Table Of Content

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