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WARD’S ANAESTHETIC EQUIPMENT Commissioning Editor: Timothy Horne / Jeremy Bowes Development Editor: Ailsa Laing Project Manager: Beula Christopher Illustrations Manager: Gillian Richards Designer: Charles Gray WARD’S ANAESTHETIC SIXTH EDITION EQUIPMENT Edited by Andrew J Davey LRCP and SI FRCA Consultant Anaesthetist, Sussex Orthopaedic NHS Treatment Centre, West Sussex, UK Ali Diba BM FRCA Consultant Anaesthetist, Queen Victoria Hospital, East Grinstead, UK Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2012 © 2012 Elsevier Ltd. All rights reserved. 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. 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As new research and experience broaden our understand- ing, 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 recom- mended 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. The Working together to grow publisher’s libraries in developing countries policy is to use paper manufactured from sustainable forests www.elsevier.com | www.bookaid.org | www.sabre.org Printed in China Contents Contents Contributors .....................................................vii 10. Ventilation in the intensive Preface ................................................................ix care unit .................................................253 Acknowledgments ..............................................x Martin Street Dedication .........................................................xi 11. Breathing filters, humidifiers Abbreviations ...................................................xii and nebulizers .......................................275 Antony R Wilkes 1. The supply of anaesthetic and other 12. Equipment for paediatric medical gasses ............................................1 anaesthesia .............................................289 Hubert Bland, Carrie Borton and Stephen Fenlon Syed Jafri 13. Equipment for regional 2. Measurement of pressure and anaesthesia ..............................................311 gas flow .....................................................27 Susanne Krone Paul Beatty 14. Physiological monitoring: principles 3. Vaporizers .................................................41 and non-invasive monitoring ...............323 Andrew J Davey Patrick T Magee 4. The anaesthetic workstation ...................65 15. Physiological monitoring: gasses ..........337 Ali Diba Patrick T Magee 5. Breathing systems and their 16. Cardiac output monitoring ...................351 components ...........................................107 Robert Sekun Kong and Andrew J Davey Luigi Vetrugno 6. Airway management equipment ..........139 17. Depth of anaesthesia and Tim Cook neurophysiological monitoring ...........369 7. Equipment for the inhalation of Andrew Morley and Gustav Strandvik oxygen and other gasses ........................207 18. Atmospheric pollution ..........................385 Thomas DA Standley and Sarah Bailey Daniel W Wheeler 19. Infusion equipment and 8. Manual resuscitators .............................225 intravenous anaesthesia ........................399 Andrew J Davey Ali Diba 9. Automatic ventilators ............................231 20. Medical suction apparatus ....................421 Andrew J Davey Andrew J Davey v Contents 21. Cleaning, disinfection and 28. The anaesthetist and the Medicines sterilization.............................................429 and Healthcare products Regulatory Trevor A King and Richard PD Cooke Agency ....................................................493 22. Information technology and Stephen Fenlon the anaesthetic workstation ..................439 29. Error, Man and Machine .......................503 Chris J Barham Sally E Rampersad and 23. Electrical hazards and Carlyle (Jai) Rampersad their prevention .....................................447 30. Warming devices ....................................513 Patrick T Magee C Mark Harper 24. Surgical diathermy .................................459 31. Physics and technology of Patrick T Magee ultrasound ..............................................525 25. Pacemakers and defibrillators ..............465 Crispian P Oates Nicholas P Gall Appendix 26. Lasers ......................................................475 SI units and conversion tables ......................541 Patrick T Magee Chetan Patel 27. Provision of anaesthesia in difficult situations and the developing world ...479 Index ...............................................................547 Deborah Harris and John A Carter vi Contributors Contributors Sarah Bailey MBBS, FRCA Richard PD Cooke FRCP, FRCPath, Dip, HIC Specialist Registrar Consultant Medical Microbiologist Queen Victoria Hospital Department of Clinical Microbiology East Grinstead, UK University Hospital Aintree Liverpool, UK Chris J Barham MBBS, FRCA Consultant Anaesthetist Andrew J Davey LRCP and SI FRCA Queen Victoria Hospital Consultant Anaesthetist East Grinstead, UK Sussex Orthopaedic NHS Treatment Centre West Sussex, UK Paul Beatty BSc, MSc, PhD, CEng, FIPEM Senior Lecturer in Biomedical Engineering Ali Diba BM, FRCA Imaging Science and Biomedical Engineering Consultant Anaesthetist The University of Manchester Queen Victoria Hospital Manchester, UK East Grinstead, UK Hubert Bland MBChB Stephen Fenlon BM, BS, FRCA Chief Medical Officer Consultant Anaesthetist Surrey Clinical Research Centre and Surrey Queen Victoria Hospital Human Performance Institute East Grinstead, UK Division of Clinical Medicine Faculty of Health and Medical Sciences Nicholas P Gall MSc, MD, MRCP, NASPExAM, Testamur University of Surrey Consultant Cardiologist and Cardiac Electrophysiologist Surrey, UK King’s College Hospital And Honorary Senior Lecturer Carrie Borton BSc King’s College London Global Regulatory Affairs Specialist London, UK Linde Healthcare Surrey, UK C Mark Harper BSc, MBBS, FRCA Consultant Anaesthetist John A Carter MBBS, FRCA Brighton and Sussex University Hospitals Consultant in Anaesthesia and Intensive Care Medicine Brighton, UK Frenchay Hospital Bristol, UK Deborah Harris LMS, FRCA Consultant in Anaesthesia and Intensive Care Medicine Tim Cook BA, MBBS, FRCA Frenchay Hospital Consultant in Anaesthesia and Intensive Care Bristol, UK Royal United Hospital Bath, UK vii Contributors Syed Jafri MBBS, MRCS, FRCR, MBA Carlyle (Jai) Rampersad BS, ATP Clinical Specialist Captain, Airbus A310 Linde Healthcare US Airways, USA Surrey, UK Sally E Rampersad MB, DCH, FRCA Trevor A King FRCA Attending Anesthesiologist Consultant Anaesthetist Seattle Children’s Hospital East Sussex Hospitals NHS Trust Seattle, USA Eastbourne, UK Thomas DA Standley MB, ChB, FRCA, EDIC Robert Sekun Kong MBBS, FRCA, EDIC Consultant in Anaesthesia / Intensive Care Consultant Cardiac Anaesthetist Western Sussex Hospitals NHS Trust Royal Sussex County Hospital West Sussex, UK Brighton, UK Gustav Strandvik MBChB, MRCP, FRCA, DICM(UK) Susanne Krone FRCA Consultant Anaesthetist and Intensive Care Physician Consultant Anaesthetist Kent and Canterbury Hospital Queen Victoria Hospital Canterbury, UK East Grinstead, UK Martin Street FJFICM Patrick T Magee MSc, FRCA, MIEE, AMI, MechE Consultant Intensivist Consultant in Anaesthesia Department of Intensive Care Royal United Hospital, Bath; Royal Sussex County Hospital and Visiting Senior Lecturer Brighton, UK Department of Mechanical Engineering University of Bath Luigi Vetrugno MD Bath, UK Consultant in Anesthesia and Intensive Care Medicine University of Udine Andrew Morley FRCA Udine, Italy Consultant Anaesthetist Guy’s and St Thomas’ Hospitals Daniel W Wheeler MA, DM, PhD, MRCP, FRCA London, UK Lecturer in Anaesthesia and Honorary Consultant Anaesthetist Crispian P Oates MSc, BSc, MIPEM, AVS University Department of Anaesthesia Head of Regional Vascular Ultrasound University of Cambridge Regional Medical Physics Department Cambridge, UK Freeman Hospital Newcastle Upon Tyne, UK Antony R Wilkes PhD, MSc, BSc Senior Research Fellow Chetan Patel MBBS, FRCA Department of Anaesthetics and Intensive Care Medicine Consultant Anaesthetist Wales College of Medicine Queen Victoria Hospital Cardiff University East Grinstead, UK Cardiff, UK viii