TY - CHAP M1 - Book, Section TI - Breathing Systems A1 - Butterworth IV, John F. A1 - Mackey, David C. A1 - Wasnick, John D. PY - 2018 T2 - Morgan & Mikhail's Clinical Anesthesiology, 6e AB - KEY CONCEPTS Because insufflation avoids any direct patient contact, there is no rebreathing of exhaled gases if the flow is high enough. Ventilation cannot be controlled with this technique, however, and the inspired gas contains unpredictable amounts of entrained atmospheric air. Long breathing tubes with high compliance increase the difference between the volume of gas delivered to a circuit by a reservoir bag or ventilator and the volume actually delivered to the patient. The adjustable pressure-limiting (APL) valve should be fully open during spontaneous ventilation so that circuit pressure remains negligible throughout inspiration and expiration. Because a fresh gas flow equal to minute ventilation is sufficient to prevent rebreathing, the Mapleson A design is the most efficient Mapleson circuit for spontaneous ventilation. The Mapleson D circuit is efficient during controlled ventilation, because fresh gas flow forces alveolar air away from the patient and toward the APL valve. Increasing the hardness of soda lime by adding silica minimizes the risk of inhalation of sodium hydroxide dust and also decreases resistance of gas flow. Malfunction of either unidirectional valve in a circle system may allow rebreathing of carbon dioxide, resulting in hypercapnia. With an absorber, the circle system prevents rebreathing of carbon dioxide at fresh gas flows that are considered low (fresh gas flow ≤1 L) or even fresh gas flows equal to the uptake of anesthetic gases and oxygen by the patient and the circuit itself (closed-system anesthesia). Because of the unidirectional valves, apparatus dead space in a circle system is limited to the area distal to the point of inspiratory and expiratory gas mixing at the Y-piece. Unlike Mapleson circuits, the circle system tube length does not directly affect dead space. The fraction of inspired oxygen (FiO2) delivered by a resuscitator breathing system to the patient is directly proportional to the oxygen concentration and flow rate of the gas mixture supplied to the resuscitator (usually 100% oxygen) and inversely proportional to the minute ventilation delivered to the patient. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1161425570 ER -