The MGH Textbook of Anesthetic Equipment

407 Pages·2010·43.51 MB·English

by  W. Sandberg

The MGH Textbook
of Anesthetic Equipment
This page intentionally left blank
The MGH Textbook
of Anesthetic Equipment
Warren S. Sandberg, MD, PhD
Professor of Anesthesiology,
Surgery and Biomedical Informatics,
Chair of Department of Anesthesiology,
Vanderbilt University School of Medicine,
Nashville, Tennessee
Richard D. Urman, MD, MBA
Assistant Professor of Anesthesia,
Harvard Medical School,
Director of Procedural Sedation Management,
Department of Anesthesiology,
Perioperative and Pain Management
Brigham and Women’s Hospital,
Boston, Massachusetts
Jesse M. Ehrenfeld, MD, MPH
Assistant Professor of Anaesthesia,
Harvard Medical School,
Director of Anesthesia Informatics Fellowship,
Director of Anesthesia Clinical Research Center,
Department of Anesthesia, Critical Care, and Pain
Medicine,
Massachusetts General Hospital,
Boston, Massachusetts
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
THE MGH TEXTBOOK OF ANESTHETIC EQUIPMENT, FIRST EDITION ISBN: 978-1-4377-0973-5
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical,
including photocopying, recording, or any information storage and retrieval system, without permission in writing
from the publisher. Details on how to seek permission, further information about the Publisher’s permissions poli-
cies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing
Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notice
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information
or methods they should be mindful of their own safety and the safety of others, including parties for whom
they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of
their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient,
and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume
any liability for any injury and/or damage to persons or property as a matter of products liability, negligence
or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the
material herein.
Library of Congress Cataloging-in-Publication Data
The MGH textbook of anesthetic equipment / [edited by]
Warren Sandberg, Richard D. Urman, Jesse M. Ehrenfeld. -- 1st ed.
p. ; cm.
Other title: Massachusetts General Hospital textbook of anesthetic equipment
Other title: Textbook of anesthetic equipment
Includes bibliographical references.
ISBN 978-1-4377-0973-5
1. Anesthesiology--Apparatus and instruments. 2. Anesthesia--Equipment and supplies. I. Sandberg, Warren,
MD. II. Urman, Richard D. III. Ehrenfeld, Jesse M. IV. Massachusetts General Hospital. V. Title: Massachusetts
General Hospital textbook of anesthetic equipment. VI. Title: Textbook of anesthetic equipment.
[DNLM: 1. Anesthesiology--instrumentation. WO 240 M617 2010]
RD78.8.M54 2010
617.9’60028--dc22
2010002825
Executive Publisher: Natasha Andjelkovic
Developmental Editor: Brad McIlwain
Publishing Services Manager: Debbie Vogel/Anitha Raj
Project Manager: Annie Victor
Design Direction: Steven Stave
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Contents
Contributors vii 16. I ntravenous Therapy, Fluid Delivery Systems for
Preface ix Resuscitation, and Cell Salvage Devices 218
Vanessa G. Henke and Warren S. Sandberg
17. D rug Infusion Pumps in Anesthesia, Critical Care,
1. Anesthesia Equipment and Patient Safety 1 and Pain Management 236
A rna Banerjee, L. Jane Easdown, N athaniel Sims, M. Ellen Kinnealey, Rick Hampton, Gayle
and Matthew B. Weinger
Fishman, and Harold DeMonaco
2. Medical Gases: Properties, Supply, and Removal 10 18. Devices for Cardiac Support 247
Jesse M. Ehrenfeld and Michael Oleyar M ichael G. Fitzsimons, Stephanie Ennis, and Thomas
3. Anesthesia Machine: A Practical MacGillivray
Overview 23 19. Patient Warming Devices 263
Jeffrey M. Feldmann Jennifer A. Chatburn and Warren S. Sandberg
4. P rinciples and Practices of Closed Circuit 20. Point-of-Care Testing in the Operating Room 271
Anesthesia 41
Marianna P. Crowley
Robert S. Holzman and Rebecca Lintner
21. Anesthesia Information Management Systems 283
5. Manual and Mechanical Ventilators 49 Sachin Kheterpal
D emet Suleymanci, Robert M. Kacmarek, and
22. P ediatric Considerations 297
Yandong Jiang
