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Vaporizers Basics

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All basic information about anesthetic vaporizers and about their evolution. Pictures of old vaporizers.

All basic information about anesthetic vaporizers and about their evolution. Pictures of old vaporizers.

Published in: Health & Medicine

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  • sir i am exam going... badly in need of ur ppt ... can u plzzz mail it to me on rohanmagoon21@gmail.com
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  • Its a very good presentation sir. Can u plz mail me at drsoleyekt54@gmail.com . Thanks in advance.
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  • Excellent ppt. Unni, I came across it as I was searching for one to teach my DOTAT students.Will you please allow me to have a copy of it for presenting to them by sending it as email to me?My email id is vkesavar@gmail.com. Thanks a lot.
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  • can u please email me at drvijaybhola@gmail.com
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  • Its a very good presentation sir. Can u plz mail me at shashankmrdr@gmail.com . Thanks in advance.
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  • 1. http://www.ppt-to-video.com
    Presenter : Dr Unnikrishnan P
    Coordinator : Dr C MadhusoodhananPillai
    Moderators : Dr SheelaRani
    Dr Ravi
    Vaporizers : 1
  • 2. 1.DO YOU FEEL YOU NEED IT?
    2.SOME IMPORTANT THINGS!
    3.CLASSIFICATION
    4.FACTORS AFFECTING VAPORIZATION
    5.ASTM VAPORIZER STANDARDS
    6.FILLING SYSTEMS
    7.HAZARDS[lengthy class..is it a hazard?]
    8.EVOLUTION
  • 3. Why we need a vaporizer?
    Most volatile agents exist as liquid at room temp & atm pressure
    Vaporizers convert this liquid form to vapor phase
    And add a certain amount of this vapor to the anesthesia circuit...
    In precisely determined concentrations over a wide range of temperatures, pressures and carrier gas flowrates.
  • 4. Who is inside the vaporizer?
    Let me introduce..I am a gas
    Below a certain temp,I am very flexible ; then I will exist in a form which is interconvertable between the liquid and gaseous states- this gaseous form is known as vapor.
    But above this temp, I am very rigid ; you cannot change me into a liquid now..yes now I am a perfect gas
    And I wont tell u the name of that temperature!
  • 5. SO VAPOR IS THE GASEOUS PHASE OF A SUBSTANCE BELOW ITS CRITICAL TEMPERATURE
    Love’ [van der Waals forces] promotes the liquid state, whereas ‘hatred’ [ Kinetic energy] promotes vapor phase
  • 6. Vapor Pressure
    This vapor exerts a pressure on its surroundings- VAPOR PRESSURE
    V.P.depends only on the liquid and temperature
  • 7.
  • 8. Saturated Vapor Pressure
    Now we close the container;the escaping ‘vapor molecules’ now may collide with the liquid surface and reenter it..an equilibrium forms
    No of molecules reentering = no of molecules leaving
    SATURATED VAPOR PRESSUREis the partial pressure of the vapor phase of a substance when at equilibrium with its liquid phase (e.g. in a closed container). Increases rapidly as boiling point approaches.
  • 9.
  • 10. Boiling Point
    You go on increasing the temperature
    The V.P. will increase
    At a point it equals the atm pressure
    B.P.OF A LIQUID IS THE TEMPERATURE AT WHICH ITS VAPOR PRESSURE IS EQUAL TO THE ATM PRESSURE
    Low atm pressure -> Low B.P.
    High SVP -> Low B.P.[..means I
    am very volatile]
  • 11. PARTIAL PRESSURE
    A MIXTURE OF GASES IN A CLOSED CONTAINER WILL EXERT A PRESSURE ON THE WALLS OF THE CONTAINER. THE PART OF THE PRESSURE EXERTED BY ANY ONE GAS IN THE MIXTURE IS CALLED ITS PARTIAL PRESSURE
    DEPENDS ONLY ON THE TEMPERATURE
    THE HIGHEST PARTIAL PRESSURE THAT CAN BE EXERTED BY A GAS AT A GIVEN TEMPERATURE IS ITS VAPOR PRESSURE. IT IS AN ABSOLUTE VALUE.
  • 12. VOLUMES PERCENT
    NO OF UNITS OF VOLUME OF A GAS IN RELATION TO A TOTAL OF 100 UNITS OF VOLUME FOR THE TOTAL GAS MIXTURE.
    IT EXPRESSES THE RELATIVE RATIO OF GAS MOLECULES IN A MIXTURE.
    MOST COMMONLY USED
    BUT UPTAKE & DEPTH OF ANESTHESIA ARE DIRECTLY RELATED TO PARTIAL PRESSURES
    PARTIAL PRESSURE/TOTAL PRESSURE= VOLUMES PERCENT/100
  • 13. HEAT OF VAPORIZATION
    THE NUMBER OF CALORIES REQUIRED TO CONVERT 1GM OF LIQUID INTO A VAPOR OR NUMBER OF CALORIES REQUIRED TO CONVERT 1 ML OF LIQUID INTO A VAPOR
    IN A VAPORIZER, AS THE LIQUID AGENT VAPORIZES,HEAT IS LOST;SO TEMPERATURE DROPS,VAPOR PRESSURE DROPS = LESSER VOL. AGENT FOR THE CARRIER GAS TO TAKE AWAY↓OUTPUT
    Oh…tell me some method to supply heat! Else my patient will wake up @#%?
  • 14. SPECIFIC HEAT
    THE QUANTITY OF HEAT REQUIRED TO RAISE THE TEMP OF 1gm OF THE SUBSTANCE BY 1⁰C
    IF ITS LOW, THE TEMPERATURE WILL NOT RISE GRADUALLY WHEN WE SUPPLY HEAT TO A VOLATILE AGENT IN ORDER TO REPLACE THAT LOST DUE TO VAPORIZATION
    IF ITS HIGH...NICE GUY..VERY OBEDIENT!
    IS THIS IMPORTANT IN ANY OTHER ASPECT?
    MATERIAL FROM WHICH VAPORIZER CONSTRUCTED
  • 15. THERMAL CAPACITY
    AMOUNT OF HEAT STORED IN THE VAPORISER BODY. IT IS THE PRODUCT OF SPECIFIC HEAT AND MASS.
    A VAPORIZER CONSTRUCTED FROM A SUBSTANCE WITH HIGH THERMAL CAPACITY WILL CHANGE TEMP MORE SLOWLY AND SO IS PREFFERED
  • 16. THERMAL CONDUCTIVITY
    SPEED WITH WHICH HEAT FLOWS THROUGH A SUBSTANCE; CU > AL > BRASS > STEEL >> GLASS.
