
Capacitance
Inductance
Identification of medical electrical equipment
Class I equipment
Class II equipment
Class III equipment
Type B equipment
Type BF equipment
Type CF equipment
Attention!
Protective earth
Functional earth
Additional protective earth
Equipotentiality
Drip proof, splash proof, water tight
Anaesthetic-proof equipment
Anaesthetic-proof equipment category G
CE
Isolated or floating circuit
Current-operated earth leakage circuit breakers (COELCB)
Maintenance of equipment
Hazards of electrical shock
The effects of electrocution
Resistive coupling
Diathermy
Components
Mechanism of action
Problems in practice and safety features
Static electricity
Lasers
Problems in practice and safety features
Airway laser surgery
Suggested Further Reading
Appendices
Appendix A
Safety and standards
Checking anaesthetic equipment
Recommendations for standards of monitoring during anaesthesia and recovery
Appendix B
Appendix C
Decontamination of medical equipment
Clean, disinfect or sterilize instruments?
Cleaning
Manual cleaning
Disinfection
Sterilization
Sterilization monitoring
Single-use items
Suggested further reading
Appendix D
Directory of manufacturers
Ambu
Anaequip UK
B Braun Medical Ltd
BD
Blease Medical Equipment Ltd
Blue Box Medical Ltd
BOC Healthcare
Chart Biomedical Ltd
Cook Medical
Covidien plc
Dräger Medical UK Ltd
Dynasthetics
Gambro Lundia AB
GE Healthcare
Gradian Health Systems
Halyard
Intersurgical
MANA-TECH LTD
Maquet Ltd
Olympus Keymed (Medical & Industrial Equipment) Ltd
Penlon Ltd
Philips HealthCare
Proact Medical LTD
Radiometer Ltd
Rimer Alco Ltd
Siemens Healthcare
Smiths Medical
Teleflex
Verathon Medical United Kingdom Ltd
Vygon (UK) Ltd
Zoll Medical UK
Glossary
Gas laws
Index
Inside Back Cover