anesthesia machine

麻酔器

WordNet

1. turn, shape, mold, or otherwise finish by machinery
2. a device for overcoming resistance at one point by applying force at some other point (同)simple_machine
3. any mechanical or electrical device that transmits or modifies energy to perform or assist in the performance of human tasks
4. a group that controls the activities of a political party; "he was endorsed by the Democratic machine" (同)political machine
5. an efficient person; "the boxer was a magnificent fighting machine"
6. an intricate organization that accomplishes its goals efficiently; "the war machine"
7. make by machinery; "The Americans were machining while others still hand-made cars"
8. loss of bodily sensation with or without loss of consciousness (同)anaesthesia

PrepTutorEJDIC

1. 『機械』 / 自動車,飛行機,自転車 / 加えられた力を強めたり方向を変えたりする機械(器具);てこ,滑車,くさび,斜面など / 組織,(特に)派閥 / (自主性も意欲もない)機械のような人,機械的に働く人 / …‘を'機械で作る(仕上げる);(特に)…‘に'ミシンをかける,‘を'ミシンで作る;(印刷機で)…‘を'印刷する / …‘を'きっちり計って作る《+『down』+『名,』+『名』+『down』》

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/04/27 08:40:15」(JST)

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[Wiki en表示]

Anaesthetic machine
An anaesthetic machine. This particular machine is a "Flow-I" model, manufactured by Maquet, a division of Getinge Group, Getinge, Sweden.
Process type	physical change
Industrial sector(s)	anesthesia (medicine)
Main technologies or sub-processes	vaporization
Feedstock	inhalational anaesthetic agents, chiefly nitrous oxide and volatile anesthetics
Product(s)	phase transition of feedstock from the liquid phase to the gas phase
Leading companies	Leading companies using this industrial process
Main facilities	hospitals and outpatient surgery centers
Inventor	William T. G. Morton is widely credited for demonstrating the technique of vaporization of diethyl ether. However, many others were involved in its development. Please refer to History of general anesthesia article for more details.
Year of invention	16 October 1846

The anaesthetic machine (UK English) or anesthesia machine (US English) or Boyle's machine is used by anaesthesiologists, nurse anaesthetists, and anaesthesiologist assistants to support the administration of anaesthesia. The most common type of anaesthetic machine in use in the developed world is the continuous-flow anaesthetic machine, which is designed to provide an accurate and continuous supply of medical gases (such as oxygen and nitrous oxide), mixed with an accurate concentration of anaesthetic vapour (such as isoflurane), and deliver this to the patient at a safe pressure and flow. Modern machines incorporate a ventilator, suction unit, and patient monitoring devices.

The original concept of Boyle's machine was invented by the British anaesthetist Henry Boyle (1875–1941) in 1917. Prior to this time, anaesthetists often carried all their equipment with them, but the development of heavy, bulky cylinder storage and increasingly elaborate airway equipment meant that this was no longer practical for most circumstances. The anaesthetic machine is usually mounted on anti-static wheels for convenient transportation.

Simpler anaesthetic apparatus may be used in special circumstances, such as the TriService Apparatus, a simplified anaesthesia delivery system invented for the British armed forces, which is light and portable and may be used effectively even when no medical gases are available. This device has unidirectional valves which suck in ambient air which can be enriched with oxygen from a cylinder, with the help of a set of bellows. A large number of draw-over type of anaesthesia devices are still in use in India for administering an air-ether mixture to the patient, which can be enriched with oxygen. But the advent of the cautery has sounded the death knell to this device, due to the explosion hazard.

Many of the early innovations in U.S. anaesthetic equipment, including the closed circuit carbon-dioxide absorber (aka: the Guedel-Foregger Midget) and diffusion of such equipment to anaesthetists within the United States can be attributed to Richard von Foregger and The Foregger Company.

In dentistry a simplified version of the anaesthetic machine, without a ventilator or anaesthetic vaporiser, is referred to as a relative analgesia machine. By using this machine, the dentist can administer a mild inhalation sedation with nitrous oxide and oxygen, in order to keep his patient in a conscious state while depressing the feeling of pain.

