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International Research Journal of Engineering and Technology (IRJET) e-ISSN: 2395-0056
Volume: 06 Issue: 06 | June 2019 www.irjet.net p-ISSN: 2395-0072
© 2019, IRJET | Impact Factor value: 7.211 | ISO 9001:2008 Certified Journal | Page 826
Microcontroller based Anesthesia Injector
Smt.Leela Salim1, Abey Thomas2, Akshay M3, Athul K Alias4, Muhammed Irshad E K5
1Assisstant Professor, Dept. of Electrical and Electronics Engineering, Mar Athanasius College of Engineering,
Kothamangalam, Kerala, India
2,3,4,5 Under Graduate Students, MarAthanasius College of Engineering, Kothamangalam, Kerala, India
---------------------------------------------------------------------***----------------------------------------------------------------------
Abstract - In the hospitals when any major operation is
performed, the patient must be in anesthetize condition. If the
operation lasts for a long time, for suppose for 4 or 5 hours,
complete dose of anesthesia cannotbeadministered inasingle
stroke. It may lead to the patient’s death. If lower amount of
anesthesia is administered, the patient may wake up at the
middle of the operation. To avoid this, the anesthetist
administers few milliliters of anesthesia per hour to the
patient. If the anesthetist fails to administer the anesthesia to
the patient at the particular time interval, other allied
problems may arise. To overcome such hazardous problems
the design of an automaticoperationofananesthesiamachine
based on a micro-controller is effective. In this system a
microcontroller and syringe infusion pump provided. The
anesthetist can decide the level of anesthesia in terms of
milliliters per hour to administer anesthesia to the patient
with the help of different sensor results.. After receiving the
signal from the sensors the microcontroller controlsthesignal
to the desire level and fed into the dc motor to drive the
infusion pump in proper manner. The anesthesia is
administered to the patient according to the dc motor
rotation.
KEY WORDS: Anesthesia,Microcontroller,Sensors,
dc motor, Syringe infusion pump
1. INTRODUCTION
An Embedded system is a combination of computer
hardware, software and additional mechanical parts
designed to perform a speci_c function. An example is the
microwave oven. It is hardly realized that the oven actually
consists of a processor and the software running inside.
Another example is the TV remote control. Very few
actually realize that there is a microcontroller inside that
runs a set of programs especially for the TV. Automatic
Anesthesia Injector system is also an application of
embedded technologies in whicha microcontrollerisusedto
control the entire device. A microcontroller is a general-
purpose device that is meant to read data, perform limited
calculations on that data and control its environment based
on those calculations. The prime use of a microcontroller is
to control the operation of a machine using a fixed program
that is stored in ROM and that does not change over the
lifetime of the system. A microcontroller is a highly
integrated chip that includes all or most of the parts needed
for a controller in a single chip. The microcontrollercouldbe
rightly called a one-chip solution. If a system is developed
with a microprocessor, the designer has to go for external
memory such as RAM, ROM or EPROM and peripherals and
hence the size of the PCB will be large to hold all the
required peripherals. But, the micro controller has got all
these peripheral facilities on a single chip and hence
developmentofsimilarsystemwithmicrocontrollerreduces
PCB size and the overall cost of the design. The difference
between a Microprocessor and Microcontroller is that a
microprocessor can only process with the data, but
Microcontroller can control external device in addition to
processing the data. If a device has tobeswitchedON orOFF,
external ICs are needed to do this work. But with
Microcontroller thedevicecanbedirectlycontrolled without
an IC. A Microcontroller often deals with bits, not bytes as in
the real world application, for example switch contracts can
be open or close, indicators should be lit or dark and motors
can be either turned on or off and so forth.
Microcontroller Based Anesthesia Injector Majoroperations
are performed to remove or reconstruct theinfectedpartsin
the human body. These operationswill leadtobloodlossand
pain. Therefore it is necessary to arrest the pain and the
blood loss. Anesthesia plays an important role in the part
of painkilling. AAI can be designed as Automatic
administration of anesthesia based on the bio-medical
parameters of the patient, eliminating futuresideeffectsand
the need for an anesthetist. Anesthesia is very essential in
performing painless surgery and so an Automatic
administration of Anesthesia is needed for a successful
surgery. At present anesthetist controlled manual operation
is employed, which may cause many difficulties such as,
Level of anesthesia may get varied and there is a chance of
getting side effects in future. Suppose the anesthetist fails to
administer the level of anesthesia during thepredetermined
period, the patient may be disturbed during the operation.
