Mapleson breathing systems

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Mapleson breathing systems

  1. 1. MAPLESON BREATHING SYSTEMS <ul><li>MODERATOR : DR RANJAN R K </li></ul><ul><li>PRESENTER : DR NIKHIL M P </li></ul>
  2. 2. History <ul><li>In 1954 Mapleson described and analyzed Five different anaesthetic breathing systems & referred as Mapleson A – E. </li></ul><ul><li>Bain circuit in 1972 by Bain & Spoeral </li></ul>
  3. 3. <ul><li>In 1975 Willis et al described F system & added to above. </li></ul><ul><li>In 1976 – Lack circuit . </li></ul>
  4. 4. CLASSIFICATION
  5. 5. <ul><li>MAPLESON A </li></ul><ul><li>Classic & Lack’s modification </li></ul><ul><li>MAPLESON B </li></ul><ul><li>MAPLESON C </li></ul><ul><li>MAPLESON D </li></ul><ul><li>Classic form & Bain’s modification </li></ul><ul><li>MAPLESON E </li></ul><ul><li>MAPLESON F </li></ul>
  6. 6. BASED ON THE RESERVOIR BAG POSITION <ul><li>Afferent reservoir system </li></ul><ul><li>eg:Mapleson A,B,C & Lack’s </li></ul><ul><li>Afferent limb:delivers FGF from machine to patient end </li></ul>
  7. 7. <ul><li>Efferent reservoir system </li></ul><ul><li>eg:Mapleson D,E,F & Bain’s </li></ul><ul><li>Efferent limb:carries expired gas from patient & vents it to the atmosphere through expiratory valve </li></ul>
  8. 8. <ul><li>Breathing systems </li></ul><ul><li>Bidirectional flow </li></ul><ul><li>& </li></ul><ul><li>without carbondioxide absorption </li></ul><ul><li>& </li></ul><ul><li>Semiclosed system </li></ul>MAPLESON SYSTEMS
  9. 9. Mapleson’s assumptions <ul><li>Gases move enblock </li></ul><ul><li>fresh gas,dead space gas,alveolar gas </li></ul><ul><li>2. Reservoir bag continues to fill,without offering any resistance till it is full </li></ul>
  10. 10. <ul><li>3. Expiratory valve opens as soon as reservoir bag is full & the pressure inside the system goes above atmospheric pressure </li></ul><ul><li>4. Valve remain opens throughout the expiratory phase and closes at the start of next inspiration </li></ul>MAPLESON’S ASSUMPTIONS CONTD.
  11. 11. Afferent reservoir systems
  12. 12. MAPLESON A SYSTEM
  13. 13. <ul><li>Magill system </li></ul><ul><li>FGF enters the system near machine end </li></ul><ul><li>A corrugated tubing connects the reservoir bag to APL valve of the system </li></ul>MAPLESON A
  14. 14. MAPLESON A
  15. 15. Lack’s modification <ul><li>Expiratory limb –from patient end to APL valve at the machine end of the system </li></ul><ul><li>2 forms </li></ul><ul><li>dual tube (parallel) </li></ul><ul><li>tube-within-a-tube(coaxial ) </li></ul>
  16. 16. LACK’S MODIFICATION
  17. 17. Functional analysis
  18. 18. Spontaneous breathing
  19. 19. MAPLESON A- spontaneous respiration
  20. 20. <ul><li>a. During inspiration,FG from the machine and reservoir bag flows to the patient,RB collapses </li></ul><ul><li>b. During expiration,FG continues to flow.expired gas (dead space gas & alveolar gas) pushes the FG into RB and collects inside the corrugated tube </li></ul>MAPLESON A – SPONT. CONTD.
  21. 21. <ul><li>c. Expiratory valve opens and alveolar gas is vented into atmosphere </li></ul><ul><li>d. During Expiratory pause,alveolar gas that had come in contact with the corrugated tube is also vented depending on FGF. </li></ul>MAPLESON A – SPONT. CONTD.
  22. 22. <ul><li>System is filled with only FG & dead space gas at the start of next inspiration when FGF =Minute ventilation </li></ul><ul><li>Alveolar gas+dead space gas+some of FG also escapes if FGF>minute ventilation </li></ul><ul><li>Some alveolar gas +dead space gas will remain if FGF < minute ventilation </li></ul>MAPLESON A – SPONT. CONTD.
  23. 23. MAPLESON A SPONTANEOUS
  24. 24. Controlled ventilation
  25. 25. MAPLESON A- controlled ventilation
  26. 26. <ul><li>a . During inspiration,patient gets ventilated with FG & part of FG is vented through the valve. </li></ul><ul><li>b. During expiration,FG flows into RB & expired gases flows back into corrugated tubing till system is full </li></ul>MAPLESON A- controlled ventilation contd.
  27. 27. <ul><li>c. During next inspiration alveolar gas is pushed back into alveoli followed by FG </li></ul><ul><li>part of expired gas & part of FG escape through the valve when sufficient pressure is developed </li></ul><ul><li>rebreathing </li></ul><ul><li>inefficient for controlled ventilation </li></ul>MAPLESON A- controlled ventilation contd.
  28. 28. MAPLESON A - CONTROLLED
  29. 29. TESTS FOR MAPLESON A SYSTEMS
