good morning everybody my sister is dr hasan kaur senior resident in the department of mawlana medical college under the guidance of dr ram navin prasad sir i want to discuss with you and see their machine which is a very very important topic this will discuss it's in two parts first the boil separators and the modern anesthesia machine one by one will go with each indicator thank you so what is first of all an anesthesia machine anesthesia machine is a machine which delivers a fixed proportion of mixture of gases which includes both the life sustaining gases and the anesthetic gases the anesthetizing gases include isofluorine sibo fluorine death touring and the life-sustaining gases include oxygen so they will give a fixed proportion to the patient today's anesthesia machine was first of all designed in 1970 popularly known as goethe which was introduced by edmund gaskin boyle in 1970. now the today's machines are known as workstations what is the workstation which includes both the life-sustaining gases and starting gases the techniques for scavenging everything and a record keeping system this is all the parts of a work station now first of all before i start discussing the machine there is a pressure system which has to be discussed which includes the high pressure system intermediate pressure system and the lower pressure system higher pressure system please remember it has oxygen at 2000 psig and nitrous oxide at 760 psi this oxygen and nitrous oxide when they come to the level of machine from that high pressure system it has to be reduced by reducing well to uh in the low pressure system we have the slenders and the pipelines which include cylinders have a psig of 45 to 50 and the pipelines have 40 to 50 psi from so from 2000 to 40 to 50 there are reduces well which will reduce and the last is the low pressure now first of all what are the three parts of high pressure system high pressure system includes the hanger use assembly the pressure reducing valve and the gauges these three strings hanger yoke assembly which is for fitting the slender the gauges which will tell the cylinder pressure gauges and the pressure reducing valve this one pressure reducing valve is for oxygen and the other side this pressure reducing valve this pressure gauge is for nitrous oxide so if three things are going to be disclosed in high pressure it is going to be hanging out gauges and the reducing valve so just first pressure regulator these three things are included in the high pressure system when we come into the low pressure system low pressure system has a psig of just five to eight psig above that mosfet pressure it includes five things in it this api valve pressure limiting valve is included in the low pressure system this back bar on which the vaporizers are mounted this is included in the low pressure second thing is vaporizers the third thing is this flow control knobs these are included in the low pressure system the common gas outlet this is included in the low pressure system apart from these three things which i discussed in the high pressure system and these fighters which are discussed in the lower energy system everything else belongs to intermediate pressure system so if someone asks me what is it intermediate it is intermediate pipeline inlet connections are intermediate [Music] so just three things in the high pressure five things in the low pressure rest everything is intermediate precious so starting with first of all the slender the high pressure system the high pressure system this is the hangar yoke assembly this is the swivel gate through which we can fix the cylinder the cylinder has a nipple on itself so which it can fix to the hanger yoke assembly from the slender the gas punches into the machine this cylinders they are also included in this uh intermediate pressure system now when they come on to this this is the pressure reducing well that will reduce 2000 psig or 780 psig of nitrous to the 45 to 50 psig pressure this is the pressure regulator which is going to reduce it pressure reducing that and is making a pressure this will be told by those gauges okay now from here the gas enters this enters here from the pressure regulator and from here it goes to the flow meters there these are the flow meters these flow meters will have nitrous and oxygen it will take the life sustaining gases from your oxygen and nitrous and then from here it comes back down and here is the circuit which switches this machine into open or closed so from here this is the open circuit and this part from here going towards this this part this there the soda line canisters the gas goes inside this and then into this expiratory and inspiratory wells then to the patient this is a closed circuit this closed circuit can be turned on from this this is open and this is closed so we can turn this machine from open circuit to a closed circuit which will include all of this parts this new parts in today's language it is circle system which will include the inspiratory valve expiratory valve soda line canisters apl valves so this all comes in the closer here there is the oxygen flush valve see as we can see the oxygen is coming from here this is the pressure regulator from which it is going after this this oxygen this is the oxygen valve through which it is having a flow of 35 to 75 liter per minute oxygen flush valve is very important for emergency situations when the patient is desaturated but there are many results of oxygen flush press