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WO1996036385A1 - Circuits de respiration sous anesthesie - Google Patents

Circuits de respiration sous anesthesie Download PDF

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Publication number
WO1996036385A1
WO1996036385A1 PCT/SE1996/000644 SE9600644W WO9636385A1 WO 1996036385 A1 WO1996036385 A1 WO 1996036385A1 SE 9600644 W SE9600644 W SE 9600644W WO 9636385 A1 WO9636385 A1 WO 9636385A1
Authority
WO
WIPO (PCT)
Prior art keywords
valve
gases
carbon dioxide
circuit
absorber
Prior art date
Application number
PCT/SE1996/000644
Other languages
English (en)
Inventor
Peter Jacob
Sören ENGLESSON
Original Assignee
Jacob & Allard Ab
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Jacob & Allard Ab filed Critical Jacob & Allard Ab
Priority to EP96914526A priority Critical patent/EP0825886A1/fr
Priority to AU57860/96A priority patent/AU5786096A/en
Publication of WO1996036385A1 publication Critical patent/WO1996036385A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/20—Valves specially adapted to medical respiratory devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/10—Preparation of respiratory gases or vapours
    • A61M16/104—Preparation of respiratory gases or vapours specially adapted for anaesthetics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/20—Valves specially adapted to medical respiratory devices
    • A61M16/208—Non-controlled one-way valves, e.g. exhalation, check, pop-off non-rebreathing valves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/22—Carbon dioxide-absorbing devices ; Other means for removing carbon dioxide