    HIGHER THE THERMAL CONDUCTIVITY, BETTER THE SUBSTANCE CONDUCTS HEAT.
  • 17. THERMOSTABILIZATION
    IS ACHIEVED BY CONSTRUCTING VAPORIZERS OF METALS WITH HIGH THERMAL CONDUCTIVITY (COPPER, BRONZE) TO MINIMIZE TEMPERATURE CHANGES WHEN THE VAPORIZER IS IN USE
    WICKS SHOULD BE IN CONTACT WITH THE METAL PART
  • 18. GAS LAWS
    BOYLES LAW:AT CONSTANT TEMPERATURE, THE VOLUME OF A GIVEN MASS OF GAS VARIES INVERSELY WITH THE ABSOLUTE PRESSURE
    CHARLE’S LAW: AT CONSTANT PRESSURE, THE VOLUME OF A GIVEN MASS OF GAS VARIES DIRECTLY WITH THE ABSOLUTE TEMPERATURE
    AT CONSTANT VOLUME, THE ABSOLUTE PRESSURE OF A GIVEN MASS OF GAS VARIES DIRECTLY WITH THE ABSOLUTE TEMPERATURE
  • 19. DALTON’S LAW OF PARTIAL PRESSURES
    IN A MIXTURE OF GASES THE PRESSURE EXERTED BY EACH GAS IS THE SAME AS THAT WHICH IT WOULD EXERT IF IT ALONE OCCUPIED THE CONTAINER
  • 20. AVOGADRO’S HYPOTHESIS
    EQUAL VOLUMES OF GASES AT THE SAME TEMPERATURE AND PRESSURE CONTAIN EQUAL NUMBER OF MOLECULES
    THIS NO IS 6.023 X 10²³
    THIS MUCH NO OF PARTICLES OF ANY GAS AT STP WILL OCCUPY 22.4 Ls
  • 21. EXAMPLE : CALIBRATION
    MOLECULAR WT OF ISOFLURANE 184.5 CONTAIN AVOGADRO NO OF PARTICLES; WILL OCCUPY 22.4 Ls @ STP
    SUPPOSE O₂VAPORIZES 18.45 GM OF ISOFLURANE INTO 224 L
    =0.1 MOLE = WILL OCCUPY 2.24Ls
    BUT THIS IS VAPORIZED INTO 224 Ls
    SO CONCENTRATION OF ISOFLURANE = 2.24/224 = 1%
  • 22. Q: WHICH LAW IS REPRESENTED HERE?
  • 23. CLASSIFICATION OF VAPORIZERS
  • 24. METHOD OF REGULATING THE OUTPUT CONCENTRATION
    CONCENTRATION CALIBRATED
    MEASURED FLOW
  • 25. METHOD OF VAPORIZATION
    FLOW OVER
    BUBBLE THROUGH
    INJECTION
    SIMPLE
  • 26. TEMPERATURE COMPENSATION
    THERMOCOMPENSATION
    SUPPLIED HEAT
  • 27. SPECIFICITY
    AGENT SPECIFIC
    MULTIPLE AGENTS
  • 28. POSITION
    VAPORIZER INSIDE CIRCUIT
    VAPORIZER OUTSIDE CIRCUIT
  • 29. RESISTANCE
    PLENUM
    LOW RESISTANCE/DRAW OVER
  • 30. BASIC DESIGN
  • 31. METHOD OF REGULATING OUTPUT CONCENTRATION
  • 32. CONCENTRATION CALIBRATED
    TOTAL FLOW FROM THE MACHINE PASSES THROUGH THE VAPORIZER. THIS IS SPLIT BY A VARIABLE RESISTANCE PROPORTIONATING VALVE INTO TWO:
    ONE PART[USUALLY MAJOR] FLOWS THROUGH THE BYPASS CHAMBER & THE OTHER [USUALLY SMALL] THROUGH THE VAPORIZING CHAMBER.
  • 33. CONCENTRATION CALIBRATED
    AGENT CONCENTRATION IS CONTROLLED BY A DIAL CALIBRATED IN VOLUMES PERCENT
    VOLUME VAPOURISED - TYPICALLY 200 ML VAPOUR PER ML OF LIQUID ANAESTHETIC
    ML LIQUID USED/HOUR = 3 X % X FGF
  • 34. IF WE DIAL A HIGH CONCENTRATION
  • 35. IF WE DIAL A LOW CONCENTRATION
  • 36. SPLITTING RATIO
    THE RATIO OF THE BYPASS GAS TO THE GAS GOING TO THE VAPORIZING CHAMBER IS CALLED THE SPLITTING RATIO. SPLITTING RATIO DEPENDS ON:
    THE RESISTANCE OF THE TWO PATHWAYS, WHICH INTURN DEPENDS ON THE VARIABLE ORIFICE OF THE INLET/OUTLET.
    TEMPERATURE OF THE LIQUID /CARRIER GAS.
    FLOW RATE OF GASES
    DENSITY OF THE PARTICULAR GAS ENTERING VAP CHAMBER. MOSTLY CARRIER GAS IS O₂
  • 37. MEASURED FLOW VAPORIZERS
    THE VAPORIZER HEATS THE ANESTHETIC AGENT TO A TEMPERATURE ABOVE ITS BOILING POINT( SO IT BEHAVES AS GAS ) AND THIS IS THEN METERED INTO THE FRESH GAS FLOW.
    A MEASURED FLOW IS SENT BY A SEPARATE OXYGEN FLOW METER TO PASS TO THE VAPORIZER WITH THE OUTPUT BEING AT SVP FOR THE ANESTHETIC AGENT.
    IN ORDER TO DILUTE THIS OTHERWISE LETHAL CONCENTRATION, OUTPUT FROM THAT FLOWMETER IS COMBINED WITH GAS PASSING FROM THE MAIN FLOWMETER e.g. COPPER KETTLE, VERNI-TRIOL
  • 38. MEASURED FLOW VAPORIZERS
    OPERATOR HAS TO SET THE FLOW TO THE VAPORIZER AND BYPASS WITH
    SEPARATE FLOWMETERS
    THIS MEANS THAT RESPECTIVE FLOWS HAVE TO BE CALCULATED FOR EACH AGENT FOR A GIVEN
    TEMPERATURE AND VAPOUR OUTPUT.
  • 39. VAPORIZATION METHODS
  • 40. FLOW OVER
    HERE THE CARRIER GAS PASSES OVER THE SURFACE OF A LIQUID.