since the oxygen is flowing at a flow rate of 35 to 75 meter per minute so this large pressure it can cause barrel drop it can cause an electrodrome there can be accidental leakage from this oxygen flush well there can be some thing which fixes it up so these are all the side effects of the oxygen flashlight so as you can see in this machine these were the pressure gauges these were the pressure generators this is the circuit which is shifting it into closed and open circuit this is oxygen flush well this is the part this is the part of open circuit where we can attach the breathing circuit so here the breathing circuits can be attacked we can attach green spool we can attach any kind of curve to it now coming on to this after this this is when this comes out here this is the nitrous which is coming here and from this side we can see this is the oxygen which is coming in this system is known as nitro log system what is nitro log system nitro log system works on the principle that if oxygen falls below a particular psip nitrosoxide does not carry this level is fixed in different machines are different in detects on the in other machines it will have 30 psi or 38 psip whenever oxygen falls below that level nitrous oxide does not get sleek it is actually a master of slaver's animal in which the master is oxygen and the slave is nitrous oxide coming from here this is the richter whistle richter whistle is an alarm which comes as soon as oxygen falls below 30 psig within 5 seconds this whistle starts alarming this whistle is for seven seconds which shows that if oxygen will fall below that level machine will give an alarm this is oxygen fail safe device mechanism which is here apart from that this machine has many safety features and a senior machine has many safety features why are they so that excellently also we do not give long gas to the patient so if i start with the safety features of the machine first of all these leaves these beads which are black in color these are anti-static in nature to prevent any electricity conduction then there is a block which is called so that the machine stays at one place there is a lock in this machine then coming on to the cylinders these cylinders are curly coated as we can see this oxygen cylinder is black body and white shoulders and the nitrous of side slender it's blue bodies slender the carbon dioxide slenders are gray in color the helium cylinders are brown in color and the air cylinders they are opposite to this they are white body and black so this is all current coating of the cylinder so that we do not attach the wrong side even if you attach by somewhere there is some mixing there is a pin in that safety system in this machine what is spin index jfp system that only a particular cylinder with a particular pin can attach him for we can say one five uh it is air for two five it is oxygen for three five it is nitrous for one six it is carbon dioxide less than seven percent for one so first which are coming from the outlets that is according to this index system diameter index safety system so that only a particular pipeline can attach in a particular circuit so coming on to the next uh as you can see these pressure bases they are also color coded white black for oxygen and blue for nitro so that even if there is some problem or some electricity is less in the you can see it properly today's flow meters are also light then close the light in itself so that if electricity goes you can at least see coming on to the flow meters if we see the safety feature here the nitrous oxide and oxygen they are again color coded white and blue the flow meters also have a bobbin which is of blue and golden color which again you show that then the striations on these are also different so that we can have a feature then again this is having broad striations in between and these are very very thin striations so that even the touch coded is also there then coming on here to the vaporizers as you can see the vaporizers are also color coded the isofluorine is blue in color and the silver fluorine it is also yellow in color and the best different color these are again so that we do not mix the vaporizers this filling of the vaporizers is also by different ways so that uh rightly the prices can be filled with the right anesthetizing glasses here there is a selector tech arrangement in the vaporizer what is this selector attack arrangement this is that when one vaporizer is open you cannot open the second vaporizer at the same time which means that you can open only one vaporizer at one time that is known apl arrangement which is a pressure reducing valve again a safety feature pop-up valve is also known as so that if there is excess pressure this pop-up valve like a whistle in a cooper it's going to pop off and all the excess gas will be out from here as you can again see here this is also the safety feature of the machine that master slave mechanism of the nitrous oxide and oxygen so that patient does not have a hypoxia richety whistle and oxygen field safety fights these are all the preventive measures so that we do not have hypoxia location apart from these there are also other safety features like in the pipeline we discuss cylinders vaporizers uh in the pressure and using well these are all the safety features of the machine now discussing with you this soda lime canister what is soda like chemistry this is uh soda lime chemistry that are added to provide l-cell energy as you all know sodium