Other systems developed to administer anesthesia operates
by sensing the consciousness level of the patient and not by
measuring his overall body conditions.[1]
2. WORKING
The system consists of 3 sensors in the input side where the
inputs are fed to the analog to digital converter. The
threshold values which are predetermined by manual
supervision, are coded as the base code to the dc motor.
Thus as the input is varied by the sensor input, the
International Research Journal of Engineering and Technology (IRJET) e-ISSN: 2395-0056
Volume: 06 Issue: 06 | June 2019 www.irjet.net p-ISSN: 2395-0072
© 2019, IRJET | Impact Factor value: 7.211 | ISO 9001:2008 Certified Journal | Page 827
microcontroller controls the motor through the driving
circuit and the step output is obtained using the specified
motor. The block diagram of the system is shown in figure.
fig-1: Block diagram
Components used in the system are
1. Microcontroller to Control the overall operation
2. Temperature Sensor to measure body temperature
3. Blood pressure sensor to measure blood pressure
4. Heart Beat Sensor to measure heartbeat
5. DC Motor to control the movement of the Syringe
Infusion Pump
6. Motor drive circuit to control dc motor
7. Arduino board
2.1 Microcontroller
The microcontroller used is ATmega328 powered by the
Arduino UNO board .The high-performance Microchip 8-bit
AVR RISC-based microcontroller combines 32KBISP ash
memory with read-while-write capabilities, 1KB EEPROM,
2KB SRAM, Operating Voltage: 5V,Input Voltage
(recommended): 7-12V,Digital I/O Pins: 14,Digital I/O Pins:
14.
2.2 Sensors
There are 3 sensors are used namely temperature sensor,
pressure sensor, heartbeat sensor. From the input values
attained from the 3 sensors, the microcontroller checks the
threshold value.
Temperature sensor used is LM35.The LM35 series are
precision integrated-circuit temperature sensors, whose
output voltage is linearly proportional to the Celsius (Centi-
grade) temperature. It has very low self-heating, less than
0.1C in still air. The LM35 is rated to operate over a -55 to
+150C temperature range.
Systolic blood pressure measurement done using blood
pressure cuff with the help of MPX5050DP-ND transducer.
Pressure is converted to equivalent voltage.
Heart beat is sensed using a sensor which employs optical
finger plethysmographic technique. peak. The change in
blood volume caused by the pressure pulse is detected by
illuminating the skin with the light from a light-emitting
diode (LED) and then measuring the amount of light either
transmitted or reflected to a photodiode.
3.1 DC motor and driving circuit
DC motor is used for control of syringe infusion pump. A DC
motor is any of a class of rotary electrical machines that
converts direct current electrical energy into mechanical
energy. The most common types rely on the forcesproduced
by magnetic fields.
Driving circuit for controlling dc motor used is l293d
according to signal from microcontroller. project.L293D is a
typical Motor driver or Motor Driver IC which allows DC
motor to drive on either direction. L293D is a 16-pin IC
which can control a set of two DC motors simultaneously in
any direction. (IC).It works on the concept of H-bridge. H-
bridge is a circuit which allows the voltage to be own in
either direction.
3.1 Syringe infusion pump
The Syringe Infusion pump provides uniform flowoffluid by
precisely driving the plunger of a syringe towards its barrel.
It provides accurate and continuous flow rate for precisely
delivering anesthesia medication in critical medical care.
It should be
1.Able to deliver the infusion accurately and consistently.
2. Easy to set up and use Portable and robust
3. Powered with battery and mains both
4.Equipped with override rapid infusion facility
5.Capable of alerting line occlusion and need to re-change
syringe
4. SIMULATION
Simulation of the implemented system done in proteus
software is given in the figure. Here the input side has only
one sensor that is the temperature sensor. Sensor output is
sent to arduino board. With the help of driving circuit the
motor rotation is controlled.
International Research Journal of Engineering and Technology (IRJET) e-ISSN: 2395-0056
Volume: 06 Issue: 06 | June 2019 www.irjet.net p-ISSN: 2395-0072
© 2019, IRJET | Impact Factor value: 7.211 | ISO 9001:2008 Certified Journal | Page 828
fig-4:Simulation in Proteus Software
5. PROGRAM FLOWCHART
Figure shows the Flow Chart for automatic anesthesia
injector implemented using microcontroller.
