Articles: closed-circuit-anesthesia.
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Anaesthesiol Reanim · Jan 1991
[A computer-controlled closed circle system for ventilation during anesthesia and intensive care and its possibilities for patient monitoring].
A computer feed back controlled anaesthesia- and intensive care ventilator has been developed with on-line and separate lung function measurement. The system design is built on the principle of a totally closed circuit (closed rebreathing respirometer) and an inspiratory "high flow", the gas being rotated through the closed circuit unidirectionally by a blower with 70 l/min. Ventilation is performed by metal membranes freely movable in membrane chambers with an internal part included into the closed circuit and an external part connected to pressurized air controlling inspiratory valves expiratory valves. ⋯ Ergonometric aspects led to the triangular from of the new anaesthesia and intensive care ventilator with the controlling service screen turnable to all three sides of the ventilator (high flexibility of the user) and all necessary equipment and material included into the "Anaesthesia workstation". All measured and present parameters are continuously displayed on the service (computer) screen and entered into the computer-memory in minute cycles with a memory capacity of 75 h anaesthesia. At any desired moment the memorized values can be transferred to IBM-compatible disc systems for storage or into the respective data management systems, thus at the end of anaesthesia, at the end of the working day or at the end of the week.
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We modified a Bain circuit by placing the circuit into the Y piece of a standard carbon dioxide absorber circle, connecting the fresh gas hose on the anesthetic machine to the Bain's fresh gas inlet, and occluding the circle's fresh gas inlet. This circle-modified Bain breathing circuit was studied to evaluate whether it reduces fresh gas flow requirements. The Bain and modified Bain steady states were analyzed by mechanical and computer modeling. ⋯ The circle-modified Bain greatly reduced retention of carbon dioxide. For example, with 1-liter tidal volumes, 10-liter minute volumes (10 breaths per minute), and a 2.1 L/min fresh gas flow, the steady-state end-tidal carbon dioxide values of the Bain and modified Bain were 9.3 and 4.6%, respectively, in the physical model (carbon dioxide inflow of 230 ml/min). Results from the mechanical model helped validate the computer model.
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Closed-circuit anesthesia (CCA) is more economical and ecologically safer than open circuit anesthesia. However, gas concentrations are more difficult to control. Computer control of CCA has been proposed to facilitate its use. ⋯ The adaptive controller performed better than the fixed controller in all cases. The most significant difference was in the anesthetic gas response time 3.6 +/- 0.70 min for adaptive control and 7.04 +/- 5.62 min for fixed control. The adaptive controller was also robust with respect to variations in the system parameters such as the functional residual capacity, leak, deadspace and gas uptakes.(ABSTRACT TRUNCATED AT 250 WORDS)
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Numerous medical applications of closed-loop control have been developed over the past 40 years. For the patient breathing system, appropriate sensors are available. ⋯ With the sensors, controllers, and delivery devices developed and tested, it seems likely that closed-loop control will be an integral part of future anesthesia workstations. The convenience and improved stability and response time will be important advantages in future anesthesia delivery systems.
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Anesthesia ventilators with bellows that rise on expiration (standing bellows) are favored over ventilators with bellows that descend during expiration (hanging bellows). Standing bellows will not rise if there is a disconnection, and thus they facilitate detection of disconnections. ⋯ Thus, spirometers that measure tidal volume (VT) in the expiratory limb of the breathing system may falsely indicate an expiratory VT after a disconnection of the breathing system at the Y-piece or the endotracheal tube. Existing low-pressure alarms and capnography alarms provide redundant warning of disconnection, however, should the ventilator continue to deliver small VTs after a disconnection.