Essentials of. Anaesthetic Equipment FOURTH EDITION

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2 i Essentials of Anaesthetic Equipment FOURTH EDITION

3 Senior Content Strategist: Jeremy Bowes Content Development Specialist: Clive Hewat Senior Project Manager: Beula Christopher Designer: Miles Hitchens Illustration Manager: Jennifer Rose Illustrator: Richard Tibbits

4 iii Essentials of Anaesthetic Equipment FOURTH EDITION Baha Al-Shaikh FCARCSI, FRCA Consultant Anaesthetist, William Harvey Hospital, Ashford, Kent, UK Honorary Senior Lecturer, King s College London, University of London, UK Visiting Professor, Canterbury Christ Church University, UK Simon Stacey FRCA Consultant Anaesthetist, Barts and The London NHS Trust, London, UK Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2013

5 2013 Elsevier Ltd. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). First edition 1995 Second edition 2002 Third edition 2007 ISBN: British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Working together to grow libraries in developing countries Printed in China The publisher s policy is to use paper manufactured from sustainable forests

6 Contents Preface Acknowledgements vii ix Chapter 1 MEDICAL GAS SUPPLY 1 Chapter 2 THE ANAESTHETIC MACHINE 19 Chapter 3 POLLUTION IN THEATRE AND SCAVENGING 45 Chapter 4 BREATHING SYSTEMS 55 Chapter 5 TRACHEAL AND TRACHEOSTOMY TUBES AND AIRWAYS 75 Chapter 6 MASKS AND OXYGEN DELIVERY DEVICES 99 Chapter 7 LARYNGOSCOPES AND TRACHEAL INTUBATION EQUIPMENT 111 Chapter 8 VENTILATORS 121 Chapter 9 HUMIDIFICATION AND FILTRATION 135 Chapter 10 NON-INVASIVE MONITORING 145 Chapter 11 INVASIVE MONITORING 177 Chapter 12 PAIN MANAGEMENT AND REGIONAL ANAESTHESIA 201 Chapter 13 ADDITIONAL EQUIPMENT USED IN ANAESTHESIA AND INTENSIVE CARE 219 Chapter 14 ELECTRICAL SAFETY 241 Appendix A CHECKING ANAESTHETIC EQUIPMENT 256 Appendix B RECOMMENDATIONS FOR STANDARDS OF MONITORING DURING ANAESTHESIA AND RECOVERY 258 Appendix C GRAPHICAL SYMBOLS FOR USE IN LABELLING MEDICAL DEVICES 263 Appendix D DECONTAMINATION OF MEDICAL EQUIPMENT 265 Appendix E LATEX ALLERGY 269 Appendix F DIRECTORY OF MANUFACTURERS 271 Glossary 275 Index 279

7 Preface Over 20 years ago, we conspired to write our colour equipment textbook Essentials of Anaesthetic Equipment. It is now in its fourth edition and hopefully as relevant to anaesthetic practice as ever. We have tried to keep the book concise, however due to the sheer number of new anaesthetic equipment products used in the clinical practice today, the size of the book has increased slightly. We have tried to freshen up the photography/diagrams wherever possible. The text has been updated too and single best answer questions have been included. We hope this book will continue to be the equipment book of choice for both the trainees sitting FRCA exams and their trainers and a useful reference tool for our Nursing and Operating Department Practitioner colleagues. BA-S Ashford, Kent SGS London 2013

8 Acknowledgements We are extremely grateful to the many manufacturers and others who have supplied the necessary information and images for this edition. Without their help, this fourth edition could not have gone ahead in its current format. Special mention goes to Andy Coughlan of Smiths Medical for his unflagging help with all things photographic. Below is a list of the people and their companies who helped us by providing images during the preparation of the book. We are also grateful to the association of Anaesthetists of Great Britain and Ireland for granting permission to reproduce their equipment checklist and monitoring recommendations. Molly Bruton (Vygon) Tony Calvo (Olympus) Emma Christmas (Gambro) Andy Coughlan (Smith s Medical) Inga Dolezar (Chart BioMedical) Bjrake Frank-Duab (Radiometer) Andrew Garnham (Penlon) John Jones (MAQUET) John van Kessel (B Braun) Vanessa Light (Philips Health Care) Sharon Maris (Teleflex) Lucy Martin-Davis (Verathon Medical) Anne Pattinson (Draeger) Mark Pedley (Blue Box Medical) Lee Pettitt (Rimer Alco) Ciska Proos (B Braun) Malcolm Pyke (Philips Heath Care) Siama Rafiq (BD Medical) Emma Richardson (Argon Medical) Rachel Stein (I-Flow) Frank Toal (B Braun) Jill Garratt (Zoll Medical)