Components of a typical machine

Simple schematic of an anaesthesia machine

A modern anaesthesia machine includes the following components:

• Connections to piped hospital oxygen, medical air, and nitrous oxide.
• Reserve gas cylinders of oxygen, air, and nitrous oxide attached via a specific yoke with a Bodok seal.
• A high-flow oxygen flush which provides pure oxygen at 30-75 litres/minute
• Pressure gauges, regulators and 'pop-off' valves, to protect the machine components and patient from high-pressure gases
• Flow meters (rotameters) for oxygen, air, and nitrous oxide, low Flow meters oxygen nitrous oxide
• Updated vaporizers to provide accurate dosage control when using volatile anaesthetics such as isoflurane and sevoflurane
• An integrated ventilator to properly ventilate the patient during administration of anaesthesia
• A manual ventilation bag in combination with an Adjustable Pressure Limiting (APL) valve
• Systems for monitoring the gases being administered to, and exhaled by the patient
• Systems for monitoring the patient's heart rate, ECG, blood pressure and oxygen saturation, in some cases with additional options for monitoring end-tidal carbon dioxide and temperature
• breathing circuits, circle attachment, or a Bain's breathing system

Safety features of modern machines

Based on experience gained from analysis of mishaps, the modern anaesthetic machine incorporates several safety devices, including:

• an oxygen failure alarm (aka 'Oxygen Failure Warning Device' or OFWD). In older machines this was a pneumatic device called a Ritchie whistle which sounds when oxygen pressure is 38 psi descending. Newer machines have an electronic sensor.
• Nitrous cut-off or oxygen failure protection device, OFPD: the flow of medical nitrous-oxide is dependent on oxygen pressure. This is done at the regulator level. In essence, the nitrous-oxide regulator is a 'slave' of the oxygen regulator. i.e., if oxygen pressure is lost then the other gases can not flow past their regulators.
• hypoxic-mixture alarms (hypoxy guards or ratio controllers) to prevent gas mixtures which contain less than 21-25% oxygen being delivered to the patient. In modern machines it is impossible to deliver 100% nitrous oxide (or any hypoxic mixture) to the patient to breathe. Oxygen is automatically added to the fresh gas flow even if the anaesthetist should attempt to deliver 100% nitrous oxide. Ratio controllers usually operate on the pneumatic principle or are chain linked (link 25 system). Both are located on the rotameter assembly, unless electronically controlled.
• ventilator alarms, which warn of low or high airway pressures.
• interlocks between the vaporizers preventing inadvertent administration of more than one volatile agent concurrently
• alarms on all the above physiological monitors
• the Pin Index Safety System prevents cylinders being accidentally connected to the wrong yoke
• the NIST (Non-Interchangeable Screw Thread) or Diameter Index Safety System, DISS system for pipeline gases, which prevents piped gases from the wall being accidentally connected to the wrong inlet on the machine
• pipeline gas hoses have non-interchangeable Schrader valve connectors, which prevents hoses being accidentally plugged into the wrong wall socket

The functions of the machine should be checked at the beginning of every operating list in a "cockpit-drill". Machines and associated equipment must be maintained and serviced regularly.

Older machines may lack some of the safety features and refinements present on newer machines. However, they were designed to be operated without mains electricity, using compressed gas power for the ventilator and suction apparatus. Modern machines often have battery backup, but may fail when this becomes depleted.

The modern anaesthetic machine still retains all the key working principles of the Boyle's machine (a British Oxygen Company trade name) in honour of the British anaesthetist Henry Boyle. In India, however, the trade name 'Boyle' is registered with Boyle HealthCare Pvt. Ltd., Indore MP.

A two-person pre-use check (consisting of an anaesthetist and an operating department practitioner) of the anaesthetic machine is recommended before every single case and has been shown to decrease the risk of 24-hour severe postoperative morbidity and mortality. Various regulatory and professional bodies have formulated checklists for different countries. A free transparent reality simulation of the checklist recommended by the United States Food & Drug Administration is available from the Virtual Anesthesia Machine web site ( see below) after registration which is also free. Machines should be cleaned between cases as they are at considerable risk of contamination with pathogens.

Anesthesia machine vs anesthesia cart

An anaesthetic machine

The Anesthesia machine contains mechanical respiratory support (ventilator) and O2 support as well as being a means for administering anesthetic gases which may be used for sedation as well as total anesthesia. An anesthesia cart holds extra IV push meds for anesthesia, sedation and reversal, extra equipment that the person giving anesthesia/sedation might need, and the hardware for respiratory support and resuscitation.