    SURFACE AREA OF VAPORISATION CAN BE INCREASED BY USING WICKS.
  • 41. FLOW OVER
  • 42. FLOW OVER
    DUE TO CAPILLARY ACTION, THE ANAESTHETIC AGENT RISES INTO THE WICKS. THIS DRAMATICALLY INCREASES THE SURFACE AREA OF ANAESTHETIC AGENT EXPOSED TO THE FRESH GAS AND THEREBY IMPROVES THE EFFICIENCY OF VAPORISATION.
    CARRIER GAS CAN BE DIRECTED USING BAFFLES OR SPIRAL TRACKS THAT LENGTHEN THE GAS PATHWAYS OVER THE LIQUID.THIS INCREASES THE TIME AND AREA OF CONTACT.
  • 43. FLOW OVER
  • 44. BUBBLE THROUGH
    CARRIER GAS IS ALLOWED TO BUBBLE THROUGH THE LIQUID.
    SMALLER THE BUBBLE ,LARGER WILL BE THE SURFACE AREA.
    METHODS TO BREAK THE GAS INTO SMALL BUBBLES ARE AGITATION & SPLASHING.
    FACTORS INFLUENCING THE VAPORIZER OUTPUT : SIZE OF THE BUBBLE, DEPTH OF LIQUID, BUBBLING SPEED
  • 45. INJECTION VAPORIZERS
    A KNOWN AMOUNT OF LIQUID AGENT OR PURE VAPOUR IS INJECTED INTO THE GAS STREAM TO PROVIDE THE DESIRED CONCENTRATION
    E.G. TEC 6 DESFLURANE VAPORIZER
  • 46. TEMPERATURE COMPENSATION
    TO MAINTAIN A CONSTANT O/P FROM THE VAPORIZER, MECHANISMS TO COMPENSATE FOR THE FLUCTUATIONS IN TEMPERATURE ARE TO BE EMPLOYED
  • 47. TEMPERATURE COMPENSATION
  • 48. THERMOCOMPENSATION
    MOST VARIABLE BYPASS VAPORIZERS COMPENSATE FOR CHANGES IN VAPOR PRESSURE BY ALTERING THE SPLITTING RATIO.
    DONE BY USING A THERMOSENSITIVE ELEMENT [BIMETALLIC STRIP] INCORPORATED IN THE VAPORIZING CHAMBER OR BYPASS CHAMBER.
    SO, THE SPLITTING OF GAS IS CONTROLLED BY TWO VALVES: (1)THE DIAL WE SET (SPLITTING VALVE) AND (2)THE TEMPERATURE COMPENSATING VALVE
  • 49. THERMOCOMPENSATION
    IN A BIMETALLIC STRIP, TWO METALS WITH VERY DIFFERENT COEFFICIENTS OF THERMAL EXPANSION ARE FIXED TOGETHER.
  • 50. THERMOCOMPENSATION
    WHEN THE TEMPERATURE OF THE VAPORISING CHAMBER DROPS, THE BIMETALLIC STRIP BENDS AND MOVES AWAY.  THIS REDUCES THE RESISTANCE TO FLOW AND THUS MORE FLOW OCCURS INTO THE VAPORISING CHAMBER.
  • 51. SUPPLIED HEAT
    AN ELECTRIC HEATER CAN BE USED TO SUPPLY HEAT TO A VAPORIZER AND MAINTAIN IT AT A CONSTANT TEMPERATURE.E.G.TEC 6
  • 52. RESISTANCE
  • 53. PLENUM [Latin= fullness]
    VAPORIZERS WITH HIGH RESISTANCE WHICH DEPEND ON COMPRESSED GAS DRIVEN UNDER PRESSURE ARE CALLED PLENUM VAPORIZERS.
    e.g. BOYLE BOTTLE,COPPER KETTLE
  • 54. DRAW OVER
    CARRIER GAS IS DRAWN THROUGH THE VAPORISER EITHER BY THE PATIENT’S OWN RESPIRATORY EFFORTS, OR BY A SELF-INFLATING BAG OR MANUAL BELLOWS
    DRAWOVER SYSTEMS OPERATE AT LESS THAN, OR AT AMBIENT PRESSURE
    FLOW THROUGH THE SYSTEM IS INTERMITTENT, VARYING WITH DIFFERENT PHASES OF INSPIRATION, AND CEASING IN EXPIRATION. A ONE-WAY VALVE PREVENTS REVERSE FLOW IN THE CIRCUIT. E.G. EMO
  • 55. DRAW OVER
    HAVE A LOW INTERNAL RESISTANCE TO GAS FLOW
    SO THAT THEY MAY BE USED WITHIN THE BREATHING CIRCUIT,
    THE GAS FLOW BEING DRIVEN THROUGH THEM BY THE PATIENT'S BREATHING. THEY MAY BE USED IN A NON-REBREATHING DRAW-OVER APPARATUS, OR AS IN-CIRCUIT VAPORIZERS IN A CIRCLE ABSORBER SYSTEM.     ARE USUALLY OF THE SIMPLE BOTTLE OR BOWL TYPE (E.G. THE OHIO 8 BOTTLE, GOLDMAN OR STEPHENS),
    BUT MORE ACCURATE, LOW RESISTANCE DRAW-OVER VAPORIZERS, SUCH AS THE PENLON OXFORD MINIATURE VAPORIZER (OMV) AND OHMEDA DRAW-OVER TEC VAPORIZERS, HAVE BEEN MANUFACTURED.
  • 56. FACTORS AFFECTING VAPORIZER OUTPUT
    1. FLOW THROUGH THE VAPORIZING CHAMBER: Varying the proportion of gas passing through the vaporizing chamber and bypass chamber
    2.SURFACE AREA OF THE LIQUID GAS INTERFACE: Greater the surface area, more will be the vaporization. Bubble through > flow over
  • 57. FACTORS AFFECTING VAPORIZER OUTPUT
    3.TEMPERATURE: As temperature increase, output increase
    4.TIME: Output concentration tend to fall over time
  • 58. FACTORS AFFECTING VAPORIZER OUTPUT
    5.GAS FLOW RATE: (A)At high flowrates,the gas leaving vaporization chamber is less saturated
    (B)Alters the total flow that passes through the vaporization chamber
  • 59. FACTORS AFFECTING VAPORIZER OUTPUT
    6. CARRIER GAS COMPOSITION:
    (a) changes in viscosity & density may affect the proportion of the total flow passing through the vaporization chamber
    (b)N₂O dissolves in the flow, thus altering the effective volume passing through the vaporization chamber
  • 60. FACTORS AFFECTING VAPORIZER OUTPUT
    7.BOILING POINT :HIGHER THE BOILING POINT,LESS WILL BE THE VAPOUR O/P.
