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  • image Equipment-related adverse outcomes are rarely due to device malfunction or failure; rather, misuse of anesthesia gas delivery systems is three times more prevalent among closed claims. An operator’s lack of familiarity with the equipment, an operator’s failure to verify machine function prior to use, or both are the most frequent causes. Such mishaps accounted for about 1% of cases in the ASA Closed Claims Project database from 1990 to 2011.

  • image The anesthesia machine receives medical gases from a gas supply, controls the flow and reduces the pressure of desired gases to a safe level, vaporizes volatile anesthetics into the final gas mixture, and delivers the gases to a breathing circuit that is connected to the patient’s airway. A mechanical ventilator attaches to the breathing circuit but can be excluded with a switch during spontaneous or manual (bag) ventilation.

  • image Whereas the oxygen supply can pass directly to its flow control valve, nitrous oxide, air, and other gases must first pass through safety devices before reaching their respective flow control valves. These devices permit the flow of other gases only if there is sufficient oxygen pressure in the safety device and help prevent accidental delivery of a hypoxic mixture in the event of oxygen supply failure.

  • image Another safety feature of anesthesia machines is a linkage of the nitrous oxide gas flow to the oxygen gas flow; this arrangement helps ensure a minimum oxygen concentration of 25%.

  • image All modern vaporizers are agent specific and temperature corrected, capable of delivering a constant concentration of agent regardless of temperature changes or flow through the vaporizer.

  • image A rise in airway pressure may signal worsening pulmonary compliance, an increase in tidal volume, or an obstruction in the breathing circuit, tracheal tube, or the patient’s airway. A drop in pressure may indicate an improvement in compliance, a decrease in tidal volume, or a leak in the circuit.

  • image Traditionally ventilators on anesthesia machines have a double-circuit system design and are pneumatically powered and electronically controlled. Newer machines also incorporate microprocessor controls and sophisticated pressure and flow sensors. Some anesthesia machines have ventilators that use a single-circuit piston design.

  • image The major advantage of a piston ventilator is its ability to deliver accurate tidal volumes to patients with very poor lung compliance and to very small patients.

  • image Whenever a ventilator is used, “disconnect alarms” must be passively activated. Anesthesia workstations should have at least three disconnect alarms: low peak inspiratory pressure, low exhaled tidal volume, and low exhaled carbon dioxide.

  • image Because the ventilator’s spill valve is closed during inspiration, fresh gas flow from the machine’s common gas outlet normally contributes to the tidal volume delivered to the patient.

  • image Use of the oxygen flush valve during the inspiratory cycle of a ventilator must be avoided because the ventilator spill valve will be closed and the adjustable pressure-limiting (APL) valve is excluded; the surge of oxygen (600–1200 mL/s) and circuit pressure will be transferred to the patient’s lungs.

  • image Large discrepancies between ...

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