List of Contributors xvii
Preface xxi
1 Medical Gas Cylinders and Pipeline Systems 1
Carl Bradbrook
1.1 Medical Gas Cylinders 1
1.2 Liquid Oxygen Tanks 8
1.3 Oxygen Concentrators 9
1.4 Medical Gas Pipeline Systems 9
References 15
2 Oxygen Concentrators 17
Allan Williamson
2.1 Introduction 17
2.2 Function 17
2.3 Product Gas 17
2.4 Clinical Use 18
2.5 Advantages 20
2.6 Disadvantages 20
2.7 Hazards 20
2.8 Summary 21
References 21
3 Small Animal Anesthetic Machines and Equipment 23
Craig Mosley and Amanda Shelby
3.1 Introduction 23
3.2 Safety and Design 23
3.3 The Basic Veterinary Anesthetic Machine 23
3.4 Breathing Systems 33
3.5 Waste Gas Scavenge Systems 33
3.6 Routine Anesthesia Machine Checkout Procedures 33
References 34
4 Large Animal Anesthesia Machines and Equipment 35
Amanda Shelby
4.1 History of the Large Animal Anesthesia Machine 35
4.2 Purpose 35
4.3 Standards 35
4.4 Similarity to Small Animal Machines 35
4.5 Components of the Anesthesia Machine 36
4.6 Large Animal Anesthesia Workstations 41
4.7 Common Commercially Available Machines 41
4.8 General Cautions 51
4.9 Miscellaneous Equipment for Large Animal Anesthesia 51
References 53
5 Anesthetic Vaporizers 55
Sharon Fornes, Kristen G. Cooley, and Rebecca A. Johnson
5.1 Introduction 55
5.2 Vaporizer Physics 55
5.3 Vaporizer Classification 56
5.4 Other Factors Affecting Vaporizers 62
5.5 Maintenance and Repair 64
5.6 Current Vaporizer Standards 65
5.7 The Modern Vaporizer 65
5.8 Specific Vaporizers 66
5.9 Summary 71
References 71
6 Anesthetic Ventilators 73
Katrina Lafferty
6.1 Introduction 73
6.2 Ventilator Function in the Breathing Circuit 73
6.3 Tidal Volume Delivery 73
6.4 Driving Gas 74
6.5 Bellows Construction 75
6.6 Pressure Limiting Controls 76
6.7 Gas Pressure Alarm 77
6.8 Exhaust Valve 77
6.9 Spill Valve 77
6.10 Ventilator Hose Connection or Ventilator Hose Switch 77
6.11 Ventilation Modes 78
6.12 Cleaning and Sterilization 79
6.13 Pressure Checking 79
6.14 General Concerns and Troubleshooting 80
6.15 Pediatric Ventilation 81
6.16 Basic Ventilator-Patient Set-up 82
6.17 Small Animal Mechanical Ventilators 82
6.18 Large Animal Mechanical Ventilators 85
6.19 Conclusion 89
References 89
7 Humidification and Positive Pressure Equipment 91
Stephanie Keating and Stuart Clark-Price
7.1 Humidification 91
7.2 Positive Pressure Equipment 96
References 98
8 Waste Anesthetic Gas Collection and Consequences 101
Heidi Reuss-Lamky
8.1 Introduction 101
8.2 Occupational WAG Exposure 101
8.3 Physical Properties and Elimination 102
8.4 Pharmacodynamics 102
8.5 History of Governmental Regulations and Trace (Waste) Gas Exposure 104
8.6 WAG Exposure Level Recommendations 104
8.7 Reducing Environmental WAG Exposure 104
8.8 The Anesthetist’s Responsibility 107
8.9 Monitoring WAG Exposure 112
8.10 Summary 112
References 113
9 Hazards of the Anesthetic Delivery System and Operating Room Fires 115
Odette O
9.1 Hazards of the Anesthetic Delivery System 115
9.2 Operating Room Fires 123
References 125
10 Components of the Breathing System 127
Craig Mosley and Amanda Shelby
10.1 Breathing Systems 127
10.2 Summary 139
References 139
11 Mapleson Breathing Systems 141
Tatiana Ferreira
11.1 Introduction 141
11.2 Fresh Gas Flows (FGFs) 141
11.3 Advantages and Disadvantages 141
11.4 Choice of System 143
11.5 Specific System Types 143
11.6 Combined Systems 150
11.7 Respiratory Gas Monitoring 150
11.8 Potential Hazards 151
References 152
12 The Circle System 155
Geoffrey Truchetti and Trish Anne Farry
12.1 Introduction 155
12.2 Components 155
12.3 Component Arrangement 162
12.4 Gas Flow 164
12.5 Resistance and Work of Breathing in the Circle System 166
12.6 Dead Space 166
12.7 Heat and Moisture 167
12.8 Maintenance 167
12.9 Advantages/Disadvantages 168
References 168
13 Laryngoscopes 171
Erin Wendt-Hornickle
13.1 History 171
13.2 Laryngoscope Use 171
13.3 Description 171
13.4 Fiber Optic Endoscopes 174
13.5 Veterinary-Specific Laryngoscopes 175