    8. AMBIENT PRESSURE : SVP IS SOLELY A FUNCTION OF TEMP. SO IF AMBIENT PRESSURE IS REDUCED,THE CONSTANT SVP BECOMES A GREATER PROPORTION OF THE TOTAL PRESSURE OUTPUT INCREASES.
    AGENTS WITH LOW BOILING POINTS ARE MORE SUSCEPTIBLE TO THE INFLUENCE OF AMBIENT PRESSURE
  • 61. EFFECT OF LOW ATMOSPHERIC PRESSURE
  • 62. CONCENTRATION CALIBRATED
    HIGH RESISTANCE PATHWAY THROUGH THE VAPORISING CHAMBER OFFERS LESS RESISTANCE, UNDER HYPOBARIC CONDITIONS AND SO A SLIGHT INCREASE IN VAPOR O/P OCCURS.
  • 63. MEASURED FLOW
    HERE THE DELIVERED PARTIAL PRESSURE & VOLUME PERCENT INCREASES.
    AMOUNT OF INCREASE DEPENDS ON THE BAROMETRIC PRESSURE & THE VAPOR PRESSURE OF THE AGENT.
    CLOSER THE VAPOR PRESSURE IS TO BAROMETRIC PRESSURE, GREATER THE EFFECT.
  • 64. EFFECT OF HIGH ATMOSPHERIC PRESSURE
  • 65. CONCENTRATION CALIBRATED
    ATM PRESSURE INCREASESDENSITY OF GAS CHANGESMORE RESISTANCE TO FLOW OF GAS THROUGH THE VAPORIZING CHAMBERDECREASED VAPOUR O/P (PARTIAL PRESSURE & VOLUME PERCENT)
    EFFECT ON PARTIAL PRESSURE IS LESS DRAMATIC
  • 66. MEASURED FLOW
    LOWER CONCENTRATION IN TERMS OF PP/VOLUME PERCENT
  • 67. EFFECT OF INTERMITTENT BACK PRESSURE
  • 68. EFFECT OF INTERMITTENT BACK PRESSURE
    WHEN ASSISTED OR CONTROLLED VENTILATION IS USED ,THE POSITIVE PRESSURE GENERATED DURING INSPIRATION IS TRANSMITTED FROM THE BREATHING SYSTEM BACK TO THE MACHINE & SOME WAY MAY BE TRANSMITTED TO THE VAPORIZERS.
    ALSO SEEN WITH THE USE OF OXYGEN FLUSH
    2 EFFECTS ARE SEEN:
  • 69. PUMPING EFFECT
    THE INCREASE IN VAPORIZER OUTPUT CONCENTRATION DUE TO BACK PRESSURE
  • 70. PUMPING EFFECT
    When the bag is squeezed ,pressure is transmitted back into both, the "by pass" channel and also to the vaporising chamber.  The fresh gas tries to move forward and gets compressed both in the 'by pass' channel and the vaporising chamber.  However, the vaporising chamber volume is much larger than the 'by pass' channel volume, and thus, more fresh gas gets compressed into it than into the 'by pass' channel.
  • 71. PUMPING EFFECT
    This extra fresh gas that enters the vaporising chamber collects anaesthetic vapor
  • 72. PUMPING EFFECT
    when the positive pressure is suddenly released (expiration) the previously compressed gases now suddenly expands in all directions. 
    Some of the rapidly expanding gas (containing vapor) enter the inlet of the vaporiser and cross over into the 'by pass' channel
  • 73. PUMPING EFFECT
    Normally, a vaporiser 'by pass' channel does not have vapor.  So this vapor due the 'pumping effect' is additional.  When this 'by pass' vapor flows across to the exit, it meets the vapor from the vaporising chamber.  The addition of the 'by pass' vapor to the vapor from the vaporising chamber raises the final concentration of anaesthetic delivered.  i.e. The 'pumping effect' increases the delivered concentration of anaesthetic agent.
  • 74. PUMPING EFFECT
    SEEN ESPECIALLY WHEN
    CARRIER GAS IS LOW
    AGENT IN VAPORIZING CHAMBER IS LOW
    DIAL SETTING IS LOW
    PRESSURE FLUCTUATIONS ARE HIGH & FREQUENT.
  • 75. PUMPING EFFECT
    MECHANISM IN MEASURED FLOW:
    GAS FLOW TO THESE VAPORIZERS BECOME SATURATED WITH VAPOUR & IS JOINED BY GAS FROM OTHER FLOWMETER,WHICH DILUTES ITS CONCENTRATION.
    WHEN BACK PRESSURE IS APPLIED,THERE IS RETROGRADE FLOW OF GAS SO THAT THE DILUTED GAS MIXTURE IS FORCED BACK INTO THE VAPORIZER.BECAUSE THIS GAS IS NOT SATURATED ,IT WILL THEN PICK UP ANESTHETIC VAPOUR.THE RESULT IS AN INCREASE IN O/P.
  • 76. MODIFICATIONS TO MINIMISE PUMPING EFFECT
    KEEP THE VAPORIING CHAMBER SMALL OR INCREASING THE SIZE OF THE BYPASS CHAMBER .
  • 77. MODIFICATIONS TO MINIMISE PUMPING EFFECT
    ADD LONG SPIRAL OR LARGE DIAMETER TUBE TO LEAD TO THE VAPORIZER CHAMBER.THE EXTRA GAS FORCED INTO THIS TUBE & SUBSEQUENTLY RETURNED TO THE BYPASS DOES NOT REACH THE VAPORIZING CHAMBER
  • 78. MODIFICATIONS TO MINIMISE PUMPING EFFECT
    INCREASE RESISTANCE TO GAS FLOW THROUGH THE VAPORIZER.
  • 79. MODIFICATIONS TO MINIMISE PUMPING EFFECT
    CHECK VALVE TO PREVENT BACKWARD FLOW OF GAS
  • 80. MODIFICATIONS TO MINIMISE PUMPING EFFECT
    EXCLUDE WICKS FROM THE AREA WHERE THE INLET TUBE JOINS THE VAPORIZING CHAMBER.
    OUTLET TUBE MAY BE MADE LONGER SO THAT UNSATURATED GAS WILL HAVE TO PASS FURTHER BACK BEFORE PICKING UP ANESTHETIC VAPOUR.