Definitions

  • the present invention refers to pulmonary ventilation of patients under general anaesthesia using breathing circuits including carbon dioxide gas absorption and connected to anaesthesia machines. More exactly it refers to a shunt valve, which makes it possible to let breathing gases by pass the carbon dioxide absorber.
  • General anaesthesia is used to reduce anxiety, ensure sleep and - above all - eliminate pain in connection with surgical in ⁇ terventions. It can be achieved by using drugs injected directly into the patients blood, and by anaesthetic gases supplied to the blood via the patient's airways and lungs. These methods can be used by themselves or, most frequently, combined.
  • the most common way of establishing a free airway for a patient in general anaesthesia is to perform an endotracheal intubation.
  • a plastic tube with an expandable plastic cuff is passed down the patient's throat.
  • This tube is connected to the breathing circuit of the anaesthetic machine.
  • This is a set of rubber or plastic hoses and valves.
  • the ventilation offered to the patients by the.breathing circuit is a partial rebreathing of exhaled gases.
  • the second breathing circuit uses no carbon dioxide absorption, the non absorber circuit.
  • the endotracheal tube is connected to a Y-piece in its turn connected to two anaesthetic hoses leading to a set of valves directing the inspiratory gases into one and the expiratory gases into the other hose.
  • An anaesthetic bag is collecting the exhaled gases and the movements of this bag indicates the patients spontaneous breathing.
  • This bag can, when needed, be manually and intermittently compressed to achieve ventilation.
  • the inspiratory gases will pass the absorber and, after receiving the fresh gases, be infused into the patients lungs.
  • the bag can be exchanged for a ventilator to give mechanical artificial ventilation to the patient.
  • the expiration is a passive procedure driven by the pressure left in the patient's lungs from the inspiration.
  • this breathing circuit creates a partial rebreathing of expired gases cleared from carbon dioxide by passing the absorber.
  • This circuit has had an increased popularity in recent years because its economic low fresh gas flow.
  • the breathing provided by the second breathing circuit is a partial rebreathing without carbon dioxide absorption.
  • This circuit corresponds to a D in Mapleson" s (a British physicist and anaesthetic analyst) classification that he performed in the late 1950th.
  • An important practical improvement by the Canadian anaesthetist J. Bain was the beginning of a renewed popularity of this circuit during the 1970th.
  • the circuit has only one hose from the endotracheal tube to the anaesthetic machine.
  • the fresh gases are supplied to the hose near the connection with the tube and they are led there through a thin plastic tube placed coaxially inside the hose.
  • This coaxial placement of the fresh gas supply tube is Dr Bain' s . contribution and makes the circuit small and flexible.
  • an anaesthetic bag or a ventilator and an excess valve In the other end of the hose there is an anaesthetic bag or a ventilator and an excess valve.
  • Each inspiration provides gases partly from the fresh gas supply and partly from the fresh gases accumulated in the hose during the expiratory pause and from the expiratory gases of the previous breath.
  • Dr Bain recommends a fresh gas flow of 70 mL/kg of body weight/min combined with a tidal volume, the size of each breath, of 10 mL/kg and a respiratory rate of 12 breaths per min. This will lead to a normal carbon dioxide pressure in arterial blood leading to a normal pH. This would mean a fresh gas flow of nearly 5 L/kg/min for a patient of 70 kg.
  • the absorber circuit allows a fresh gas flow of 1 to 2 L/min compared to 5 L/min with the Bain circuit, but tends to lead to a subnormal carbon dioxide pressure.
  • the Bain circuit it is possible to counteract the formation of atelectasis by using slightly supernormal tidal volumes and an intentional rebreathing of carbon dioxide leading to a normal pressure.
  • Mentell circuit This is a combination of an absorber circuit and a Bain circuit.
  • the construction of the Mentell circuit demonstrates an ambition to find a solution to the problem of using low fresh gas flows and still be able to use carbon dioxide rebreathing and supernormal tidal volumes and thereby achieve the benefits of both circuits. Even with this circuit there are some difficulties with the ability to regulate rebreathing and keep an economic and low fresh gas flow.
  • the object of the present invention is to solve these problems. This object is achieved by a shunt valve described by the patent claims for anaesthesia breathing circuits used in connection with anaesthetic machines.
  • FIG. 1 depicts schematically an anaesthetic breathing circuit (an absorber circuit) according to the invention and for regulation of the carbon dioxide concentration and the supply of fresh gases to the circuit used for general anaesthesia to patients.
  • FIG. 2 is a cut through the shunt valve included in FIG. 1. The cut is laid along the line II - II seen in FIG. 3.
  • FIG. 3 is a cut along the line III - III seen in FIG. 2, and
  • FIG. 4 is a profile view of the valve body of the valve seen in FIG. 2 and 3.
  • the breathing circuit in FIG. 1 in accordance with the invention is connected to an anaesthetic machine. It comprises an endotra ⁇ cheal tube 1, which is meant to be put into the patient's airway, a Y-piece 2 (and a device for analysing the gases to and from the patient), from which two anaesthetic hoses 3 and 4 lead and where the expiratory branch leads to a carbon dioxide absorber 5.
  • the breathing gases in the hoses are forced by a set of one-way valves 6 and 7 to follow in the direction of the arrows 8.
  • Artificial ventilation can be performed by a ventilator 9, either comprising a manually operated anaesthetic bag or a mechanical ventilator.
  • a fresh gas inflow which is not indicated in the figure, but placed in-between the absorber and valve 7. So far it constitutes a conventional circular absorber breathing circuit earlier described and the function of which the present invention aims to improve.
  • a shunt line 10 is introduced between the hoses 3 and 4 parallel to the absorber 5 and a shunt valve 11 is interposed in the shunt line 10.
  • the one way valves 6 and 7 as well as the ventilator 9 are placed in-between the Y-piece 2 (with the analysing device) and the connection of the shunt line 10 to the hoses 3 and 4.
  • the gas analysing device (not shown in the figure) is in a conventional way connected to the gases in the breathing circuit and registers both during inspiration and expiration and continuously in a suitable way presents the values to the person responsible for the anaesthetic.
  • the adjustable shunt valve 11 it is possible to direct a suitable flow of expiratory gas to bypass the absorber 5.
  • This adjustable flow of gas containing carbon dioxide can in an easy and superviseable way compensate for the loss of carbon dioxide caused by the increased tidal volumes required to keep the alveoli of the lungs from collapsing into atelectasis. In this manner it is possible to achieve the aim of optimal oxygenation of the blood and at the same time keep the carbon dioxide pressure normal and thereby maintaining a normal pH of the blood.
  • FIGS 2 and 3 depict in a schematic way cuts of a preferred embodiment of the shunt valve 11. It comprises a valve house block 12 with two parallel gas passages 13 and 14 where passage 13 constitutes the continuing passage from hose 4 of the inspiratory gases and passage 14 correspondingly the continuing passage from hose 3 of the expiratory gases. Between these passages there is placed a valve chamber 15 which contains a turnable valve body 16. A duct 17 connects the valve chamber 15 with passage 14 and a duct 18 connects the valve chamber with passage 13. These ducts 17 and 18 are both open into the valve chamber 15 but at different sites.
  • the valve body 16 having a circular cross-section, as best seen in Fig. 4, has a form that corresponds to the valve chamber 15, which implies that it can be rotated while it continuously maintains an air tight seal against the valve chamber wall.
  • the valve body 16 is at one end provided with a knob 19, which is situated outside the valve house block 12 when the valve body 16 is placed within the valve chamber 15 and allows a rotation of the valve body 16 and thereby a regulation of the gas flow through the shunt 11.
  • a cylindrical end tap 20 is provided, which is part of the assembly to hold the valve body 16 tightly in the valve chamber 15, as illustrated in FIG. 3.
  • the valve body 16 has a section in the form of a frustum of a cone adjacent to the tap 20 and between that section and the knob 19 a cylindrical section 22 is provided.
  • the tap 20, the conical section 21 and the cylindrical section 22 are concentric.
  • a groove 23 is formed, which extends in a radial plane and which at one end is elongated V-shaped and turns into a portion of parallel walls.
  • the bottom of the groove 23 has a slight spiral form such that the groove gets deeper from the top of the V up to the position where the walls becomes parallel, and from there on the depth is constant.
  • the groove 23 has its largest cross-sectional area where the walls become parallel and this area is at least as large as the cross-section of the ducts 17 or 18, which in turn have a smaller cross- sectional area than the passages 13 or 14.
  • the groove 23 does not extend all the way around the circumference of the conical section 21 but leaves a full segment 24, which is left in order to make it possible to totally shut off the shunt between the ducts 17 and 18.
  • the shape of the groove 23 can of course be different from the one described here. However, fundamental is that the groove has a shape that makes it possible to open the shunt from zero to fully open in a gradual and easy adjustable way.
  • the breathing circuit in accordance with this present invention presumes that the breathing of the anaesthetised patient runs through this circuit.
  • the expiratory gas leaves the patient through the tube 1, passes the Y-piece 2 (and is sampled by the gas analyser) and continues through hose 3 and passes one-way- valve 6 and runs through passage 14 in the shunt 11 and reaches the carbon dioxide absorber 5.
  • the gases are transformed into inspiratory gases and continue through hose 4 and maybe receiving an addition of shunted gases from passage 13 to the shunt 11.
  • the inspiratory gases also receive an addition of fresh gases here (not depicted in the figures) and run along to the one-way-valve 7 over to the Y-piece 2 and down into the tube and into the lungs of the patient.
  • the medically qualified person responsible for the anaesthetic can decide about the fresh gas flow and concentration of anaesthetic gases, the respiratory rate, tidal volume etc.
  • the tidal volume and respiratory rate are regulated either by changing the manual ventilation or by adjusting the mechanical ventilator 9.
  • tidal volume In order to avoid and counteract the formation of atelectasis in the lungs and thereby sub optimal oxygenation of the blood during anaesthesia a slightly larger tidal volume is chosen. This increase in tidal volume plus the normal respiratory rate results in a hyperventilation in its turn resulting in a decrease in carbon dioxide pressure in blood and also an increase in blood pH compared to normal.
  • the shunt 11 can be regulated with knob 19 and turn the valve body 16 and get an opening of the shunt valve 11 resulting in a shunt flow of expiratory gases directly from hose 3 to the inspiratory gases of hose 4.
  • the shunt flow is determined by how much the shunt 11 is opened as well as by the resistance to gas flow in the absorber 5.

