Simple,inexpensive and rugged,parts are easy to dismentle and sterilize, safe to use. Delivers the right gas mixture Allows all methods of ventilation in all age groups Resistence low at flows in practice Compression and compliance loss is less. Sturdy, small and light Allows easy removal of waste gases Easy to maintain with low running costs

1. Dr. Nishat Nasrin Nitu
Student of DA Course
ShSMCH, Dhaka.

2. The Ideal Breathing System
Simple,inexpensive and rugged,parts are easy to
dismentle and sterilize, safe to use.
Delivers the right gas mixture
Allows all methods of ventilation in all age groups
Resistence low at flows in practice
Compression and compliance loss is less.
Sturdy, small and light
Allows easy removal of waste gases
Easy to maintain with low running costs

3. Breathing System Components
Fresh Gas connection
Patient connection
Adjustable Pressure Limiting (APL) Valve
Reservoir (Bag or bellows)
Tubing
Waste gas connection

4. Open, semi open, semi closed?
• Open is the old fashioned method of dropping ether
or chloroform over a gauze or lint. Later modernised
by the likes of the Schimmelbusch mask.
• Semi-open systems used today such as the Mapleson
systems.
• Semi-closed and Closed systems use a CO2 absorbent
so that the gases are re-circulated, the classification is
defined by the amount of fresh gas flow.

5. Semi-open Systems
• In the early 1954’s, Prof. WW Mapleson from
University of Wales, Cardiff, classified the several
breathing systems depending on what components
they contained and what position they took in the
system.
• It is known today as ‘The Mapleson Alphabet’‘The Mapleson Alphabet’

6. TheThe
MaplesonMapleson
AlphabetAlphabet
The F was added later to the alphabetThe F was added later to the alphabet

7. Semi-open Circuit Anaesthesia
This is typically used for induction of the patient. It
is usually a single limb system that uses an APL valve
to control the pressure of the gas, and allows for
waste gas to leave the system.
High fresh gas flows (more than patients minute
volume) are required with these systems to stop
rebreathing of expired CO2.

8. Types of Semi-open Circuit Systems
Mapleson D or Bain System
Mapleson A or Magill System
Mapleson A or Lack System
Mapleson F or Ayres T Piece System
Mapleson F with APL Valve
Mapleson C Bagging System

9. Semi-open Circuit Anaesthesia
Mapleson D or Bain System
Mapleson A or Magill System
Mapleson A or Lack System
Mapleson E or Ayres T Piece System
Mapleson F ,Jackson Rees modification
Mapleson C Bagging System,Water’s to and fro

10. What FGF’s are needed?
Mapleson Systems Uses FGF SV FGF
IPPV
A
Magill
Lack
Spontaneous
Gen Anaesthesia
70-100 ml/kg/min Min 3 x MV
B
Very uncommon,
not in use today
C
Resuscitation
Bagging
Min 15 lpm
D
Bain Spontaneous
IPPV, Gen.
Anaes
150-200
ml/kg/min
70-100 ml/kg/min
E
Ayres T Piece Very uncommon,
not in use today
F
Jackson Rees Paediatric
<25 Kg
2.5 – 3 x MV
Min 4 lpm

11. Mapleson A (Magill) System
The Mapleson A or Magill system is good for
spontaneous breathing patients, so the fresh gas flow
can be lower. However as the APL valve is close to the
patient, it is regarded by many as difficult to use.
1950’s1950’s

12. Mapleson A (Lack) System
The Mapleson A or Lack system is a modification of the
Magill where the valve is moved to the machine end of
the system using another length of tubing. This adds
volume to the system and makes it rather heavy at the
patient end.
19761976

13. Advantage:
The expiratory valve is at the proximal end. So easier
to adjust & scavenging waste gases.
The patient end is lighter.

14. Disadvantages :
The system is bulky & relatively inflexible.
The system has greater resistance to expiration than
the magill system.
The system is not as efficient as the magill
attachment.

15. Mapleson D (Bain)
The Mapleson D or Bain System is a co-axial system
where the fresh gas is delivered directly to the patient.
It requires very high fresh gas flows to prevent
rebreathing of CO2. It is very convenient to use, thus is
very popular especially for induction of anaesthesia.
19721972

16. Mapleson D(Bain)
Advantages :
Lighter & longer.
Expiratory valve at the machine end,so allowing easy
adjustment & scavenging.
Long bain system may be used for distant
ventilation .