    CONNECTIONS OF OXYGEN FLUSH VALVE LINE TO THE COMMON GAS OUTLET BE DESIGNED TO MINIMISE PRESSURE FLUCTUATIONS THAT MAY PRODUCE A PUMPING EFFECT
    LIMIT PRESSURE TRANSMITTED TO VAPORIZER TO <10KPa ABOVE NORMAL WORKING PRESSURE ,CONC NOT TO INCREASE >20%
  • 81. PRESSURIZING EFFECT
    THE O/P OF SOME VAPORIZER USED IN CONJUNCTION WITH AUTOMATIC VENTILATOR HAS BEEN FOUND TO BE LOWER THAN DURING FREE FLOW TO ATMOSPHERE.
    MOSTLY SEEN WHEN
    HIGH FLOW
    LARGE PRESSURE FLUCTUATIONS
    LOW DIAL SETTINGS
  • 82.
  • 83. PRESSURIZING EFFECT
    No of mol.s of the agent picked by carrier gas ∝ density of vapor mol.s in vaporizing chamber ∝ vapor pressure
    Increased pressure in vaporizer chamber compress carrier gas more mol.s/mL No of mols of the anesthetic agent same o/p ↓ed
    The Changes In Vaporizer O/P Caused By The Pumping Effect Usually Are Greater In Magnitude Than Those Associated With The Pressurizing Effect
  • 84. 1988 ASTM MACHINE STANDARDS FOR VAPORIZERS
    A VAPORIZER MUST BE CAPABLE OF ACCEPTING A TOTAL GAS FLOW OF 15 lts/min FROM THE ANESTHESIA MACHINE AND IN TURN, DELIVERING A GAS FLOW WITH A PREDICTABLE CONC OF VAPOUR.
    THE EFFECTS OF THE CONDITIONS OF USE(VARIATIONS IN TEMP,PRESSURE,BACKPRESSURE,INPUT FLOW RATES)ON VAPORIZER PERFORMANCE MUST BE STATED IN CATALOGS.THE EFFECT OF CARRIER GAS COMPOSITION ON VAPORIZER O/P SHOULD ALSO BE SUPPLIED.
  • 85. 1988 ASTM MACHINE STANDARDS FOR VAPORIZERS
    THE EXTENT TO WHICH TEMP & INFLOW RATES INFLUENCE THE VAPORIZER CONC MUST BE STATED.
    VAPORIZER MUST BE DESIGNED SO THAT IT CANNOT BE OVERFILLED WHEN IN NORMAL OPERATING POSITION.
    A SYSTEM THAT ISOLATES THE VAPORIZER FROM EACH OTHER & PREVENTS GAS FROM PASSING THROUGH THE VAPORIZER CHAMBER OF ONE VAPO & THEN THROUGH THAT OF ANOTHER MUST BE PROVIDED
    CONTROL MUST BE PROVIDED TO LIMIT THE ESCAPE OF ANESTHETIC VAPOUR FROM THE VAP CHAMBER INTO THE FRESH GAS ,SO THAT THE DELVERED CONC IS <0.1% WHEN THE VAPORIZER IS TURNED OFF
  • 86. 1988 ASTM MACHINE STANDARDS FOR VAPORIZERS
    ALL THE VAPORIZER KNOB MUST TURN COUNTER CLOCKWISE TO INCREASE THE CONC.
    VAPORIZER MUST BE PROVIDED WITH A LIQUID LEVEL INDICATOR VISIBLE FROM THE FRONT OF THE MACHINE
    THE VAPORIZER MUST PERMIT MAXIMAL CALIBRATED FLOWS OF O2&N20 IN AN ON & OFF POSITIONS WITH THE VAPORIZER FILLED TO THE MAXIMUM SAFE INDICATED LEVEL WITHOUT DISCHARGING LIQUID THROUGH ITS OUTLET WHEN IT IS MOUNTED & USED IN ACCORDANCE WITH THE MANUFACTURERS INSTRUCTIONS
  • 87. 1988 ASTM MACHINE STANDARDS FOR VAPORIZERS
    VAPORIZER UNSUITABLE FOR USE IN THE BREATHING SYSTEM MUST ‘VE NONINTERCHANGEABLE 23MM FITTINGS.THE 22MM OR 15MM FITTINGS CANNOT BE USED.THE INLET OF THE VAPORIZER MUST BE MALE,OUTLET MUST BE FEMALE & THE DIRECTION OF GAS FLOW MUST BE MARKED WHEN 23MM FITTINGS ARE USED.
    VAPORIZER SUITABLE FOR USE IN THE BREATHING SYSTEM MUST ‘VE STANDARD 22MM FITINGS OR SCREW THREADED,WEIGHT BEARING FITTINGS WITH INLET FEMALE & OUTLET MALE.THE INLET &OUTLET PORTS MUST BE MARKED,THE DIRECTION OF GAS FLOW MUST BE INDICATED BY ARROWS & VAPORIZER MUST BE MARKED “FOR USE IN BREATHING SYSTEM”.
  • 88. 1988 ASTM MACHINE STANDARDS FOR VAPORIZERS
    ALL VAPORIZER LOCATED IN THE FRESH GAS CIRCUIT BE CONCENTRATION CALIBRATED & THAT THE CONTROL OF VAPOUR CAN BE PROVIDED BY MEANS OF CALIBRATED KNOBS OR DIALS.THE MEASURED FLOW SYSTEMS NOT MENTIONED IN THE STANDARDS ARE THEREFORE NOW CONSIDERED BY MOST TO BE OBSOLETE ,ALTHOUGH MILITARY FIELD ANESTHESIA MACHINE STILL USE SUCH SYSTEM
  • 89. AGENT SPECIFIC FILLING SYSTEMS
  • 90. AGENT SPECIFIC FILLING SYSTEMS
    A VAPORIZER DESIGNED FOR A SINGLE AGENT BE FITTED WITH A PERMANENTLY ATTACHED AGENT SPECIFIC DEVICE TO PREVENT ACCIDENTAL FILLING WITH A WRONG AGENT.
    THEY PREVENT ACCIDENTAL FILLING WITH THE WRONG AGENT
    REDUCE AIR POLLUTION
    PREVENT CONTAMINANTS ENTERING VAPORIZATION CHAMBER
    TYPES
    KEYED FILLING SYSTEM
    SCREW CAPPED FILLING SYSTEM
    PIN SAFETY SYSTEM
  • 91. AGENT SPECIFIC FILLING SYSTEMS
    BOTTLE COLLAR
    ATTACHED AT THE NECK OF THE BOTTLE.