Rebecca N. Lintner and Robert S. Holzman
6. S upraglottic Airway Devices 72
23. A nesthesia Equipment Outside of the
Jordan L. Newmark and Warren S. Sandberg
Operating Room 309
7. Intubation Equipment 92 Sergio D. Bergese, Erika G. Puente, and Gilat Zisman
Z hongcong Xie, Ali Diba, and Zhipeng Xu
24. P rovision of Anesthesia in Difficult Situations
8. Endotracheal Airway Devices 111 and the Developing World 320
Young K. Ahn and Warren S. Sandberg D eborah J. Harris, John A. Carter, John Hodgson, and Necia
9. Noninvasive Physiological Monitors 127 Williams
Jordan L. Newmark and Warren S. Sandberg 25. P revention of Infection: Disinfection and
10. Invasive Hemodynamic Monitoring 148 Sterilization of Equipment 330
Beverly J. Newhouse and Rafael Montecino Arnold J. Berry
11. Transesophageal Echocardiography 160 26. L egal and Regulatory Issues 339
Jacob Kaczmarski and Sugantha Sundar Eric T. Pierce
12. D epth of Anesthesia Monitoring: Principles 27. P hysical Principles 344
and Applications 171 Paul D. Davis
Roy Esaki and George Mashour 28. Basic Physics of Electricity 352
13. Alarms in Clinical Anesthesia 187 Paul D. Davis
F. Jacob Seagull and Richard P. Dutton 29. O perating Room Electrical, Fire, Laser, and
14. E quipment for Regional Anesthesia and Acute Pain Radiation Safety 361
Management 197 A nuja K. Antony, Chunbai Zhang, and William G. Austen
Reuben Slater and Lisa Warren 30. N euroanesthesia Equipment in the Intraoperative
15. U ltrasound for Regional Anesthesia and Vascular Setting 372
Access 207 Sergio D. Bergese, Gilat Zisman, and Erika G. Puente
Lisa Warren and Reuben Slater Appendix 381
v
This page intentionally left blank
Contributors
Young Ahn, MD Harold J. DeMonaco, MS Rick Hampton, BS
Clinical Fellow in Anaesthesia, Harvard Medical Director, Innovation Support Center, Wireless Communications Manager, Partners
School; Department of Anesthesia, Critical Care Massachusetts General Hospital, Boston, HealthCare System, Boston, Massachusetts
and Pain Medicine, Massachusetts General Massachusetts
Hospital, Boston, Massachusetts Deborah Harris, LMS, FRCA
Ali Diba, BM, FRCA Consultant in Anaesthesia and Intensive Care
Anuja Antony, MD, MPH Consultant Anaesthetist, Anaesthetic Medicine, North Bristol NHS Trust, Bristol,
Assistant Professor, University of Illinois Department, Queen Victoria Hospital NHS UK
at Chicago; Clinical Research Fellow, Foundation Trust, East Grinstead, UK
Massachusetts General Hospital, Harvard Vanessa Henke, MD
Medical School, Boston, Massachusetts Richard P. Dutton, MD, MBA Department of Anaesthesia, Critical Care
Professor of Anesthesiology, University and Pain Medicine, Massachusetts General
William G. Austen Jr, MD of Maryland Medical Center, Baltimore, Hospital, Boston, Massachusetts
Chief, Division of Plastic and Reconstructive Maryland
Surgery, Massachusetts General Hospital, Robert Holzman, MD
Harvard Medical School, Boston, Jane Easdown, MD Senior Associate in Anesthesiology, Children’s
Massachusetts Associate Professor of Anesthesiology and Hospital Boston; Associate Professor of
Associate Residency Director, Vanderbilt Anaesthesia, Harvard Medical School, Boston,
Arna Banerjee, MD University Medical Center, Nashville, Massachusetts
Assistant Professor of Anesthesiology and Tennessee
Surgery, Vanderbilt University Medical Yandong Jiang, MD, PHD
Center; Medical Co-Director, Surgical ICU, Jesse Ehrenfeld, MD Assistant Professor of Anaesthesia,
VA Tennessee Valley Healthcare System, Assistant Professor of Anaesthesia, Harvard Medical School; Department of
Nashville, Tennessee Harvard Medical School; Director of Anesthesia, Critical Care, and Pain Medicine,
Anesthesia Informatics Fellowship, Director Massachusetts General Hospital, Boston,
Sergio D. Bergese, MD of Anesthesia Clinical Research Center, Massachusetts
Director of Neuroanesthesia, Department of Department of Anesthesia, Critical Care,
Anesthesiology, The Ohio State University, and Pain Medicine, Massachusetts General Robert M. Kacmarek, PhD
Columbus, Ohio Hospital, Boston, Massachusetts Professor of Anaesthesia, Harvard Medical
School; Director of Respiratory Care,
Arnold Berry, MD, MPH Stephanie Ennis, NP Massachusetts General Hospital, Boston,