17. Mapleson D(Bain)
Disadvantages :
Some resistance to expiration .
Inner tube may be disconnected & result in
rebreathing ,awareness,hypoxemia,hypercapnoea.
Circuit dead space becomes much longer.
May not be as efficient as the mapleson D system
because of gas mixing at the patient end.

18. Mapleson F (Jackson Rees
Modification)
 The Mapleson F or Jackson
Rees modification of the Ayres
T Piece is a basic system for
use with very small
patients,but big disadvantage
is that waste gases cannot be
removed safely.
 Because this has a bag with an
open tail, it is technically a
Jackson-Rees Modification
system
Ayres – 1937Ayres – 1937
JR - 1950JR - 1950

19. Advantages :
It provides visual evidence of breathing during
spontaneous ventilation .
By occluding the open end of the bag temporarily , it
is possible to confirm that fresh gas is entering the
system .
It provides a degree of CPAP during spontaneous
ventilation positive end-expiratory pressure during
IPPV.
It provides a convenient method of assessing or
controlling ventilation.

20. Disadvantages :
Efficient scavenging is unsatisfactory & requires high
gas flows due to which inspired gas heat and
humidity tends to be low.

21. Mapleson F with APL Valve
Intersurgical decided to
modify the Jackson-Rees
by using a closed tail bag
and a specially modified
APL valve. Now the
waste gases can be
removed safely from the
system via the APL
valve’s 30mm outlet.
19981998

22. Mapleson C Bagging System
The Mapleson C is more
than an anaesthesia
system. It can be found
all over the hospital for
use as an emergency
bagging system for
resuscitation or manual
ventilation using oxygen,
as well as being a
standard induction
system in some
countries.

23. Advantage of Mapleson sysytem:
1.Simple and inexpensive
2.Resistence is usually low
3.Light weight and not bulky
4.They are easy to position
5.No possibility of production of CO

24. Disadvantage of Mapleson system:
1.Require high fresh gas flow to prevent rebreathing.
2.Wastage of anesthetic agent.
3.Pollution of the operating Room environment.
4.Loss of patient’s heat & humidity.

25. Semi Closed Circuit Anaesthesia
This type of General Anaesthesia is used mainly for
maintenance of anaesthesia following induction. It
can be used for induction of anaesthesia, but this is a
slower process.
It requires an absorber system containing a CO2
Absorbent to remove CO2 from the expired patient
gases, and a higher level of patient monitoring,
specially respiratory gas monitoring to measure levels
of inspired and expired CO2and the volatile agent.

26. Semi Closed Anaesthesia Explained
Semi Closed Anaesthesia is where the expired
gases from the patient pass through a canister in
the breathing system which contains a CO2
absorbent. This absorbent by an exothermic
chemical reaction removes the CO2
, so the
patients expired gases can be rebreathed. Because
of this exothermic chemical reaction, some
warmth and humidity is added to the inspired
gases.

27. Semi Closed Anaesthesia Explained
Because the patients expired gases are re circulated (where
the ‘circle’ comes from), this means that we do not have to
add so much fresh gas to the system like an open system.
So the fresh gas flow rate can be reduced to low flow, i.e., 1
litre per minute. If the flows were as low as a few hundred
cc’s of gas, equivalent to the patients metabolic uptake of
gases, this would be closed circuit anaesthesia, or
metabolic (basal) flow, or minimal flow.
Circle systems were first used back in 1930 by Brian Sword
in the USA

28. Types of Semi Closed Circuit System
Standard Parallel Y System
Extendible Parallel Y System
Complete Semi Closed Circuit Systems
Co-Axial Semi Closed Circuit Systems

29. ‘Tight Connections’
 It is important with
conical connectors
such as those used on
breathing systems,
always connect with a
firm push and twist.
This will ensure a
leak tight
connection.

30. The silver ion based anti-microbial
additive reduced the potential risk of
cross contamination from the outside of
the breathing system
Conclusion

31. This means that the anti-microbial additive in
Breathing Systems not only inhibits bacterial
growth but will reduce colonisation on the
circuit, and therefore can reduce cross
infection in the Intensive CareUnit( ICU) and
the operating theatre