    2 PROJECTIONS,ONE THICKER THAN THE OTHER ARE THERE.
    THIS MATES WITH THE CORRESPONDING INDENTATIONS ON THE BOTTLE ADAPTOR.
  • 92. AGENT SPECIFIC FILLING SYSTEMS
  • 93. AGENT SPECIFIC FILLING SYSTEMS
    BOTTLE ADAPTOR
    AT ONE END IS
    1) THE BOTTLE CONNECTOR WITH A SCREW THREAD TO MATCH THE THREAD ON THE BOTTLE
    2)SKIRT THAT EXTENDS BEYOND THE SCREW THREADS
    3)SLOTS THAT MATCH THE PROJECTIONS ON THE BOTTLE COLLAR
  • 94. AGENT SPECIFIC FILLING SYSTEMS
    AT THE OTHER END IS
    1.THE MALE ADAPTOR THAT FITS INTO THE VAPORIZER FILLER RECEPTACLE.
    2.A SHORT LENGTH OF PLASTIC TUBING WITH 2 INNER TUBES CONNECTS THE ENDS.
    3.THE TUBE ALLOWS THE BOTTLE TO BE HELD HIGHER OR LOWER THAN THE VAPORIZER.
  • 95. AGENT SPECIFIC FILLING SYSTEMS
    MALE ADAPTER
    HAS A GROOVE ON ONE SIDE TO PREVENT THE PROBE FROM BEING PLACED IN THE INCORRECT VAPORIZER
    TWO HOLES ON THE OTHER SIDE
    LARGER FOR AGENT TO LEAVE / ENTER
    SMALLER FOR AIR
  • 96. AGENT SPECIFIC FILLING SYSTEMS
    FILLER RECEPTACLE
    [FILLER SOCKET/VAPORIZER FILLER UNIT/FILL & DRAIN SYSTEM]
    MUST PERMIT THE INSERTION OF THE INTENDED BOTTLE
    .
    MUST ‘VE A MEANS OF TIGHTENING THE MALE ADAPTER ,TO FORM A TIGHT SEAL.
  • 97. AGENT SPECIFIC FILLING SYSTEMS
    FILLER RECEPTACLE
    MUST ‘VE A MEANS OF SEALING THE ADAPTOR WHEN BOTTLE ADAPTOR NOT INSERTED.
    SINGLE PORT FOR FILLING & DRAINAGE.
    A VALVE ATTACHED TO A KNOB AT THE TOP CONTROLS THE OPENING INTO THE VAPORIZER
    A BALL VALVE IN THE AIRLINE OCCLUDES THE AIR PORT AFTER THE VAP IS FILLED TO PREVENT OVERFILLING & FLOODING OF AIRLINE WITH THE AGENT.
  • 98. AGENT SPECIFIC FILLING SYSTEMS
    FILLING
    CAP OF BOTTLE REMOVED
    ADAPTER SCREWED TO THE COLLAR
  • 99. AGENT SPECIFIC FILLING SYSTEMS
    FILLING
    VAPORIZER TURNED OFF
    PLUG REMOVED
    BOTTLE WITH ADAPTER INSERTED SUCH THAT THE GROOVES MATCH; [TUBE BENT SUCH THAT BOTTLE IS BELOW INLET]
  • 100. AGENT SPECIFIC FILLING SYSTEMS
    FILLING
    RETAINING SCREW TIGHTENED
    FILL VALVE [VENT] OPENED
    BOTTLE HELD HIGH
    AIR FROM THE VAPORIZER
    DISPLACED BY THE LIQUID
    MOVES THROUGH THE OTHER
    TUBE AND ENTERS THE AIR SPACE INSIDE THE BOTTLE
    GENTLE UP AND DOWN MOTION MAY HELP
  • 101.
  • 102. AGENT SPECIFIC FILLING SYSTEMS
    DRAINING
    ADAPTER ATTACHED TO BOTTLEFILLER PLUG REMOVED MALE ADAPTOR INSERTEDRETAINING SCREW TIGHTENEDBOTTLE HELD BELOW THE RECEPTACLE DRAIN VALVE OPENEDDRAINED SCREW LOOSENEDADAPTOR REMOVEDFILLER PLUG REINSERTED
  • 103. AGENT SPECIFIC FILLING SYSTEMS-PROBLEMS
    1.DIFFICULTY IN FILLING
    2.MISALIGNMENT OF ADAPTOR IN FILLER RECEPTACLE
    .
    3.ADAPTOR NOT SEALING AT THE BOTTLE END
    .
    4.LEAK IN THE BOTTLE ADAPTOR
    5.AIR BUBBLES.
    6.LOST BOTTLE ADAPTOR
    7.FAILURE OF KEYED SYSTEM
    8.LIQUID LEAKS
    9.INCOMPLETE EMPTYING
  • 104. AGENT SPECIFIC FILLING SYSTEMS-PROBLEMS
    10.VAPORIZER TIPPING
    IF FILLER RECEPTACLE ON VAPORIZER EXTENDS BEYOND THE BASEIT CANNOT BE SET UPRIGHT ON A FLAT SURFACETHIS CAN CAUSE TIPPING
    PREVENTED BY SETTING THE VAPORIZER RECEPTACLE AT THE EDGE OF THE SURFACE OR A RING CAN BE FITTED AT THE BASE THAT EXTENDS BELOW THE PROJECTION OF THE FILLER REEPTACLE
    .