The three sensors namely temperature sensor. Blood
pressure sensor, heartbeat sensor.Thevaluesfromthese are
measured using computer interface. They are crosschecked
with the thresholds. Depending on the conditions the
microcontroller can control the motor using drive circuit.
If the conditions in the program are not satisfied there will
be no change in dc motor rotation.
The anesthesia is injected by rotating the motor in both
directions by drive circuit and appropriate delaysecondand
other changes made in the arduino program by the user.
fig-5:flow chart
6. PROTOTYPE
This is the picture of the model using the above mentioned
components .This system is generally administered for the
case that the operation tends to extendformorehours asthe
operation is not completed. So there is a possibility that the
patient might awaken. Thus the implemented system
administers the anesthetic drug Bupivacaine 0.5 in the
respective amount according to the time more required for
the operation. Different drugs are administeredaccording to
the physique of the patient. Bupivacainedruggenerallygives
4-5 hours for 4ml of administration.
The amount quantity of the drug is deter mined by the
weight of the patient (0.05mg per kg).The standard syringe
volume is selected and when 6 second delay time is given in
the microcontroller ,4ml anesthetic fluid is administered
according to the experimental results. From theinputvalues
attained from the 3 sensors, the microcontroller checks the
threshold value and gives the control to the motor drive
circuit according to the delay time provided. The heart beat
sensor takes the heart beat pulse, threshold value being 80
pulse per min, temperature sensor threshold being 38
degree celsius , blood pressuresensorthreshold being24mV
which is equivalent to 80mmHg.If the attained input value
from the patient normally when awakened during the
operation is above the proposed threshold, the microcon-
troller triggers the DC motor to drive the syringe infusion
pump according to the delay time.
. fig-6:Protype of the model
International Research Journal of Engineering and Technology (IRJET) e-ISSN: 2395-0056
Volume: 06 Issue: 06 | June 2019 www.irjet.net p-ISSN: 2395-0072
© 2019, IRJET | Impact Factor value: 7.211 | ISO 9001:2008 Certified Journal | Page 829
7. EXPERIMENTAL RESULTS
The performance of the microcontroller was checked
virtually by interfacing it with the computer. The program
was written in the micro controller for analyzing the
parameters. The threshold values of sensor parameters
which are predetermined by manual supervision, are coded
as the base code to the dc motor .DC motor will control the
syringe infusion pump according to the program burned in
arduino board
8. CONCLUSION
Microcontroller is made use to perform anesthesia injecting
operation, where the quantity to be inject and the timing is
provided. By using various electrical circuits thebio-medical
parameters can be found. The output of the circuits is
amplified by means of an amplifier and fed into an A/D
converter. The digital signal is then fed into the input port of
the Microcontroller. The Microcontroller displays the
parameters in digital value in the display device. The
parameters like temperature, respirationand heartbeatrate
the stepper motor speed is varied. If the level of the
temperature or respiration is increased or decreased the
level of anesthesia was controlled automatically with the
help of micro-controller and the stepper motor actions.
Syringe infusion pump is mechanically connected to the
motor. Making use of sensor it detects its destination where
it need to inject then by precisely drives the plunger. Since
the surgery time varies, externally it is reset or turned off_.
Modern technologies have developed using embedded
systems promoting comfortable and better life.
MICROCONTROLLER BASED ANESTHESIA INJECTOR is one
of the efficient systems plays its major role in Bio-Medical
field. Using this system time management is obtained since
the periodic interval is set using program. Themeasurement
of bio-medical parameters is a vital process. These
parameters determine the overall condition of thepatient. It
plays a very significant process in the level ofanesthesia that
has to be administered to the patient. The transducers used
are just those that find applications inpatient monitoring
systems and experimental work on four parameters namely
blood pressure, temperature, pulse and respiratory activity,
more precision might obtained if multiple parameters like
retinal size, age and weight are considered.
REFERENCES
[1] Engr Rana M shakeel, Microcontroller based anasthesia
injector,2007
[2] Kenneth J. Ayala,The 8051 microcontrollerarchitecture,
programming, and ap-plications, Indian reprint 2007,
THOMSON Delmar learning
[3] Moneypenny,When are human factors can't intubate
oxygenate scenarios?.British journal of anesthesia
2017;118:469-9
[4] G.C.L.Fletcher,McGeorge ,The roleofnon-technical skills
in anesthesia:a review
[5] Dr Lees N,When are human factors can't intubate
oxygenate scenarios?,Anesthesia
[6] wikipedia.org/anesthesia.