13.6 Summary 175
References 176
14 Supraglottic Airway Devices and Tracheal Tubes and Stylets 177
Jennifer Sager
14.1 Introduction 177
14.2 Laryngeal Mask Airway (LMA) 177
14.3 Veterinary-gel (v-gel®) Airway Device 178
14.4 Endotracheal Tubes 179
14.5 Large Animal Endotracheal Tubes 184
14.6 Reinforced Tubes 185
14.7 Laser Safe Tubes 185
14.8 Single Lung Intubation 186
14.9 Stylets 187
14.10 Cuff Pressure Manometers 188
14.11 Summary 190
References 190
15 Oxygen Delivery Systems 193
Jonathan Bach
15.1 Introduction 193
15.2 Oxygen Supplementation Techniques 193
15.3 Hyperbaric Oxygen 197
References 197
16 Gas Monitoring 199
Louise O’Dwyer
16.1 Introduction 199
16.2 Capnometry/Capnography 199
16.3 Oxygen Measurement 207
16.4 Nitrous Oxide and Inhalation Agent Analyzers 208
16.5 Blood Gas Analysis: Partial Pressures of Oxygen and CO2 210
16.6 Conclusion 210
References 210
17 Airway Volumes, Flows and Pressures 213
Andrew Claude and Alanna Johnson
17.1 Introduction 213
17.2 Definitions 213
17.3 Volume and Flow Measurement Devices 214
17.4 The Ventilatory (Respiratory) Cycle 218
17.5 Airway Pressure Monitoring 219
17.6 Spirometry Loops 219
References 222
18 Pulse Oximetry 223
Odette O
18.1 Introduction 223
18.2 History 223
18.3 Importance of Pulse Oximetry 223
18.4 Function 224
18.5 Pulse Oximeter Probes 224
18.6 Uses 225
18.7 Oxyhemoglobin Dissociation Curves in Different Species 225
18.8 Patient Factors 226
18.9 Abnormal Hemoglobin 227
18.10 Sources of Error 227
18.11 Perfusion Index (PI) and Plethysmograph Variability Index (PVI) 228
18.12 Other Pulse Oximeter Models 229
18.13 Low Saturation Alarms 231
18.14 Pulse Oximetry Use in the Recovery Period 231
18.15 Summary 231
References 232
19 Cardiovascular Monitoring 235
Anderson Favaro da Cunha and Rebecca A. Johnson
19.1 Introduction 235
19.2 Definitions 235
19.3 Measurement Techniques 235
19.4 Patient Point of View 244
19.5 Central Venous Pressure (CVP) 245
19.6 Cardiac Output Monitoring 246
19.7 Conclusion 248
References 248
20 Electrocardiography 253
Tracey Lawrence
20.1 Overview 253
20.2 The ECG Machine 253
20.3 Lead Systems 254
20.4 Mean Electrical Axis (MEA) 257
20.5 ECG Cycle 258
20.6 Electrode Placement 260
20.7 ECG Filters 263
20.8 Evaluating the ECG 264
20.9 Equipment Maintenance 268
20.10 Summary 268
References 269
21 Neuromuscular Transmission Monitoring 271
Molly Allen and Rebecca A. Johnson
21.1 Introduction 271
21.2 Neuromuscular Transmission 271
21.3 Peripheral Nerve Stimulation 271
21.4 Monitoring Techniques 275
21.5 Other Equipment 279
References 280
22 Temperature Regulation and Monitoring 285
Caroline Baldo and Darci Palmer
22.1 Introduction 285
22.2 Heat and Thermodynamics 285
22.3 Thermoregulation 285
22.4 Types of Heat Loss 286
22.5 Heat Loss During Anesthesia 287
22.6 Effects of Hypothermia and Hyperthermia 288
22.7 Re-Warming 289
22.8 Temperature Monitoring Devices 290
22.9 Sites of Temperature Monitoring 291
22.10 Warming Devices 293
22.11 Active Warming Devices 293
22.12 Other Techniques to Minimize Heat Loss 298
22.13 High-Risk Heating Methods 299
References 300
23 Fluid Regulation and Monitoring 303
Julie Walker
23.1 Overview of Fluid Physiology 303
23.2 Assessment of Fluid Balance 304
23.3 Advanced Fluid Balance Monitoring Techniques 307
23.4 Fluid Therapy 311
23.5 Equipment for Fluid Therapy 312
23.6 Summary 319
References 319
24 Anesthetic Records 323
Thomas Riebold
24.1 Introduction 323
24.2 Maintaining Anesthetic Records 323
24.3 Monitoring Recommendations 323
24.4 Paper Anesthetic Records 324
24.5 Electronic Anesthetic Records 324
24.6 Transitioning from Paper to Electronic Medical Records 327
24.7 Specific Types of Anesthetic Monitoring Software 328
24.8 Patient Management and Digital Records 330
24.9 Automated Dispensing Systems and Record Keeping 333
References 333
25 Equipment for the Magnetic Resonance Imaging System 335
Kris Kruse-Elliott