    11.POOR DRAINAGE
    12.BROKEN INNER TUBE
  • 105. LOCATION
    BETWEEN THE FLOWMETERS & COMMON GAS OUTLET
    BETWEEN THE COMMON GAS OUTLET & BREATHING SYSTEM
    IN- SYSTEM VAPORIZERS
  • 106. HAZARDS
    INCORRECT AGENT
    LOW OUTPUT OR HIGH OUTPUT
    MISPLACING DESFLURANE DANGEROUS
    GAS ALLOWEDTO FLOW THRUGH IT UNTIL NO AGENT DETECTED IN THE OUTFLOW
  • 107. HAZARDS
    TIPPING
    LIQUIDFROM VAPORIZING CHAMBERBYPASS/OUTLETHIGH OUTPUT
    DRAINED BEFORE MOVING
  • 108. HAZARDS
    OVERFILLING
    IN MAJORITY, THE DESIGN OF THE FILLING PORT AND AGENT SPECIFIC FILLING SYSTEMS PREVENT THIS
    DURING FILLING DO NOT:
    TURN THE DIAL ON/ UNSCREW THE BOTTLE ADAPTOR
  • 109. HAZARDS
    REVERSED FLOW
    INLET MALE & OUTLET FEMALE
    INCRESED OUTPUT
    CONCENTRATION DIAL IN WRONG POSITION
    CONTAMINANTS IN VAPORIZING CHAMBER
    PHYSICAL DAMAGE
    OBSTRUCTION TO FRESH GAS FLOW
    INTERLOCK MALFUNCTION
    LEAKS
  • 110. Evolution of vaporizers
    MORTONS ETHER INHALER 1846,OCT 16
  • 111. SNOW ETHER INHALER 1847
    It incorporates the basic principles of vaporization
    He knew the importance of ambient temperature on vaporization
    Had a metal box as bath for water at 50-60⁰F
  • 112. CLOVER PORTABLE REGULATING ETHER INHALER 1877
    By Joseph Clover [surgeon ->anesthetist]
    For ether & chloroform
    Can regulate the amount of vapor inhaled, rapid onset,no valves
    Metal sphere with ether; sphere rotated around a central tube through which patient inhales
    Model for Ombredanne’s inhaler
    Markings not related to output concentration
  • 113. CLOVER GIVING CHLOROFORM
  • 114. VERNON HARCOURT CHLOROFORM INHALER 1903
    BY AG Vernon Harcourt
    For chloroform [amount inhaled <2%,hence safe]
    Simple, accurate, portable
    Apparatus could be worn around the chloroformist’s neck
    Danger! Don’t lean to take something from the floor
  • 115. MORE BURDENS ON THE NECK………
  • 116. OMBREDANNE ETHER INHALER 1908
    Louis Ombredanne [plastic Sxn]
    Strongly argued for air! Against ether!
    Criticized Clovers ‘useless’ water chamber
    Had a modern bag [made from cow’s caecum]
  • 117. OMBREDANNE INHALER
  • 118. SOMNOFORM INHALER 1908
    SOMNOFORM MIXTURE: Ethyl chloride+ Methyl chloride+ Ethyl bromide [60:35:5]
  • 119. OPEN DROP MASKS
    ESMARCH 1879
    SCHIMMELBUSCH 1890
    YANKAUER MASK 1910
    For agents like ether,chloroform, divinyl ether & ethyl chloride
    Mask was covered with flannel/gauze onto which,these agents were poured
  • 120. YANKAUER’S MASK
  • 121. YANKAUER’S MASK
    (1)Yankauer’s facemask with mesh and (2)removable spiral wire collar for holding in place, lint or gauze, on to which agents such as ether &chloroform were applied
    Length 15cm Width 7.9cm Depth 5.5cm
    Materials: Copper alloy, chrome plate
  • 122. SCHIMMELBUSCH MASK
  • 123. SCHIMMELBUSCH MASK
    SCHIMMELBUSCH FOLDING FACE MASK with a hinged frame for holding gauze/lint in place
    Height : 18.3cm Width 11.3cm depth 7.3cm
    Materials: copper alloy, nickel plate
    For ether 16 layers of gauze; ether dropped over the whole area
  • 124. SCHIMMELBUSCH MASK
    Heat of vaporization high;so require much latent heat
    Mask cools & water vapour condenses on it and freezes
    Increased resistance and reduced rate of vaporisation
    Keep a second mask and fresh gauze in supply
    There should be a Drop Bottle to drop the agent into the mask
  • 125. SCHIMMELBUSCH MASK
    For Chloroform, 12 layers of gauze
    Liquid agent poured over one half of the mask in order to ensure that air is entrained to avoid high concentration
    Cover the patients face with a piece of cloth of 25X20 cm.
    In this make a central hole to expose patients nose and mouth. This prevents vapor or liquid from entering eyes. Also reduces the amount of air drawn in
  • 126. OXFORD VINETHENE INHALER 1940
    Used for Divinyl ether
  • 127. OXY-COLUMBUS TRILENE INHALER 1950
    By Hans Hosemann
    Analgesic properties of Trichloroethylene utilized in labour,dressingchanges,dentistry,ENT
    Held over nose / mouth
    Chain passed around patients neck
    Vaporization by warmth of patients hand
    Inhaler fell from hand as she become unconcious
  • 128. DUKES TRILENE INHALER 1952
    Draw over
    Non rebreathing mechanism to prevent CO2 accumulation
    Trileneupto 0.5% ; conc. Controlled by the patient
    Wrist strap to prevent falling away
    Mainly in Rx of pain during child birth
  • 129. DUKES TRILENE INHALER
  • 130. DRAGER BAR TRILENE INHALER 1955
    Safe self administration
    Overdosing practically impossible
    Max 1%
  • 131. PENTHRANE ANALGIZER 1968
    For Methoxyflurane
    Light weight
    Disposable
    No face mask
  • 132. SKINNERS WIRE FACE MASK 1862
    By Thomas Skinner , an Obstetric Physician
    For chloroform
    Wire frame and gauze
    Can be folded and kept in pocket
  • 133. JUNKERS CHLOROFORM BOTTLE
    FIRST BLOW OVER APPARATUS
    Air blown by hand held bellows through glass bottles containing chloroform
    Modified later with wire face mask,which is safer
  • 134. OGSTON INHALER
    Mask is like that of Schimmelbusch
    Surmounted by a wire frame
    Around this a gauze could be erected
