Anaesthetic circuits

Samantha Morgan

Aim
To provide an overview of anaesthetic circuits

Objectives
By the end of the session students should be able to;
Describe Endotracheal intubation List advantages and disadvantages of Endotracheal intubation Recognise the common anaesthetic circuits Calculate the fresh flow rate of patients on the different circuits Perform a safety test on an anaesthetic machine

Endotracheal intubation
Ensuring a patent airway Ideally the tube should extend from the incisor to a point level with the spine of the scapula. Surplus dead space is minimised by cutting off the projecting tube. Choose the maximum tube diameter appropriate to the patient to minimise resistance to air flow

Intubation
The jaws must be relaxed and laryngeal reflexes suppressed before intubation is attempted. Laryngeal reflexes in cats persist to relatively deep level of anaesthesia, and laryngospasm is not uncommon. Lignocaine is used to depress this spasm.

Advantages of Endotracheal intubation

Airway protection Allows positive pressure ventilation Reduces waste-gas pollution Reduces anatomical dead space.

Disadvantages of Endotracheal intubation

Airway resistance Kinking or occlusion possible Traumatic laryngitis Chemical/ischemic tracheitis Apparatus dead space Endobronchial intubation Surgical interference from the tube.

Endotracheal tubes
Magill tube 3 mm to 40 mm internal diameter plain or with an inflatable cuff Can also be made from PVC (Portex)

Endotracheal tubes
Endobronchial intubation
Inserted into one of the main stem bronchi arterial hypoxemia cyanosis laboured breathing uptake of the inhalation anaesthetic agent may be impaired

Endotracheal tubes
Impaction
Tip of the tube against the tracheal wall The Murphy eye

Endotracheal tubes
Herniation of the cuff

Compression of the lumen

Endotracheal tubes
Stretching of the tracheal wall
Tracheitis Pressure necrosis of the tracheal wall Tracheal rupture.

Endotracheal tube check

Correct size Check patency Check cleanliness Check cuff and balloon are functioning Ensure adequate lubrication to avoid mucosal trauma.

Laryngeal Masks
1980s Alternative to endotracheal intubation Difficulties in producing a gas-tight seal in animal patients Considerable cost

Mask inductions-advantages
Do not damage the airway Produce smooth induction when patients are depressed or heavily sedated.

Mask inductions-disadvantages
Causes resistance/anxiety to poorly sedated patients Mask increases mechanical dead space Limited ventilator support during IPPV Greater atmospheric pollution.

Circuits
Used to deliver anaesthetic agents Can be classified as rebreathing and nonrebreathing Ventilation
Inspiration Expiration End expiratory pause

Calculations
Tidal volume
10-15mls x Bodyweight (kgs)

Respiratory minute volume

Tidal volume x respiratory rate (BPM)

How do we end up with circuit factors?....

By calculating the resistance of the circuit Tube diameter alters the resistance Corrugated tubing has a greater pull Flushing the system

Reservoir bags
The volume should be 3-6 times the patients tidal volume. Oversized bags increase circuit volume Inadequately sized bags collapse during large breaths and over distended during expiration. For small animal use, 2,4 and 6 litre bags are required.

Circuits
To and fro rebreathing Circle
Ayres tpiece Bain Humphrey ADE Nonrebreathing Magill Lack

Ideal breathing system

Simple, safe and inexpensive Delivers intended inspired gas mixture Permits spontaneous, manual and controlled ventilation in all age groups Efficient, allows low fresh gas flow Protects patient from barotrauma Sturdy, compact, lightweight Permits easy removal of gases

Rebreathing circuits
Exhaled gases are collected and the exhaled CO2 is removed
Sodalime

Flow rate is approximately 10mls/kg/min

5-

Advantage of re-breathing circuits

Low flow rate Cheaper to run Lower theatre contamination Less anaesthetic agent requirements.

Disadvantages of re-breathing circuits

Respiratory tract irritation Heavy Need to check soda lime Heat produced Higher resistance.

De-nitrogenation
Patients expire considerable volumes of nitrogen Lowers circuit oxygen levels Use high flow rates for the first 10-15 mins of anaesthesia or Empty the reservoir bag every 3 minutes for the first 15 minutes.

To and Fro
Bidirectional flow improves CO2 scrubbing efficiency Greater heat conservation Lower low circuit volume Can roll off table Suitable for patient over 7kgs Valve position is inconvenient for IPPV

Circle circuit
High gas efficiency Less circuit inertia unlike to and fro Can be expensive and cumber some For animals over 5-10kgs Unidirectional flow is dependant on the valves.

Soda lime
Baralyme Soda lime
94% calcium hydroxide 5% calcium hydroxide 1% potassium hydroxide

Water pH sensitive dye

Soda lime
Two types
White to purple Pink to white

Exhausted after about 8 hours

Colour change will disappear!

Non-rebreathing circuits
Rely on adequate gas flow rate
remove carbon dioxide from the circuit avoid re-breathing of expired gas.

Ayres T piece
Jackson-Rees modification Circuit factor 2.5-3 x minute volume

Ayres T Piece
Minimal apparatus, dead space and resistance Simple and inexpensive Good for IPPV Fresh gas flow (FGF) is high Need the modified system to scavenge effectively Afferent reservoir system

Magill
Circuit factor 1-1.5 x minute volume

Magill
For use in dogs greater than 8kgs If no end expiratory pause you can get mixing of gases Cumbersome at patient end as scavenging attaches there Inexpensive Efferent reservoir system

Bain
Circuit factor 2.5-3 x minute volume Useful circuit for IPPV Basically same as Ayres Watch frequently the inner tube becomes disconnected, kinked and leaks! Afferent reservoir system

Lack
Circuit factor 1-1.5 x minute volume

Lack
For dogs over 10kgs Similar to Magill but with the valve more conveniently placed Should not be used for prolonged IPPV Afferent reservoir system

Mini Lack
Smaller version of standard Alternative to Ayres Bodyweight range 1-10kg

Circuit factor 1-1.5 x minute volume

Humphrey ADE
Has three different modes
Semi-closed system for under 7-10kg Recycling for over 7-10kgs Ability to connect a ventilator

Fresh gas flow recommendations (after induction)- MINIMUM 300ml/min

Cats

70-100 ml/kg/min semi closed without absorber

Dogs under 10kgs

70-100 ml/kg/min semi closed without absorber

Dogs over 10kgs

30ml/kg/min induction recycling with soda lime canister 10ml/kg/min maintenance

Anaesthetic machine check

Open the oxygen cylinder valve Slowly anticlockwise

Anaesthetic machine check

Check the registered quantity of oxygen on the pressure dial

Anaesthetic machine check

Turn on the oxygen flow meter control to check smooth function Turn it off after this

Anaesthetic machine check

Press the emergency oxygen flush button

Anaesthetic machine check

Attach the in use label to oxygen cylinder

Anaesthetic machine check

Check the vaporiser percentage dial to ensure it turns easily

Anaesthetic machine check

Check the level of the volatile agent in the vaporiser