Landscapes

  • Health & Medical Sciences (AREA)
  • Emergency Medicine (AREA)
  • Pulmonology (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
  • Respiratory Apparatuses And Protective Means (AREA)
  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)

Abstract

Circuit de respiration sous anesthésie du type boucle et de réinhalation comprenant un tube trachéal (1) conçu pour être placé dans les voies respiratoires du patient, deux tuyaux respiratoires (3, 4) fixés au tube par l'intermédiaire d'un élément en Y (2) et se prolongeant vers un absorbeur de dioxyde de carbone (5) où des clapets de non-retour (6, 7) sont placés afin de faire circuler les gaz dans le circuit à travers l'absorbeur (5) et de les renvoyer au patient. Ce circuit permet de ventiler le patient soit manuellement, soit au moyen d'un ventilateur mécanique (9) et de l'alimenter en gaz frais. Un conduit de dérivation est disposé de telle façon qu'une partie des gaz d'expiration contourne l'absorbeur (5) et ce conduit comporte un clapet de dérivation (11) servant à réguler l'écoulement contournant l'absorbeur (5).
PCT/SE1996/000644 1995-05-15 1996-05-15 Circuits de respiration sous anesthesie WO1996036385A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
EP96914526A EP0825886A1 (fr) 1995-05-15 1996-05-15 Circuits de respiration sous anesthesie
AU57860/96A AU5786096A (en) 1995-05-15 1996-05-15 Anaesthesia breathing circuits