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IRJET- Microcontroller based Anesthesia Injector

  • 1. International Research Journal of Engineering and Technology (IRJET) e-ISSN: 2395-0056 Volume: 06 Issue: 06 | June 2019 www.irjet.net p-ISSN: 2395-0072 © 2019, IRJET | Impact Factor value: 7.211 | ISO 9001:2008 Certified Journal | Page 826 Microcontroller based Anesthesia Injector Smt.Leela Salim1, Abey Thomas2, Akshay M3, Athul K Alias4, Muhammed Irshad E K5 1Assisstant Professor, Dept. of Electrical and Electronics Engineering, Mar Athanasius College of Engineering, Kothamangalam, Kerala, India 2,3,4,5 Under Graduate Students, MarAthanasius College of Engineering, Kothamangalam, Kerala, India ---------------------------------------------------------------------***---------------------------------------------------------------------- Abstract - In the hospitals when any major operation is performed, the patient must be in anesthetize condition. If the operation lasts for a long time, for suppose for 4 or 5 hours, complete dose of anesthesia cannotbeadministered inasingle stroke. It may lead to the patient’s death. If lower amount of anesthesia is administered, the patient may wake up at the middle of the operation. To avoid this, the anesthetist administers few milliliters of anesthesia per hour to the patient. If the anesthetist fails to administer the anesthesia to the patient at the particular time interval, other allied problems may arise. To overcome such hazardous problems the design of an automaticoperationofananesthesiamachine based on a micro-controller is effective. In this system a microcontroller and syringe infusion pump provided. The anesthetist can decide the level of anesthesia in terms of milliliters per hour to administer anesthesia to the patient with the help of different sensor results.. After receiving the signal from the sensors the microcontroller controlsthesignal to the desire level and fed into the dc motor to drive the infusion pump in proper manner. The anesthesia is administered to the patient according to the dc motor rotation. KEY WORDS: Anesthesia,Microcontroller,Sensors, dc motor, Syringe infusion pump 1. INTRODUCTION An Embedded system is a combination of computer hardware, software and additional mechanical parts designed to perform a speci_c function. An example is the microwave oven. It is hardly realized that the oven actually consists of a processor and the software running inside. Another example is the TV remote control. Very few actually realize that there is a microcontroller inside that runs a set of programs especially for the TV. Automatic Anesthesia Injector system is also an application of embedded technologies in whicha microcontrollerisusedto control the entire device. A microcontroller is a general- purpose device that is meant to read data, perform limited calculations on that data and control its environment based on those calculations. The prime use of a microcontroller is to control the operation of a machine using a fixed program that is stored in ROM and that does not change over the lifetime of the system. A microcontroller is a highly integrated chip that includes all or most of the parts needed for a controller in a single chip. The microcontrollercouldbe rightly called a one-chip solution. If a system is developed with a microprocessor, the designer has to go for external memory such as RAM, ROM or EPROM and peripherals and hence the size of the PCB will be large to hold all the required peripherals. But, the micro controller has got all these peripheral facilities on a single chip and hence developmentofsimilarsystemwithmicrocontrollerreduces PCB size and the overall cost of the design. The difference between a Microprocessor and Microcontroller is that a microprocessor can only process with the data, but Microcontroller can control external device in addition to processing the data. If a device has tobeswitchedON orOFF, external ICs are needed to do this work. But with Microcontroller thedevicecanbedirectlycontrolled without an IC. A Microcontroller often deals with bits, not bytes as in the real world application, for example switch contracts can be open or close, indicators should be lit or dark and motors can be either turned on or off and so forth. Microcontroller Based Anesthesia Injector Majoroperations are performed to remove or reconstruct theinfectedpartsin the human body. These operationswill leadtobloodlossand pain. Therefore it is necessary to arrest the pain and the blood loss. Anesthesia plays an important role in the part of painkilling. AAI can be designed as Automatic administration of anesthesia based on the bio-medical