    Semiopen method, economical use of ether
  • 135. BOYLES BOTTLE
    PARTS:(1)VAPORIZING BOTTLE 300 mL (2) METAL TOP INCORPORATING CONTROLS (3)LEVER,PLUNGER WHICH IS CHROME PLATED (4)STOPPER & RETAINING CHAIN
  • 136. BOYLES BOTTLE
    Stoper cork should be air tight
    It is retained by small chain
    Top of cork insulated to avoid electric spark
  • 137. BOYLES BOTTLE
  • 138. BOYLES BOTTLE
    Copper in U-Tube & hood of plunger prevents decomposition of ether
    Before operating the ether vaporizer, the filling orifices should be kept open for some seconds and then closed ;otherwise high concentration may be delivered
    Temperature compensated by copper plate or water bath
  • 139. BOYLES BOTTLE: ETHER-CHLOROFORM-TRILENE
  • 140. PINSON ETHER BOMB
    Avoids carrying of complex machines & heavy cylinders
    100% warmed ether vapor
  • 141. TRILENE POCKET VAPORIZER 1941
    Self administration of trilene in war
    Small, non spillable, easy to use
    Easily refilled
    .3-.4% vapor @ room temperature
  • 142. OXFORD MINIATURE VAPORIZER[OMV]
    Advantages
    Small, portable, simple, less servicing
    May be drained of one agent & filled with the other
    Detachable scales for several agents
  • 143. OXFORD MINIATURE VAPORIZER[OMV]
    PARTS:
    ETHER PLACED IN INNER CONTAINER
    SURROUNDED BY CRYSTALS OF HYDRATED CaCl₂
    MIXING CHAMBER
    CONTROL VALVE
    50 Ml CAPACITY
    WEIGHT WITH WATER 1060gm
  • 144. OXFORD MINIATURE VAPORIZER[OMV]
    hot water jackets causes melting of CaCl₂. It cools and solidifies and relases heat of crystalisation. This heat absorbed by ether vaporisation  mixed with O₂ in the mixing chamber  delivered
    Prone to tipping
    Screw cap filling
    Back pressure compensation by circuit valves
  • 145. TRISERVICE ANESTHESIA APPARATUS
    Consists of 2 OMVs + LAERDEL folding manual resuscitator quick change from one to other possible, high concentration of each agent can be obtained
    All except O₂ cylinder housed in a box
    Dropped from a parachute in war fields
  • 146. EPSTEIN MACINTOSH OXFORD VAPORIZER 1952 [EMO]
  • 147. EPSTEIN MACINTOSH OXFORD VAPORIZER 1952 [EMO]
  • 148. EPSTEIN MACINTOSH OXFORD VAPORIZER 1952 [EMO]
  • 149. EMO-INTERIOR PARTS
    VAPORIZATION CHAMBER
    BYPASS CHAMBER
    MIXING CHAMBER
    CONTROL VALVE
    METAL BELLOWS CONTAINING LIQUID IN VAPORIZATION CHAMBER
    WICKS AROUND VAPORIZING CHAMBER WALL
    WATER JACKET OF 1250 ML DISTILLED WATER ALUMINIUM OR STEEL
    CONTROL VALVE AT THE MOUTH OF THE VAPORIZATION CHAMBER
  • 150. EMO-INTERIOR PARTS
  • 151. EMO- HOW IT WORKS
    CONTROL VALVE CONTROLS AIR FLOW INTO THE CHAMBER
    METAL BELLOWS IS THE THERMOCOMPENSATOR
    USED WITH OXFORD INFLATING BELLOWS
    A MAGNET IS USED TO IMMOBILIZE NON REBREATHING VALVE DURING SPONTANEOUS RESPIRATION
    IN CONTROLLED VENTILATION, NO MAGNET IS USED
    APL VALVE NEAR PATIENT END KEPT OPEN FOR EXPIRATION
  • 152. EMO- HOW IT WORKS
    TIPPING PREVENTED BY ON-OFF VALVES
    BACK PRESSURE COMPENSATION PREVENTED BY CIRCUIT VALVES
    ADVANTAGES: LOW COST, PORTABLE,CAN BE USED IN HIGH ALTITUDES AS IT AUTOMATICALLY ADJUSTS FOR CHANGES IN BAROMETRIC PRESSURES
    IN TROPICS IT HAS TO BE COOLED BEFORE USE
    IN CLOD TEMPERATURE, ANTIFREEZE SOLUTION 25% GLYCOL USED IN WATER JACKET
    AIR IS THE CARRIER
  • 153. EMO HOW IT WORKS
  • 154. GOLDMAN VAPORIZER
  • 155. GOLDMAN VAPORIZER-PARTS
    SMALL GLASS POT
    METAL HEAD
    INLET & OUTLET
    CONTROL LEVER ON TOP OF METAL HEAD
    CAPACITY 30 ML
    MAX CONCENTRATIO 2±0.5%
  • 156. GOLDMAN VAPORIZER
  • 157. Goldman
    Adjustment is made by means of a ratchet type control valve. The glass jar is screwed on to the body and can be quickly detached for easy filling
  • 158. ROWBOTHOM VAPORIZER
    MODIFICATION OF GOLDMAN VAPORIZER
  • 159. FOREGGER COPPER KETTLE 1952
  • 160. FOREGGER COPPER KETTLE 1952
    COPPER VESSELHIGH HEAT CAPACITY & THERMAL CONDUCTIVITY
    GAS BREAKS AS IT PASSES THROUGH THE DIFFUSER AND GETS FULLY SATURATED IN ITS PASSAGE THROUGH THE LIQUID
    HIGH DEGREE OF ACCURACY
    HALOX VAPORIZER- MODIFICATION
  • 161.
    • TRUE OR FALSE
    • 162. TEMPERATURE COMPENSATION IN BOYLE BOTTLE IS BY ETHYL CHLORIDE
    • 163. WHEN I SPEAK OF COPPER KETTLE THE FIRST WORD THAT COMES TO MY MIND IS MEASURED FLOW
    • 164. GOLDMAN IS A FLOW OVER TYPE VAPORIZER
    • 165. GOLDMAN OMV EMO BYLES BOTTLE; ALL ARE DRAW OVER TYPE
    • 166. TEMPERATURE STABILISATION AND COMPENSATION ARE THE SAME
    • 167. NO TEMPERATURE COMPENSATION IN GOLDMAN BOYLE BOTTLE
    • 168. COPPER KETTLE: TEMPERATURE COMPENSATION IS MANUAL
    • 169. BIMETALLIC STRIP IN BYPASS CHAMBER IN ALLADIN CASSETTE
    • 170. GOLDMAN IS AN AGENT SPECIFIC VAPORIZER
    • 171. OMV IS AN AGENT SPECIFIC VAPORIZER
  • REFERENCES
    UNDERSTANDING ANESTHESIA EQUIPMENT,JERRY A DORSCH,4/e
    ANESTHESIA EQUIPMENT MANUAL, MITCHEL B SOSIS
    PHYSICS FOR THE ANESTHETIST,MACINTOSH,4/e
    BASIC PHYSICS & MEASUREMENT IN ANESTHESIA,PAUL D DAVIS,5/e
    VAPORIZERS,ARUNA PARAMESHWARI,ISACON-2009
    VAPORISERS,L.BHARGAVA,IJA 2004(48)4
    THE DEVELOPMENT OF ANESTHETIC APPARATUS,ASSOCIATION OF ANESTHETISTS OF GREAT BRITAIN & IRELAND
  • 172.
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