25.1 Basic Principles of Magnetic Resonance Imaging 335
25.2 Regulations 337
25.3 MRI Hazard Classification 337
25.4 Types of Metal 338
25.5 Gauss Lines and Safety Zones 338
25.6 Specific Hazards 339
25.7 Compatible MRI Equipment 340
25.8 Anesthetic Machines 340
25.9 Vaporizers 341
25.10 Ventilators 342
25.11 Laryngoscopes 342
25.12 Endotracheal Tubes and Airway Devices 342
25.13 Monitors 342
25.14 Miscellaneous Items 345
25.15 Summary 346
References 346
26 Equipment for Environmental Extremes and Field Techniques 349
David Brunson and Kristen G. Cooley
26.1 Environmental Extremes 349
26.2 Temperature 349
26.3 Atmospheric Pressure 351
26.4 Drug Delivery Systems 352
26.5 Monitoring Equipment 356
26.6 Field Techniques 358
26.7 Anesthesia for Situations with Limited Means 358
26.8 Stress 362
26.9 Summary 363
References 363
27 Equipment Checkout and Maintenance 365
Molly Allen and Lesley Smith
27.1 Introduction 365
27.2 Daily Checks 365
27.3 Other Equipment 373
27.4 End of Case 373
27.5 Preventative Maintenance 374
References 374
28 Equipment Cleaning and Sterilization 377
Cristina de Miguel Garcia and Kristen G. Cooley
28.1 Introduction 377
28.2 The Decontamination Process 378
28.3 Recommendations for Cleaning and Disinfecting Specific Items 384
References 388
29 Unique Species Considerations: Dogs and Cats 391
Turi Aarnes
29.1 Introduction 391
29.2 Intubation 391
29.3 Breathing System 392
29.4 Monitoring 392
29.3 Recovery 393
29.6 Anesthetic Risk 393
References 394
30 Unique Species Considerations: Ruminants and Swine 395
Denise Radkey, Lindsey Snyder, and Rebecca A. Johnson
Part I: Ruminants 395
30.1 Introduction 395
30.2 Handling and Restraint 395
30.3 IV Catheterization 396
30.4 Induction Equipment 397
30.5 Tracheal Insufflation and Demand Valves 403
30.6 Padding and Positioning 404
30.7 Monitoring Equipment 406
30.8 Commercial Anesthetic Machines 408
30.9 Anesthetic Circuit 408
30.10 Anesthetic Recovery 409
30.11 Summary 410
Part II: Swine 410
30.12 Introduction 410
30.13 Handling and Restraint 410
30.14 Intravenous Catheter Placement 411
30.15 Induction Equipment 412
30.16 Monitoring Equipment 414
30.17 Anesthetic Circuit 415
30.18 Anesthetic Recovery 416
30.19 Summary 416
References 416
31 Unique Species Considerations: Equine 419
Carolyn Kerr
31.1 Introduction 419
31.2 Sedation and Pre-Anesthetic Period Considerations 419
31.3 General Anesthesia 426
31.4 Recovery Period 437
31.5 Medical Records 437
References 438
32 Unique Species Considerations: Avian 441
Carrie Schroeder
32.1 Introduction 441
32.2 Anesthetic Considerations 443
32.3 Venous Access 445
32.4 Anesthetic Monitors 446
32.5 Anesthetic Circuits 447
32.6 Maintenance of Body Temperature 448
32.7 Anesthetic Recovery 448
References 449
33 Unique Species Considerations: Rabbits 451
Katrina Lafferty
33.1 Introduction 451
33.2 Intubation 451
33.3 Breathing Circuits 454
33.4 Monitors 454
33.5 Thermal Support 458
33.6 Summary 458
References 458
34 Unique Species Considerations: Rodents 461
Mario Arenillas Baquero and Rebecca A. Johnson
34.1 Introduction 461
34.2 Anesthetic Machines 461
34.3 Anesthetic Induction Chambers 462
34.4 Masks 464
34.5 Endotracheal Intubation and Intubation Devices 466
34.6 Ventilators 469
34.7 Monitoring Equipment 469
34.8 Warming Devices 473
34.9 Summary 474
References 474
35 Unique Species Considerations: Fish and Amphibians 477
Kurt Sladky
35.1 Introduction 477
35.2 Fish and Amphibian Anesthesia: Induction and Maintenance 477
35.3 Anesthetic Monitoring 483
References 486
36 Unique Species Considerations: Reptiles 489
Christoph Mans
36.1 Introduction 489
36.2 Anesthetic Induction 489
36.3 Airway Intubation 489
36.4 Anesthetic Monitoring 491
36.5 Summary 495
References 495
37 Unique Species Considerations: Non-Human Primates 497
Stephen Cital
37.1 General Anatomy 497
37.2 Taxonomy 497
37.3 Immobilizing Equipment 497
37.4 Anesthetic Machines 497
37.5 Monitors 498
37.6 Summary 501
References 502
Index 503