parameters of the patient, eliminating futuresideeffectsand the need for an anesthetist. Anesthesia is very essential in performing painless surgery and so an Automatic administration of Anesthesia is needed for a successful surgery. At present anesthetist controlled manual operation is employed, which may cause many difficulties such as, Level of anesthesia may get varied and there is a chance of getting side effects in future. Suppose the anesthetist fails to administer the level of anesthesia during thepredetermined period, the patient may be disturbed during the operation. Other systems developed to administer anesthesia operates by sensing the consciousness level of the patient and not by measuring his overall body conditions.[1] 2. WORKING The system consists of 3 sensors in the input side where the inputs are fed to the analog to digital converter. The threshold values which are predetermined by manual supervision, are coded as the base code to the dc motor. Thus as the input is varied by the sensor input, the
  • 2. International Research Journal of Engineering and Technology (IRJET) e-ISSN: 2395-0056 Volume: 06 Issue: 06 | June 2019 www.irjet.net p-ISSN: 2395-0072 © 2019, IRJET | Impact Factor value: 7.211 | ISO 9001:2008 Certified Journal | Page 827 microcontroller controls the motor through the driving circuit and the step output is obtained using the specified motor. The block diagram of the system is shown in figure. fig-1: Block diagram Components used in the system are 1. Microcontroller to Control the overall operation 2. Temperature Sensor to measure body temperature 3. Blood pressure sensor to measure blood pressure 4. Heart Beat Sensor to measure heartbeat 5. DC Motor to control the movement of the Syringe Infusion Pump 6. Motor drive circuit to control dc motor 7. Arduino board 2.1 Microcontroller The microcontroller used is ATmega328 powered by the Arduino UNO board .The high-performance Microchip 8-bit AVR RISC-based microcontroller combines 32KBISP ash memory with read-while-write capabilities, 1KB EEPROM, 2KB SRAM, Operating Voltage: 5V,Input Voltage (recommended): 7-12V,Digital I/O Pins: 14,Digital I/O Pins: 14. 2.2 Sensors There are 3 sensors are used namely temperature sensor, pressure sensor, heartbeat sensor. From the input values attained from the 3 sensors, the microcontroller checks the threshold value. Temperature sensor used is LM35.The LM35 series are precision integrated-circuit temperature sensors, whose output voltage is linearly proportional to the Celsius (Centi- grade) temperature. It has very low self-heating, less than 0.1C in still air. The LM35 is rated to operate over a -55 to +150C temperature range. Systolic blood pressure measurement done using blood pressure cuff with the help of MPX5050DP-ND transducer. Pressure is converted to equivalent voltage. Heart beat is sensed using a sensor which employs optical finger plethysmographic technique. peak. The change in blood volume caused by the pressure pulse is detected by illuminating the skin with the light from a light-emitting diode (LED) and then measuring the amount of light either transmitted or reflected to a photodiode. 3.1 DC motor and driving circuit DC motor is used for control of syringe infusion pump. A DC motor is any of a class of rotary electrical machines that converts direct current electrical energy into mechanical energy. The most common types rely on the forcesproduced by magnetic fields. Driving circuit for controlling dc motor used is l293d according to signal from microcontroller. project.L293D is a typical Motor driver or Motor Driver IC which allows DC motor to drive on either direction. L293D is a 16-pin IC which can control a set of two DC motors simultaneously in any direction. (IC).It works on the concept of H-bridge. H- bridge is a circuit which allows the voltage to be own in either direction. 3.1 Syringe infusion pump The Syringe Infusion pump provides uniform flowoffluid by precisely driving the plunger of a syringe towards its barrel. It provides accurate and continuous flow rate for precisely delivering anesthesia medication in critical medical care. It should be 1.Able to deliver the infusion accurately and consistently. 2. Easy to set up and use Portable and robust 3. Powered with battery and mains both 4.Equipped with override rapid infusion facility 5.Capable of alerting line occlusion and need to re-change syringe 4. SIMULATION Simulation of the implemented system done in proteus software is given in the figure. Here the input side has only one sensor that is the temperature sensor. Sensor output is sent to arduino board. With the help of driving circuit the motor rotation is controlled.
