Aestiva Machine Check
Preparation of anaesthesia machines for use by malignant hyperthermia susceptible patients requires purging the machines of halogenated anaesthetic agents. The endpoint of this process is to reach a gas concentration of 5 ppm or less, which has been arbitrarily chosen as the safe limit of exposure to avoid triggering a malignant hyperthermia event. We examined the washout characteristics of sevoflurane and desflurane from the Datex-Ohmeda Aestiva® Anaesthesia System and Aisys® Anaesthesia Carestation®anaesthetic machines. The machines were contaminated for two hours using either sevoflurane 2 vol% or desflurane 6 vol%. At the end of the priming period, the patient breathing circuit and reservoir bag, carbon dioxide absorbent, sampling line and test lung were replaced with uncontaminated components. During the test period, machines were purged using oxygen flows of 10 l/minute. The average time to reach 5 ppm with the Aestiva machines was 51 minutes with sevoflurane and 71 minutes with desflurane. The average time to reach 5 ppm for the Aisys machines was 55 minutes with sevoflurane and 69 minutes with desflurane. All configurations of machines and anaesthetic gases demonstrated a rebound effect in agent concentration above 5 ppm when the fresh gas flow was subsequently reduced from 10 to 2 l/minute. Aestiva and Aisys anaesthetic machines require a prolonged period to adequately purge them of halogenated volatile anaesthetic agent. The rebound effect poses a serious concern, suggesting that after the purging period, fresh gas flows of 10 l/minute should be maintained for the duration of anaesthesia care of the malignant hyperthermia susceptible patient.
- Aestiva Machine Check Error
- Machine Check Exception
- Datex Aestiva-anesthesia Machine Checkout Procedure
Check that scavenger reservoir bag (if present) is not distended under pressure. If so, increase scavenger suction to green zone indicator. The oxygen flush valve should not stick. The Aestiva/5 scavenges patient fresh gas AND ventilator drive gas and therefore requires high suction; otherwise, undesired PEEP may develop. 9: Suction for patient. Check machine is plugged into an un-interrupted power supply and/or that battery is charging. Check machine moves freely. Check service dates on machine and vaporisers. Test negative pressure device for leaks by deflating bulb whilst occluding 15mm connector. Ensure bulb does not re-inflate.
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Aestiva Machine Check Error
A response to a previously published article or letter can be submitted to the Online Correspondence section at http://www.anaesthesiacorrespondence.com. A selection of this correspondence is published several times a year in Anaesthesia.
All correspondence intended for publication in Anaesthesia should be addressed to Dr David Bogod, Editor‐in‐Chief, and submitted as an e‐mail attachment to anaesthesia@nottingham.ac.uk. For multi‐author letters, a covering letter signed by all authors must be submitted either by post, fax (44 (0) 115 962 7670) or by e‐mail as a scanned document before correspondence can be published. Alternatively, letters may be submitted typewritten on one side of paper, double spaced with wide margins to Anaesthesia, 1st Floor, Maternity Unit, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK. All paper submissions must include a signed covering letter, a disc or CD‐ROM with a Word for Windows or .rtf version of the letter and an email address for the corresponding author.
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Copy should be prepared in the usual style of the Correspondence section. Zte mf190 driver windows 10. Authors must follow the advice about references and other matters contained in the Author Guidelines at http://www.blackwellpublishing.com/journals/ana/submiss.htm. Correspondence presented in any other style or format will be returned to the author for revision.
Machine Check Exception
At the end of a routine case the patient was disconnected from the breathing circuit to allow safe transfer from the table. The patient was still paralysed and ventilated. On reconnection to the circuit it was not possible to ventilate the lungs or fill the circuit. Suspecting a leak due to a disconnection, the unions were checked at the patient and anaesthetic machine ends of the circuit. It was noticed that the male connection on the expiratory flow sensor (see Fig. 3) was loose. Pushing it back into position resulted in elimination of the leak. The patient was ventilated until muscle relaxation was reversed and the patient recovered.
After the case, the anaesthetic machine (Datex Aestiva/5, Datex‐Ohmeda Ltd, Hatfield, UK) was examined. It had passed its machine check prior to the list with no detectable leak. Most of expiratory flow sensor is not visible without partially dismantling the machine. The component is in two parts as it is houses a pneumotachograph. On inspection the component had come apart, resulting in the large leak (see Fig. 4). The flow sensor is vulnerable to damage from theatre equipment and staff and may be used as a handle when moving the machine by untrained staff. The problem may be magnified by the attachment of an HME filter, making the breathing attachment stand proud of the anaesthetic machine. It may be significant that this component is regarded as a disposable item. It is not routinely changed during the machine service. It is also possible that fatigue contributed to its failure.
Datex Aestiva-anesthesia Machine Checkout Procedure
The leak was not only large but potentially difficult to detect as it was within the machine. On examination of other machines in the department one other similar leak was found and subsequently a further similar critical incident has occurred. This incident has been reported to Scottish Healthcare Supplies.