Professor of Anesthesiology, Emory Nurse Practitioner, Cardiology Service, Massachusetts
University School of Medicine, Atlanta, Massachusetts General Hospital, Boston,
Georgia Massachusetts Jacob Kaczmarski, MD
Staff Physician, Baptist Hospital of Miami,
John A. Carter, MBBS, FRCA Roy K. Esaki, MD, MS Miami, Florida
Consultant in Anaesthesia and Critical Resident, Department of Anesthesia, Stanford
Care Medicine, Department of Anaesthesia, University School of Medicine, Palo Alto, Sachin Kheterpal, MD, MBA
Frenchay Hospital, Bristol, UK California Assistant Professor of Anesthesiology,
University of Michigan Medical School,
Jennifer A. Chatburn, MD Jeffrey M. Feldman, MD Ann Arbor, Michigan
Clinical Fellow in Anesthesia, Harvard Division Chief, General Anesthesiology,
Medical School; Department of Anesthesia, Children’s Hospital of Philadelphia, M. Ellen Kinnealey, BSN
Critical Care and Pain Medicine, Philadelphia, Pennsylvania Advanced Infusion Systems Specialist,
Massachusetts General Hospital, Boston, Massachusetts General Hospital, Boston,
Massachusetts Gayle Fishman, BSN, MBA Massachusetts
Vice President of Clinical Services,
Marianna P. Crowley, MD Massachusetts Eye and Ear Infirmary, Rebecca Lintner, MD
Assistant Professor, Harvard Medical School; Boston, Massachusetts Assistant Professor of Anesthesiology, Mount
Anesthetist, Massachusetts General Hospital, Sinai School of Medicine, New York, New York
Boston, Massachusetts Michael G. Fitzsimons, MD
Assistant Professor of Anaesthesia, Thomas E. MacGillivray, MD
Paul D. Davis, BSc Harvard Medical School; Department of Assistant Professor of Surgery, Harvard
Principal Physicist, Department of Clinical Anesthesia, Critical Care and Pain Medicine, Medical School; Division of Cardiac Surgery,
Physics and Bioengineering, Southern Massachusetts General Hospital, Boston, Massachusetts General Hospital, Boston,
General Hospital, Glasgow, UK Massachusetts Massachusetts
vii
viii Contributors
George Mashour, MD, PhD Warren S. Sandberg, MD, PhD Lisa Warren, MD
Director, Division of Neuroanesthesiology, Professor of Anesthesiology, Surgery and Instructor in Anesthesia, Harvard Medical
Assistant Professor of Anesthesiology and Biomedical Informatics School; Director, Ambulatory and Regional
Neurosurgery, University of Michigan Chair, Department of Anesthesiology, Anesthesia, Department of Anesthesia,
Medical School, Ann Arbor, Michigan Vanderbilt University School of Medicine, Critical Care, and Pain Medicine,
Nashville, Tennessee Massachusetts General Hospital, Boston,
Rafael Montecino, MD Massachusetts
Clinical Assistant Professor of Surgery, F. Jacob Seagull, PhD
Leavenworth VA Medical Center, University Assistant Professor, Division of General Matthew B. Weinger, MD
of Kansas, Lawrence, Kansas Surgery, University of Maryland Medical Professor of Anesthesiology, Medical
School, Baltimore, Maryland Simulation, and Biomedical Informatics,
Beverly Newhouse, MD Vanderbilt University Medical Center;
Assistant Clinical Professor of Anesthesiology Nathaniel M. Sims, MD Senior Physician Scientist, Geriatric Research
and Critical Care, University of California− Assistant Professor of Anaesthesia, Education and Clinical Center, VA Tennessee
San Diego Medical Center, San Diego, Harvard Medical School; Department of Valley Healthcare System, Nashville,
California Anesthesia, Critical Care and Pain Medicine, Tennessee
Massachusetts General Hospital, Boston,
Jordan L. Newmark, MD Massachusetts Zhongcong Xie, MD
Clinical Fellow in Anaesthesia, Harvard Associate Professor of Anaesthesia, Harvard
Medical School; Department of Anesthesia, Reuben Slater, FANZCA Medical School, Boston, Massachusetts
Critical Care and Pain Medicine, Staff Anaesthetist, St. Vincent’s Hospital,
Massachusetts General Hospital, Boston, Melbourne, Australia Zhipeng (David) Xu, MD, PhD
Massachusetts Research Fellow of Anaesthesia, Harvard
Demet Suleymanci, MD Medical School, Boston, Massachusetts
Michael Oleyar, DO, JD Research Fellow, Department of Anesthesia,
Michigan State University College of Critical Care, and Pain Medicine, Massachusetts Chunbai Zhang, MD, MPH
Osteopathic Medicine, East Lansing, General Hospital, Boston, Massachusetts Chief Resident, Occupational and