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
SE9501792A SE506727C2 (sv) 1995-05-15 1995-05-15 Shuntventil i ett andningssystem av cirkulationstyp
SE9501792-7 1995-05-15

Publications (1)

Publication Number Publication Date
WO1996036385A1 true WO1996036385A1 (fr) 1996-11-21

Family

ID=20398309

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/SE1996/000644 WO1996036385A1 (fr) 1995-05-15 1996-05-15 Circuits de respiration sous anesthesie

Country Status (4)

Country Link
EP (1) EP0825886A1 (fr)
AU (1) AU5786096A (fr)
SE (1) SE506727C2 (fr)
WO (1) WO1996036385A1 (fr)

Cited By (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1998041266A1 (fr) * 1997-03-19 1998-09-24 Fisher Joseph A Elimination de vapeurs d'anesthesique chez un sujet apres une intervention chirurgicale
WO1999040961A1 (fr) * 1998-01-30 1999-08-19 Anmedic Ab Appareil permettant de melanger des gaz et technique afferente
GB2335604A (en) * 1998-03-26 1999-09-29 Eugenio Brugna Anaesthesia apparatus
US6295985B1 (en) 1998-10-27 2001-10-02 Siemens Elema Ab Anaesthetic machine
ES2168216A1 (es) * 2000-06-22 2002-06-01 Temel S A Equipo para la aplicacion de anestesias.
US6612308B2 (en) 2000-03-31 2003-09-02 Joseph Fisher Portable isocapnia circuit and isocapnia method
EP1419795A1 (fr) * 2002-11-13 2004-05-19 Maquet Critical Care AB Dispositif d'absorption pour appareil d'anaesthesie
US6799570B2 (en) 2001-05-04 2004-10-05 Joseph Fisher Method of maintaining constant arterial PCO2 and measurement of anatomic and alveolar dead space
WO2011043651A1 (fr) 2009-10-07 2011-04-14 Alcmair Partners Bv Appareil respiratoire destiné à des patients

Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE2543266A1 (de) * 1975-09-27 1977-04-07 Moyat Peter Dr Phil Nat Co tief 2 - regelung am patienten unter narkose

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
IE56756B1 (en) * 1984-07-13 1991-12-04 Master Medical Corp Flow control device for administration of intravenous fluids

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE2543266A1 (de) * 1975-09-27 1977-04-07 Moyat Peter Dr Phil Nat Co tief 2 - regelung am patienten unter narkose

Cited By (12)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1998041266A1 (fr) * 1997-03-19 1998-09-24 Fisher Joseph A Elimination de vapeurs d'anesthesique chez un sujet apres une intervention chirurgicale
US6708689B2 (en) 1997-03-19 2004-03-23 Joseph A. Fisher Elimination of vapor anaesthetics from patients after surgical procedures
WO1999040961A1 (fr) * 1998-01-30 1999-08-19 Anmedic Ab Appareil permettant de melanger des gaz et technique afferente
GB2335604A (en) * 1998-03-26 1999-09-29 Eugenio Brugna Anaesthesia apparatus
US6295985B1 (en) 1998-10-27 2001-10-02 Siemens Elema Ab Anaesthetic machine
US6612308B2 (en) 2000-03-31 2003-09-02 Joseph Fisher Portable isocapnia circuit and isocapnia method
US6622725B1 (en) 2000-03-31 2003-09-23 Joseph A. Fisher Rebreathing circuit to set and stabilize end tidal and arterial PCO2 despite varying levels of minute ventilation
ES2168216A1 (es) * 2000-06-22 2002-06-01 Temel S A Equipo para la aplicacion de anestesias.
US7100606B2 (en) 2000-10-02 2006-09-05 Joseph Fisher Method of maintaining constant arterial PCO2 and measurement of anatomic and alveolar dead space
US6799570B2 (en) 2001-05-04 2004-10-05 Joseph Fisher Method of maintaining constant arterial PCO2 and measurement of anatomic and alveolar dead space
EP1419795A1 (fr) * 2002-11-13 2004-05-19 Maquet Critical Care AB Dispositif d'absorption pour appareil d'anaesthesie
WO2011043651A1 (fr) 2009-10-07 2011-04-14 Alcmair Partners Bv Appareil respiratoire destiné à des patients

Also Published As

Publication number Publication date
AU5786096A (en) 1996-11-29
EP0825886A1 (fr) 1998-03-04
SE9501792L (sv) 1996-11-16
SE9501792D0 (sv) 1995-05-15
SE506727C2 (sv) 1998-02-02

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