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Breathing systems and ancillary equipment

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Abstract

Breathing systems are interposed between an anaesthetic machine and an endotracheal tube, facemask. They serve to: deliver oxygen and volatile anaesthetic agents from the anaesthetic machine to the patient; remove carbon dioxide exhaled by the patient and provide a means of ventilating the lungs. This chapters looks at the basic components of breathing systems and their function, names and classification of breathing systems, low-flow anaesthesia, leak testing of breathing systems, the common hazards and their maintenance, endotracheal tubes, facemasks, laryngoscopes, induction chambers and humidifiers.

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Figures

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5.2 T-pieces. (a) Paediatric T-piece with APL valve (Mapleson D). (b) Ayre’s T-piece (Mapleson E). (c) Jackson Rees modified T-piece (Mapleson F).
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5.4 (a) The Bain system (Mapleson D). (b) The patient end of the Bain system, showing the coaxial arrangement of tubing. (b, Courtesy of Tanya Duke-Novakovski, Western College of Veterinary Medicine, University of Saskatchewan, Canada)
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5.5 The Magill system (Mapleson A).
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5.6 (a) The Lack system (Mapleson A). (b) The parallel Lack (Mapleson A). (c) The mini-parallel Lack (Mapleson A).
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5.7 The Humphrey ADE system. (a) Without canister, with parallel breathing tubing and reservoir bag. The ventilator port is not visible. 1 = lever to select spontaneous or controlled ventilation. The lever is in the ‘up’ or Mapleson A position for spontaneous ventilation; 2 = inspiratory tubing; 3 = expiratory tubing; 4 = exhaust valve with visible indicator; 5 = scavenging shroud; 6 = safety pressure relief valve. (b) With absorbent canister attached. (a, Courtesy of Chris Seymour, Royal Veterinary College, London, UK; b, Courtesy of Asher Allison, Animal Health Trust, Newmarket, UK)
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5.9 (a) Schematic of the circle system. (b) A semi-disposable circle system in use. (c) Schematic of the to-and-fro system. 1 = fresh gas inflow; 2 = inspiratory unidirectional valve; 3 = patient connector; 4 = expiratory unidirectional valve; 5 = exhaust valve; 6 = reservoir bag; 7 = absorbent canister.
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5.11 The F circuit. 1 = fresh gas inflow; 2 = exhaled gas. (Courtesy of Chris Hughes)
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5.12 A spring-loaded valve can be placed on the scavenger side of the APL valve to enable manual intermittent positive pressure ventilation. The button is pressed while squeezing the rebreathing bag and released after the manoeuvre. This device avoids accidentally leaving the APL valve closed. (Courtesy of Tanya Duke-Novakovski, Western College of Veterinary Medicine, University of Saskatchewan, Canada)
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5.13 Endotracheal tubes. (a) PVC. (b) A PVC tube showing the Murphy eye opposite the bevel. (c) Silicone. (d) Red rubber. (Courtesy of Asher Allison, Animal Health Trust, Newmarket, UK)
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5.15 An armoured endotracheal tube. (Courtesy of Asher Allison, Animal Health Trust, Newmarket, UK)
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5.17 (a) Premeasuring the length of an endotracheal tube before placement (see text for details). (b) Technique for intubating cats and dogs (see text for details).
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5.18 (a) View of cat larynx. (b) View of dog larynx. (Courtesy of Asher Allison, Animal Health Trust, Newmarket, UK)
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5.20 (a) A laryngeal mask airway. Note the inflatable cuff surrounding the mask’s inner rim. (b) Cat v-gel supraglottic airway device (dorsal view). Note the inflatable dorsal pressure adjuster (balloon) (A) to increase the sealing pressure if required. (c) Cat v-gel (ventral view). (Courtesy of Asher Allison, Animal Health Trust, Newmarket, UK)
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5.21 A selection of facemasks.
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5.22 Darvall ZDS mask. Gas flow within the mask is unidirectional: this results in zero dead space and consequently the animal’s nose does not have to fill the mask. (Courtesy of Colin Dunlop, Advanced Anaesthesia Specialists, Australia)
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5.24 Types of laryngoscope blade. (a) Miller blades designed for human medical use. (b) A novel laryngoscope blade has been designed for veterinary use with the light source positioned to permit better visualization. (c) Macintosh blade. (Courtesy of Asher Allison, Animal Health Trust, Newmarket, UK)
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5.25 An anaesthetic induction chamber. (Courtesy of Tanya Duke-Novakovski, Western College of Veterinary Medicine, University of Saskatchewan, Canada)
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5.26 Scavenging tubing should be a different colour from the breathing tubing. (Courtesy of Tanya Duke-Novakovski, Western College of Veterinary Medicine, University of Saskatchewan, Canada)
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5.27 Components of an active anaesthetic gas scavenging system (AGSS). (Courtesy of Coltronics Systems)
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5.28 Detail of an air break receiver unit. (a) Air break off. (b) Air break on.
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5.29 A veterinary ‘Anaesorber’ activated charcoal canister with scavenging tubing attached. (Courtesy of Asher Allison, Animal Health Trust, Newmarket, UK)
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5.30 Heat and moisture exchangers (HMEs) and heat and moisture exchanging filters (HMEFs). (Courtesy of Asher Allison, Animal Health Trust, Newmarket, UK)
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5.31 A bubble-through humidifier, which brings dry oxygen gas to ambient levels of humidity. Dry gas from the flowmeter is directed into the water bottle, where it is broken up into small bubbles, which gain humidity as they rise to the surface of the water.
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5.32 (a) An Intersurgical PEEP valve. (b) PEEP valve positioned between a ventilator valve and the scavenging tubing. (Courtesy of Asher Allison, Animal Health Trust, Newmarket, UK)

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