What type of circuit is this?

[SevoInduction]

Ok, stupid question from a pre-med...

What type of circuit is being used in this video? I was trying to explain verbally what this looked like to a CRNA and her response was "God knows what they use in those third world countries.." Alright funny, but Spain isn't exactly third world. 🙂

Anyways.. The link to the video.. It's in Castillian Spanish, sorry about that:

http://www.youtube.com/watch?v=dsVlLCOjNXk

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[aredoubleyou]

Ok, stupid question from a pre-med...

What type of circuit is being used in this video? I was trying to explain verbally what this looked like to a CRNA and her response was "God knows what they use in those third world countries.." Alright funny, but Spain isn't exactly third world. 🙂

Anyways.. The link to the video.. It's in Castillian Spanish, sorry about that:

http://www.youtube.com/watch?v=dsVlLCOjNXk

looks like a normal circle system with the addition of a valve at the y piece (additional apl?) presumably for teaching purposes, but i dont know a lick of spanish

 

[SevoInduction]

looks like a normal circle system with the addition of a valve at the y piece (additional apl?) presumably for teaching purposes, but i dont know a lick of spanish

Basically what he is saying about that valve is "Turn it to the 6 o'clock position, replace the security top, then prime the circuit with 8% sevo and 70% N2O for two minutes..." In that position, that valve allows you to preoxygenate while the circuit primes. Then move it to 12 o'clock, and the volatile and N2O is delivered.

So without that valve, how do you prime a circuit when you do VIMA?

And the bag that he is pumping during the induction.. (not the reservoir bag, the other bag that stays fully inflated) what is that?

I've always asked for VIMA when I've had to go under. I must be really sensitive to propofol, because even with lidocaine it still burns like hell, and I think I have a better recovery when I don't get it. The way it's been done with me though is: preoxygenate, turn on the nitrous, then slowly increase the sevo. I suppose this video is more about teaching single breath technique?

 

[aredoubleyou]

Basically what he is saying about that valve is "Turn it to the 6 o'clock position, replace the security top, then prime the circuit with 8% sevo and 70% N2O for two minutes..." In that position, that valve allows you to preoxygenate while the circuit primes. Then move it to 12 o'clock, and the volatile and N2O is delivered.

So without that valve, how do you prime a circuit when you do VIMA?

And the bag that he is pumping during the induction.. (not the reservoir bag, the other bag that stays fully inflated) what is that?

I've always asked for VIMA when I've had to go under. I must be really sensitive to propofol, because even with lidocaine it still burns like hell, and I think I have a better recovery when I don't get it. The way it's been done with me though is: preoxygenate, turn on the nitrous, then slowly increase the sevo. I suppose this video is more about teaching single breath technique?

Sounds like the valve allows the circut to prime with volatile while you preoxygenate from the bag....cant say I see the point or cost effectiveness, but whatever.

Not sure what a 'VIMA' is but i think its the same as a mask induction? W/o a valve you turn your flow rates up and your sevo crancked up and majically a minute later its primed. I think with adults its probably pointless to preoxygenate for a mask induction since it takes so freakin long. (w kids its usually impossible due to cooperation).

The reason no one masks you down is it is slower, some would argue less safe (I generally disagree), and not as pleasant for the vast majority of people.

If you dont want the propofol to burn, tell them to stick a big iv in a big vein on the otherside of your elbow...problem solved.

 

[Planktonmd]

This is a regular circle system to which they added a reservoir bag that should fill up with the vapor during induction and make the inhaled induction theoretically faster! 😳
There are people in this world who love complicating life and this is a great example: they asked themselves how do we turn a simple straight forward process into a complicated mess that requires at least 10 extra steps before the induction of anesthesia is achieved and the answer was: let's add a reservoir bag, an additional oxygen line and a multi positional valve!

 

[SevoInduction]

This is a regular circle system to which they added a reservoir bag that should fill up with the vapor during induction and make the inhaled induction theoretically faster! 😳
There are people in this world who love complicating life and this is a great example: they asked themselves how do we turn a simple straight forward process into a complicated mess that requires at least 10 extra steps before the induction of anesthesia is achieved and the answer was: let's add a reservoir bag, an additional oxygen line and a multi positional valve!

Thanks for the responses guys... I thought that looked awfully complicated.. 🙂

Oh @Aredoubleyou - VIMA = Volatile Induced and Maintained Anesthesia