Michigan Environmental Medicine and Epidemiology,
Sugantha Sundar, MD Harvard School of Public Health, Boston,
Eric Pierce, MD, PhD Assistant Professor of Anaesthesia, Harvard Massachusetts
Assistant Professor, Harvard Medical School; Medical School, Beth Israel Deaconess
Vice-Chair, Anesthesia Quality Assurance Medical Center, Boston, Massachusetts Gilat Zisman, BS
Committee, Massachusetts General Hospital, Post-Doctoral Researcher, Department of
Boston, Massachusetts Richard D. Urman, MD, MBA Anesthesiology, The Ohio State University,
Assistant Professor of Anethesia, Harvard Columbus, Ohio
Erika G. Puente, MD Medical School; Director of Procedural
Professor of Anesthesiology, Surgery and Sedation Management, Department of
Biomedical Informatics Anesthesiology, Perioperative and Pain
Chair, Department of Anesthesiology, Management, Brigham and Women’s Hospital,
Vanderbilt University School of Medicine Boston, Massachusetts
Preface
Medical technology has changed at a rapid pace over the past role in the education of future anesthesiologists, including
30 years and continues to evolve quickly as new devices and education about the use of equipment and management of
techniques change and facilitate the way we practice anesthe- equipment in failure mode. It is increasingly problematic to
siology. For example, a mere 15 years ago, ultrasound was a learn how to use equipment ‘on the fly’ with actual patients.
luxury in anesthesia. Today portable ultrasound has become Recognizing that technology evolves rapidly, we sought
a de facto standard of care for central venous catheter place- to illustrate fundamental principles succinctly, rather than
ment and for regional anesthesia. There are numerous exam- provide a completely comprehensive review of each available
ples of the profusion of such ‘ancillary’ anesthesia equipment, device within every category. This book represents the collec-
with completely new classes of equipment appearing almost tive wisdom of almost one hundred experts in the fields of
overnight. On the other hand, some aspects of technology – anesthesiology, biomedical engineering, and technology. We
such as the anesthesia machine – seem to be fairly constant. are grateful to all of our contributors whose efforts, insight,
However, a closer examination reveals that this is not really and expertise made this book the most accessible and up-to-
correct as modern equipment only appears to function like date work of its kind.
its predecessors. Learning to operate, diagnose and trouble- We would like to thank a number of individuals with-
shoot all of this equipment competes aggressively with the out whom this book would not have come to fruition. They
patient- and disease-oriented components of anesthesiology include Dr Elisabeth H. Sandberg, Dr Katharine M. Nicode-
practice. mus, Dr David C. Ehrenfeld, and Dr Zina Matlyuk-Urman.
Our goal in writing this book was to help clinicians better Additionally, we would like to thank our families and col-
understand the underlying principles behind the equipment leagues for their tireless support, and the generations of train-
they use on a daily basis. In this firstst edition, we cover all ees, from whom we have learned as much as we have taught,
of the equipment used in the operating room from the anes- for their inspiration. Special thanks to the Elsevier editorial
thesia machine to airway devices, physiologic monitors, and team, especially Natasha Andjelkovic and Bradley McIlwain.
equipment used for point-of-care testing. We also included We hope you find this book useful and wish you well in your
chapters on anesthesia information management systems, journey through the world of clinical anesthetic equipment.
alarms, challenges encountered working outside of the oper- Warren S. Sandberg, MD, PhD
ating room, and equipment for use in unusual environments Vanderbilt University
such as a field hospital. Richard D. Urman, MD, MBA
We begin this book with a chapter on simulation in anes- Harvard University
thesia. This was deliberate – complexity in anesthesia practice Jesse M. Ehrenfeld, MD, MPH
has increased to the point where simulation must play a larger Harvard University
ix