  • 3. International Research Journal of Engineering and Technology (IRJET) e-ISSN: 2395-0056 Volume: 06 Issue: 06 | June 2019 www.irjet.net p-ISSN: 2395-0072 © 2019, IRJET | Impact Factor value: 7.211 | ISO 9001:2008 Certified Journal | Page 828 fig-4:Simulation in Proteus Software 5. PROGRAM FLOWCHART Figure shows the Flow Chart for automatic anesthesia injector implemented using microcontroller. The three sensors namely temperature sensor. Blood pressure sensor, heartbeat sensor.Thevaluesfromthese are measured using computer interface. They are crosschecked with the thresholds. Depending on the conditions the microcontroller can control the motor using drive circuit. If the conditions in the program are not satisfied there will be no change in dc motor rotation. The anesthesia is injected by rotating the motor in both directions by drive circuit and appropriate delaysecondand other changes made in the arduino program by the user. fig-5:flow chart 6. PROTOTYPE This is the picture of the model using the above mentioned components .This system is generally administered for the case that the operation tends to extendformorehours asthe operation is not completed. So there is a possibility that the patient might awaken. Thus the implemented system administers the anesthetic drug Bupivacaine 0.5 in the respective amount according to the time more required for the operation. Different drugs are administeredaccording to the physique of the patient. Bupivacainedruggenerallygives 4-5 hours for 4ml of administration. The amount quantity of the drug is deter mined by the weight of the patient (0.05mg per kg).The standard syringe volume is selected and when 6 second delay time is given in the microcontroller ,4ml anesthetic fluid is administered according to the experimental results. From theinputvalues attained from the 3 sensors, the microcontroller checks the threshold value and gives the control to the motor drive circuit according to the delay time provided. The heart beat sensor takes the heart beat pulse, threshold value being 80 pulse per min, temperature sensor threshold being 38 degree celsius , blood pressuresensorthreshold being24mV which is equivalent to 80mmHg.If the attained input value from the patient normally when awakened during the operation is above the proposed threshold, the microcon- troller triggers the DC motor to drive the syringe infusion pump according to the delay time. . fig-6:Protype of the model
  • 4. International Research Journal of Engineering and Technology (IRJET) e-ISSN: 2395-0056 Volume: 06 Issue: 06 | June 2019 www.irjet.net p-ISSN: 2395-0072 © 2019, IRJET | Impact Factor value: 7.211 | ISO 9001:2008 Certified Journal | Page 829 7. EXPERIMENTAL RESULTS The performance of the microcontroller was checked virtually by interfacing it with the computer. The program was written in the micro controller for analyzing the parameters. The threshold values of sensor parameters which are predetermined by manual supervision, are coded as the base code to the dc motor .DC motor will control the syringe infusion pump according to the program burned in arduino board 8. CONCLUSION Microcontroller is made use to perform anesthesia injecting operation, where the quantity to be inject and the timing is provided. By using various electrical circuits thebio-medical parameters can be found. The output of the circuits is amplified by means of an amplifier and fed into an A/D converter. The digital signal is then fed into the input port of the Microcontroller. The Microcontroller displays the parameters in digital value in the display device. The parameters like temperature, respirationand heartbeatrate the stepper motor speed is varied. If the level of the temperature or respiration is increased or decreased the level of anesthesia was controlled automatically with the help of micro-controller and the stepper motor actions. Syringe infusion pump is mechanically connected to the motor. Making use of sensor it detects its destination where it need to inject then by precisely drives the plunger. Since the surgery time varies, externally it is reset or turned off_. Modern technologies have developed using embedded systems promoting comfortable and better life. MICROCONTROLLER BASED ANESTHESIA INJECTOR is one of the efficient systems plays its major role in Bio-Medical field. Using this system time management is obtained since the periodic interval is set using program. Themeasurement of bio-medical parameters is a vital process. These parameters determine the overall condition of thepatient. It plays a very significant process in the level ofanesthesia that has to be administered to the patient. The transducers used are just those that find applications inpatient monitoring systems and experimental work on four parameters namely blood pressure, temperature, pulse and respiratory activity, more precision might obtained if multiple parameters like retinal size, age and weight are considered. REFERENCES [1] Engr Rana M shakeel, Microcontroller based anasthesia injector,2007 [2] Kenneth J. Ayala,The 8051 microcontrollerarchitecture, programming, and ap-plications, Indian reprint 2007, THOMSON Delmar learning [3] Moneypenny,When are human factors can't intubate oxygenate scenarios?.British journal of anesthesia 2017;118:469-9 [4] G.C.L.Fletcher,McGeorge ,The roleofnon-technical skills in anesthesia:a review [5] Dr Lees N,When are human factors can't intubate oxygenate scenarios?,Anesthesia [6] wikipedia.org/anesthesia.