Clinical Conference Anesthesia Machines don’t fail,
do they?
James H. Philip M(E)E, MD
Brigham and Women’s Hospital
October 30, 2002
© Copyright 2002, James H Philip, all rights reserved
Clinical Conference – Anesthesia Machines don’t fail, do they?
Case 1
57 yo F for Laparoscopy
PMHHypertension on Atenalol, GERD successfully Tx’s w Prilosec, Mild COPD.Otherwise healthy
5’2” 165# + COPD
Elect GETA
Plan Propofol, Succinylcholine, Tube, Desflurane, Vecuronium if necessary
Preparation
Resident starts IV
I check the Anesthesia Machine
Desflurane vaporizer is missing
I page Anes Tech
Tech and Vaporizer arrive
He attaches vaporizer
What do I do next?
I have added a vaporizer
Negative Pressure Leak Test
Where do I find the bulb?
Bottom Drawer of Anesthesia Machine
Is there anything wrong here?
Cable does better here
Negative Pressure Leak Test
OK
And, the Exclusion Interlock now works.
Remainder of Check out
What am I doing here?
What is my FGF set to?
What pressure am I trying to hold?
What pressure do I not want to exceed?
How big can the bag get?
Pressure = 30 cmH2O
Actually find minor leak
Tighten Expiratory Valve Cover
Resident brings patient to OR
Apply Monitors,
Apply Bair Hugger
Prepare to denitrogenate
What Fresh Gas Flow?
What Fresh Gas Flow?Oxygen onlyFIO2 > 80Flow keeps bag mostly full
Denitrogenate
Mask - Tight or Loose?
FGF - High or Low?
Pop-off valve - Open or Closed?
Selector Switch - Bag or Vent?
Select Bag, Pop off open
Patient feels smothered. Why?
Patient feels smothered. Why?
Airway pressure
What does it mean?
Select Bag, Pop off open
What is good about the bellows?
What is bad about the bellows?
What is good about the bellows?
Low opening pressure
What is good about the bellows?
What is bad about the bellows?Low opening pressure
Tachycardia and Hypertension
What is good about the bellows?
What is bad about the bellows?Low opening pressure
Tachycardia and HypertensionIn the anesthesiologist
Who feels total obstruction
Select Bag, Pop off open
Smothered again!
What can I do?
Remove Reservoir Bag
Difficult to ventilate
Slow Exhalation
What should I do?
Decide to Intubate
Airway Pressure normal?
Ventilate and Monitor gases
Expiratory Valve - Missing O Ring
How did this happen?
PEEP Valve incorrectly removed
Note that Cage and Valve are depressed !
Replace valve, cage, o-ring
Normal airway pressure curve
Normal ventilation
Unremarkable case
Patient went home in time for Lunch !
Who ya’ gonna call
OR Biomedical Engineering
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