hydroxide is alkaline in nature what it is going to do it is going to absorb carbon dioxide so sodium hydroxide plus carbon dioxide it is going to form soda vitamin that would be four of the circuit alkaline in nature this uh has produced of sodium hydroxide barium uh there are two types sodaline and beverage in sodaline we have sodium hydroxide calcium hydroxide and water in there line we have very microoxide also included in it these are put in granule small sizes so that uh [Music] whenever gas passes through it there can be more surface area for the gas to give out its carbohydrate had between just one block the surface area would have been less so more the number of venues more will use the surface area for absorption of carbon dioxide and silica is added to for hardness in this circuit and these are more the mesh size more will be the absorption of carbon dioxide now so again concentration with our boiled apprentice as we were discussing i want to show you the modern anesthesia this modern anesthesia machine has been modified electrically pneumatically and mechanically by the volunteer figures so first of all we'll discuss the electrical modifications in the electrical cord which is starting with the master switch this master switch is electrical switch this can be pulled on and off of the machine this electrical switch has a ups which is attached like a ups we have in our common processing unit so that if by chance the back supply goes off there's a reserve power with the machine and the machine can remain outlet which you can see at the back of the machine these electrical ports are for attaching the circuits as i had discussed with you high pressure system has hanger yoke assembly so this hanger loop assembly is in this modern and a serial machine this is hanger yoke assembly which is giving an attachment to the cylinders this is a part of high pressure system but the slender pressure regulators and the gauges which we could see in the boilerplates are not visible in this machine again this is the pipeline which were coming which were not in that machine these pipelines as i told you are color coded these are color coded for nitrous air and oxygen so this color coding of the pipeline this pipeline comes out here as i had already told you that this pipeline pressure it comes in the intermediate pressure system so this is the part of intermediate pressure system where the pipelines are at the psig of 45 to 50 psig so this is the part of a high pressure system this is the intermediate pressure system which we can see and coming on to the last low pressure system as i had already told you the flow control knobs are no longer this is the mounting system of the vaporizer which is a part of low pressure system apl valve is there which is a part of low pressure system and a common gas outlet is there which is again a part of low pressure system there is also an auxiliary oxygen control that if the backups if the oxygen is not working there is an auxiliary oxygen supply which can work for that much time this is the oxygen flush valve as we had discussed oxygen flush valve is a part of intermediate pressure system has a flow of 35 to 75 liter per minute this is oxygen flush well for this modern machines and this is the common gas outlet this is the circuit which is for turning this machine into open and closed type so again this is the this and uh this apl valve also has a part where we can hand ventilate the patient and machine ventilation so this circuit is for hand and machine ventilation this hole this part which comes here is the circle system that has the inspiratory valve expiratory valve the whole circuit to the patient it goes on to the patient these are the piping which are going to connect to the patient so this is there and apart from this going in the circle system is this soda line canister as we have discussed soda lime chemistry inspiratory valve expiratory valve apl well for turning it into a hand and back position all of these are parts of circle system which come in the modern and simple machine this modern anesthesia machine is actually a work station this workstation has all the energizing glasses life sustaining acid oxygen and the part this is the whenever the patient is on ventilator he's under general anesthesia we can see the oxygen and nitrous oxide which we used to see in the flow meters this nitrous oxide is blue which is again a safety feature this oxygen is white here we can see the flows at later per minute at which the oxygen and nitrous oxide are going we can also read here that oxygen is forty percent and the total flow which is going is two liter two liters per flow is actually today's low flow anesthesia which is for better scavenging and decreasing the ot pollution this is the ventilator mode on which the patient is going which shows the volume control mode at what tidal volume what respiratory rate inspiratory expertise and what p positive expiratory pressure has been applied to the patient this is the p peak which is the airway pressure at this time the flow minute ventilation of the patient which is 4 to 5.6 this is the end tidal carbon dioxide which is very important monitor again so we'll discuss all of these monitors and rest of the parts of machine in details in further class this is a basic introductory class for telling you the parts of the anesthesia and seeing those in the body and in the modern anesthesia machine further classes will discuss each of those parts and