See also

• Ether Dome
• History of general anesthesia

References

External links

• Virtual Anesthesia Machine (VAM) — a free transparent reality simulation of a generic anesthesia machine from the University of Florida
• Various anesthesia-related simulations
• Virtual Anaesthesia Textbook
• FRCA UK — resources for UK anaesthetist in training
• History of Richard von Foregger and the Foregger Company — written by his son, R. Foregger, this website chronicles one of the leading manufacturers and developers of anesthesiology equipment in the early 20th century.
• Checking Anaesthetic machines

UpToDate Contents

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English Journal

• Accuracy of inhaled agent usage displays of automated target control anesthesia machines.

• Dehouwer A1, Carette R, De Ridder S, De Wolf AM, Hendrickx JF.
• Journal of clinical monitoring and computing.J Clin Monit Comput.2015 Aug 7. [Epub ahead of print]
• Automated low flow anesthesia machines report how much inhaled anesthetic agent has been used for each anesthetic. We compared these reported values with the amount of agent that had disappeared by weighing the vaporizer/injectors before and after each anesthetic. The vaporizers/injectors of the Ais
• PMID 26249754

• Smartphones in the Operating Room: Distraction or Diagnostic Aid? A Case of Newly Diagnosed Wolff-Parkinson White in a Pediatric Patient Having Bronchoscopy Under General Anesthesia.

• Esenther B1, Ko R.
• A & A case reports.A A Case Rep.2015 Aug 1;5(3):40-2. doi: 10.1213/XAA.0000000000000176.
• A 4-year-old boy presented for elective bronchoscopy after years of pharmacologically unresponsive reactive airway disease that limited physical activity. After mask induction with nitrous oxide and sevoflurane, the patient was noted to be intermittently in a hemodynamically stable tachyarrhythmia.
• PMID 26230306

• Compliance with the automated machine check.

• O'Shaughnessy SM1, Mahon P2.
• Anaesthesia.Anaesthesia.2015 Aug;70(8):1005-6. doi: 10.1111/anae.13159.
• PMID 26152263

Japanese Journal

• 小児開放腎生検の術後鎮痛管理における超音波ガイド下傍脊椎神経ブロックの経験

• 石川 紗希,鈴木 康生,関島 千尋,広木 公一,宮澤 典子,山本 信一
• 日本臨床麻酔学会誌 35(2), 172-176, 2015
• 全身麻酔下での小児開放腎生検に対する傍脊椎神経ブロックの術後鎮痛効果を，診療録より後方視的に検討した．対象は0〜15歳の30例で，全身麻酔導入・気管挿管後に術側を上にした側臥位で超音波ガイド下に神経ブロック針を進め，傍脊椎腔を確認後，0.2または0.375％ロピバカイン0.3〜0.5mL/kgを注入した．術後24時間の観察で，30例中疼痛の訴えがあったのは10例（33.3％）で，うち7例（23.3 …
• NAID 130005087390

• 麻酔器の気化器接続部からのリーク

• 村田 雄哉,高橋 宏,徳若 純子 [他]
• 麻酔 62(12), 1472-1475, 2013-12
• NAID 40019894315

• 超音波ガイド下神経ブロック(9)超音波ガイド下神経ブロックの教育に必要な知識・技術

• 北山 眞任
• 日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia
• …   超音波ガイド下神経ブロックでは，従来のランドマーク法による解剖学的な知識や穿刺技術だけでなく，患者と施行者をつなぐ超音波機器を含む関係（man-machine system）を円滑にすることが肝要である．そのために機器の運用や超音波画像の知識と施行者の目－手指－針先の動きを画面上で調整する高度な技術が必要とされる． …
• NAID 10031185515

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★リンクテーブル★

リンク元	「麻酔器」
関連記事	「machine」「anesthesia」

「麻酔器」

　　[★]

英

anesthesia machine, anesthesia apparatus

関

麻酔

工業用ボンベと医療用の配管の色

ボンベの色			気体	パイピング野色
			空気	..	黄
青/灰	..	..	笑気	..	青
黒	..		酸素	..	緑
緑	..		二酸化炭素
黄	..		塩素
赤	..		水素
白	..		アンモニア
褐	..		アセチレン
灰	..		その他

「machine」

　　[★]

• n.

• 機械、マシーン、器械、装置

関

apparatus、device、instrument、mechanic

　 　 　 　 　 　 　 　

「anesthesia」

　　[★]

• n.

• 麻酔、 感覚消失、 無感覚、 無知覚、 知覚脱失