Indian journal of anaesthesia
-
Anaesthesia is one of the few sub-specialties of medicine, which has quickly adapted technology to improve patient safety. This application of technology can be seen in patient monitoring, advances in anaesthesia machines, intubating devices, ultrasound for visualisation of nerves and vessels, etc., Anaesthesia machines have come a long way in the last 100 years, the improvements being driven both by patient safety as well as functionality and economy of use. Incorporation of safety features in anaesthesia machines and ensuring that a proper check of the machine is done before use on a patient ensures patient safety. This review will trace all the present safety features in the machine and their evolution.
-
Mapleson breathing systems are used for delivering oxygen and anaesthetic agents and to eliminate carbon dioxide during anaesthesia. They consist of different components: Fresh gas flow, reservoir bag, breathing tubes, expiratory valve, and patient connection. There are five basic types of Mapleson system: A, B, C, D and E depending upon the different arrangements of these components. ⋯ For adults, Mapleson A is the circuit of choice for spontaneous respiration where as Mapleson D and its Bains modifications are best available circuits for controlled ventilation. For neonates and paediatric patients Mapleson E and F (Jackson Rees modification) are the best circuits. In this review article, we will discuss the structure of the circuits and functional analysis of various types of Mapleson systems and their advantages and disadvantages.
-
From a simple pneumatic device of the early 20(th) century, the anaesthesia machine has evolved to incorporate various mechanical, electrical and electronic components to be more appropriately called anaesthesia workstation. Modern machines have overcome many drawbacks associated with the older machines. However, addition of several mechanical, electronic and electric components has contributed to recurrence of some of the older problems such as leak or obstruction attributable to newer gadgets and development of newer problems. ⋯ Trace anaesthetic gases polluting the theatre atmosphere can have several adverse effects on the health of theatre personnel. Therefore, safe disposal of these gases away from the workplace with efficiently functioning scavenging system is necessary. Other ways of minimising atmospheric pollution such as gas delivery equipment with negligible leaks, low flow anaesthesia, minimal leak around the airway equipment (facemask, tracheal tube, laryngeal mask airway, etc.) more than 15 air changes/hour and total intravenous anaesthesia should also be considered.
-
The main purpose of this review article is to bring up what has been known (practiced) about decontamination, disinfection, and sterilisation of anaesthetic equipment. It also discusses how this evidence-based information on infection prevention and control impacts care of patient in routine anaesthesia practice. This review underscores the role played by us, anaesthetists in formulating guidelines, implementing the same, monitoring the outcome and training post-graduate trainees and coworkers in this regard. ⋯ For this review, we conducted literature searches in Medline (PubMed) and also searched for relevant abstracts and full texts of related articles that we came across. There is much to be learned from the western world where, health care organisations now have legal responsibility to implement changes in accordance with the newer technology to reduce health care associated infection. There is a need to develop evidence-based infection prevention and control programs and set national guidelines for disinfection and sterilisation of anaesthesia equipment which all the institutions should comply with.
-
Invention of oxygen cylinder was one of the most important developments in the field of medical practice. Oxygen and other gases were compressed and stored at high pressure in seamless containers constructed from hand-forged steel in1880. Materials technology has continued to evolve and now medical gas cylinders are generally made of steel alloys or aluminum. ⋯ The type of valve varies with cylinder size. Small cylinders have a pin index valve while large have a bull nose type. Safety features in the cylinder are: Color coding, pin index, pressure relief device, Bodok seal, and label attached etc., Safety rules and guidelines must be followed during storage, installation and use of cylinders to ensure safety of patients, hospital personnel and the environment.