  30. 30. <ul><li>Tested for leaks by occluding the patient end of the system,closing the APL valve & pressurizing the system </li></ul><ul><li>APL valve opens </li></ul>TESTS FOR MAPLESON A CONTD.
  31. 31. <ul><li>To attach a tracheal tube to the inner tubing at the patient end of the system </li></ul><ul><li>To occlude both limbs at the patient connection with APL valve open </li></ul>TESTS FOR COAXIAL LACKS SYSTEM
  32. 32. FGF Requirement <ul><li>Spontaneous : equal to minute </li></ul><ul><li>ventilation </li></ul><ul><li>Controlled :very high & difficult to </li></ul><ul><li>predict. </li></ul>
  33. 33. MAPLESON B SYSTEM
  34. 34. MAPLESON C SYSTEM
  35. 35. MAPLESON A,B,C
  36. 36. Efferent reservoir system
  37. 37. <ul><li>They have a 6mm d. tube as afferent limb and carries FGF from machine end to patient end . </li></ul><ul><li>Reservoir bag is attached to efferent limb which is a wide bore corrugated tube </li></ul>EFFERENT RESERVOIR SYSTEM CONTD .
  38. 38. <ul><li>APL valve is placed near the reservoir bag </li></ul><ul><li>In Bain’s modification afferent & efferent limbs are coaxially placed </li></ul><ul><li>Inner tube – 6mm </li></ul><ul><li>Outer tube – 22 mm </li></ul><ul><li>Length- 180 cms </li></ul>EFFERENT RESERVOIR SYSTEM CONTD .
  39. 39. Mapleson D system
  40. 40. MAPLESON D
  41. 41. BAIN’S CIRCUIT
  42. 42. Functional analysis
  43. 43. Spontaneous respiration
  44. 44. MAPLESON D - Spontaneous respiration
  45. 45. <ul><li>a.During inspiration,FG from the machine,RB & corrugated tube flow to the patient </li></ul><ul><li>b.During expiration,FGF to the system at the patient end & expired gas gets continuously mixed with FG as it flows back into corrugated tube & reservoir bag </li></ul>MAPLESON D CONTD .
  46. 46. <ul><li>c.Once the system is full, the excess gas is vented to the atmosphere through the APL valve </li></ul><ul><li>during expiratory pause FG continues to flow & fill the proximal portion of corrugated tube while mixed gas is vented through the valve </li></ul>MAPLESON D CONTD .
  47. 47. <ul><li>d . During next inspiration,patient breaths FG & mixed gas. </li></ul>MAPLESON D CONTD.
  48. 48. Controlled ventilation
  49. 49. MAPLESON D-controlled ventilation
  50. 50. <ul><li>a.During inspiration the patient gets ventilated with FGF from the machine,corrugated tube & RB. </li></ul><ul><li>b.During expiration the expired gas gets mixed with the fresh gas that is flowing into the system at patient end </li></ul><ul><li>During expiratory pause the FG continues to enter the system and pushes the mixed gas towards RB. </li></ul>MAPLESON D CONTROLLED CONTD .
  51. 51. <ul><li>c. When next ventilation is initiated patient gets ventilated with the gas in the corrugated tube. As the pressure in the system increases APL valve opens and contents of RB are released into the atmosphere. </li></ul>MAPLESON D CONTROLLED CONTD .
  52. 52. BAIN’S CONTROLLED.
  53. 53. FGF Requirement <ul><li>Spontaneous : 1.5 to 3 times minute </li></ul><ul><li>ventilation </li></ul><ul><li>( 100 to 300 ml/kg/min) </li></ul><ul><li>Controlled : 1 to 2 times minute </li></ul><ul><li>ventilation </li></ul>
  54. 54. MINUTE VENTILATION F R E S H G A S F L O W PaCO 2 Almost same PaCO2- for FGF from 100 to 240ml/kg/min
  55. 55. Tests for Mapleson D
  56. 56. <ul><li>By occluding the patient end & closing the APL valve,pressurizing the system </li></ul><ul><li>Open the APL valve </li></ul><ul><li>Bag deflates easily </li></ul>TESTS FOR MAPLESON D CONTD.
  57. 57. <ul><li>Occlude the inner tube at the patient end after setting a low flow oxygen </li></ul><ul><li>If the inner tube is intact the flowmeter indicator will fall </li></ul>TESTS FOR BAINS SYSTEM
  58. 58. <ul><li>Pethick test </li></ul><ul><li>Activate oxygen flush & observe the bag </li></ul><ul><li>Venturi effect caused by high flow oxygen at the patient end will create a negative pressure at the outer tube </li></ul><ul><li>Bag deflates </li></ul>TESTS FOR BAINS SYSTEM
  59. 59. Advantages <ul><li>Can be usedin controlled/spontaneous respiration </li></ul><ul><li>Adults & Pediatrics </li></ul><ul><li>Portable,Light weight </li></ul><ul><li>Scavenging of exhaled gases </li></ul>
  60. 60. Hazards <ul><li>Accidental disconnection of inner tube from machine end. </li></ul><ul><li>‘ Double back’ itself & cause obstruction to FGF. </li></ul>
  61. 61. THANK YOU

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