mapleson breathing systems
TRANSCRIPT
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MAPLESON MAPLESON BREATHING SYSTEMSBREATHING SYSTEMS
MODERATOR : DR RANJAN R KMODERATOR : DR RANJAN R K
PRESENTER : DR NIKHIL M P PRESENTER : DR NIKHIL M P
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History
In 1954 Mapleson described and analyzed Five different anaesthetic breathing systems & referred as Mapleson A – E.
Bain circuit in 1972 by Bain & Spoeral
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In 1975 Willis et al described F system & added to above.
In 1976 – Lack circuit .
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CLASSIFICATIONCLASSIFICATION
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• MAPLESON A Classic & Lack’s modification• MAPLESON B• MAPLESON C• MAPLESON D Classic form & Bain’s modification• MAPLESON E• MAPLESON F
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BASED ON THE RESERVOIR BAG
POSITION
Afferent reservoir system eg:Mapleson A,B,C &
Lack’s Afferent limb:delivers FGF from
machine to patient end
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Efferent reservoir system eg:Mapleson D,E,F &
Bain’s
Efferent limb:carries expired gas from patient & vents it to the atmosphere through expiratory valve
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Breathing systems
Bidirectional flow & without carbondioxide absorption & Semiclosed system
MAPLESON SYSTEMS
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Mapleson’s assumptions
1. Gases move enblock fresh gas,dead space
gas,alveolar gas
2. Reservoir bag continues to fill,without offering any resistance till it is full
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3. Expiratory valve opens as soon as reservoir bag is full & the pressure inside the system goes above atmospheric pressure
4. Valve remain opens throughout the expiratory phase and closes at the start of next inspiration
MAPLESON’S ASSUMPTIONS CONTD.
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Afferent Afferent reservoir reservoir systemssystems
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MAPLESON A SYSTEMMAPLESON A SYSTEM
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Magill systemMagill system FGF enters the system near machine end A corrugated tubing connects the reservoir bag to APL valve of the system
MAPLESON A
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MAPLESON A
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Lack’s modificationLack’s modification
Expiratory limb –from patient end to APL valve at the machine end of the system2 forms
dual tube (parallel) tube-within-a-tube(coaxial)
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LACK’S MODIFICATION
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Functional Functional analysisanalysis
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Spontaneous Spontaneous breathingbreathing
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MAPLESON A- spontaneous respiration
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a. During inspiration,FG from the machine and reservoir bag flows to the patient,RB collapses
b. During expiration,FG continues to flow.expired gas (dead space gas & alveolar gas) pushes the FG into RB and collects inside the corrugated tube
MAPLESON A – SPONT. CONTD.
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c. Expiratory valve opens and alveolar gas is vented into atmosphere
d. During Expiratory pause,alveolar gas that had come in contact with the corrugated tube is also vented depending on FGF.
MAPLESON A – SPONT. CONTD.
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System is filled with only FG & dead space gas at the start of next inspiration when FGF =Minute ventilation Alveolar gas+dead space gas+some of FG also escapes if FGF>minute ventilation Some alveolar gas +dead space gas will remain if FGF < minute ventilation
MAPLESON A – SPONT. CONTD.
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MAPLESON A SPONTANEOUS
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Controlled Controlled ventilationventilation
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MAPLESON A- controlled ventilation
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a. During inspiration,patient gets ventilated with FG & part of FG is vented through the valve.
b. During expiration,FG flows into RB & expired gases flows back into corrugated tubing till system is full
MAPLESON A- controlled ventilation contd.
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c. During next inspiration alveolar gas is pushed back into alveoli followed by FG
part of expired gas & part of FG escape through the valve when sufficient pressure is developed
rebreathing
inefficient for controlled ventilation
MAPLESON A- controlled ventilation contd.
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MAPLESON A - CONTROLLED
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TESTS FOR MAPLESON A TESTS FOR MAPLESON A SYSTEMSSYSTEMS
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Tested for leaks by occluding the patient end of the system,closing the APL valve & pressurizing the system
APL valve opens
TESTS FOR MAPLESON A CONTD.
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To attach a tracheal tube to the inner tubing at the patient end of the system
To occlude both limbs at the patient connection with APL valve open
TESTS FOR COAXIAL LACKS SYSTEM
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FGF RequirementFGF RequirementSpontaneous : equal to minute
ventilation Controlled :very high & difficult to
predict.
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MAPLESON B SYSTEM
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MAPLESON C SYSTEM
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MAPLESON A,B,C
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Efferent reservoir system
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They have a 6mm d. tube as afferent limb and carries FGF from machine end to patient end .
Reservoir bag is attached to efferent limb which is a wide bore corrugated tube
EFFERENT RESERVOIR SYSTEM CONTD.
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APL valve is placed near the reservoir bag
In Bain’s modification afferent & efferent limbs are coaxially placed
Inner tube – 6mm Outer tube – 22 mm Length- 180 cms
EFFERENT RESERVOIR SYSTEM CONTD.
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Mapleson D system
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MAPLESON D
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BAIN’S CIRCUIT
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Functional analysis
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Spontaneous Spontaneous respirationrespiration
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MAPLESON D - Spontaneous respiration
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a.During inspiration,FG from the machine,RB & corrugated tube flow to the patient
b.During expiration,FGF to the system at the patient end & expired gas gets continuously mixed with FG as it flows back into corrugated tube & reservoir bag
MAPLESON D CONTD.
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c.Once the system is full, the excess gas is vented to the atmosphere through the APL valve
during expiratory pause FG continues to flow & fill the proximal portion of corrugated tube while mixed gas is vented through the valve
MAPLESON D CONTD.
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d. During next inspiration,patient breaths FG & mixed gas.
MAPLESON D CONTD.
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Controlled ventilation
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MAPLESON D-controlled ventilation
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a.During inspiration the patient gets ventilated with FGF from the machine,corrugated tube & RB.
b.During expiration the expired gas gets mixed with the fresh gas that is flowing into the system at patient end
During expiratory pause the FG continues to enter the system and pushes the mixed gas towards RB.
MAPLESON D CONTROLLED CONTD.
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c. When next ventilation is initiated patient gets ventilated with the gas in the corrugated tube. As the pressure in the system increases APL valve opens and contents of RB are released into the atmosphere.
MAPLESON D CONTROLLED CONTD.
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BAIN’S CONTROLLED.
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FGF RequirementFGF RequirementSpontaneous : 1.5 to 3 times minute
ventilation ( 100 to 300 ml/kg/min)
Controlled : 1 to 2 times minute
ventilation
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MINUTE VENTILATION
FRESH
GAS
FLOW
PaCO2
Almost same PaCO2- for FGF from 100 to 240ml/kg/min
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Tests for Mapleson DTests for Mapleson D
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By occluding the patient end & closing the APL valve,pressurizing the system
Open the APL valve
Bag deflates easily
TESTS FOR MAPLESON D CONTD.
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Occlude the inner tube at the patient end after setting a low flow oxygen
If the inner tube is intact the
flowmeter indicator will fall
TESTS FOR BAINS SYSTEM
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Pethick test Activate oxygen flush &
observe the bag
Venturi effect caused by high flow oxygen at the patient end will create a negative pressure at the outer tube
Bag deflates
TESTS FOR BAINS SYSTEM
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AdvantagesAdvantages Can be usedin controlled/spontaneous respirationAdults & Pediatrics Portable,Light weightScavenging of exhaled gases
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Hazards Hazards Accidental disconnection of inner tube from machine end.
‘Double back’ itself & cause obstruction to FGF.
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