AANA Journal course: update for nurse anesthetists--utilizing the Ohmeda draw-over vaporizer in the operating room.

The draw-over anesthesia system (DOAS) is a portable, lightweight, safe system for administering anesthesia in a remote or disaster situation. Unfortunately, the DOAS (which has many models worldwide) cannot be used in a modern operating room because it lacks safety monitors that are required by the Joint Commission on Accreditation of Healthcare Organizations and Harvard standards. Therefore, this article examines modifications to the DOAS to permit staff familiarization with it in a modern operating room. All anesthesia providers who have an interest or obligation in assisting in civil defense, humanitarian missions, or volunteer healthcare organizations should be aware of this anesthesia delivery system, its unique characteristics, and this suggested method of familiarization.

Airway pressure effects on the performance of the Ohmeda Universal Portable Anesthesia Complete vaporizer with push-over mechanical ventilation.

In previous studies, the use of mechanical ventilation in a push-over configuration with the Ohmeda Universal Portable Anesthesia Complete vaporizer was evaluated by bench testing and clinical application. During the clinical evaluation, it was noted that airway pressure transmitted back through the vaporizer during inspiration affected performance based on the concentration of inhalation agent delivered. This study evaluated the effects of airway pressure on vaporizer performance and established concentration curves for clinically significant incremental increases in airway pressure. Vaporizer performance was consistent, predictable, and correlated with the data obtained in previous studies.

Performance of the universal portable anesthesia complete vaporizer with mechanical ventilation in both drawover and pushover configurations.

Currently, a mechanical ventilator that can be adapted to the Universal Portable Anesthesia Complete (UPAC) vaporizer and anesthetic delivery system does not exist. The need for the anesthetist to concentrate on drug delivery and fluid resuscitation for the combat casualty in the field setting provides an expedient for the adaptation of a ventilator to the UPAC system. The purpose of this study was to determine whether the performance of the UPAC vaporizer was significantly altered when mechanical ventilation was provided in a drawover versus a pushover configuration, and to provide vaporizer performance curves for ventilatory parameters common for mechanical ventilation. The Ohio V5A and Lifecare PLV-100 ventilators were used in controlled benchwork analysis. The results of the comparison between the two ventilators indicated that there was no significant difference in vaporizer output between drawover and pushover configurations. The data indicated that vaporizer output could be reliably predicted in either mode and was correlated with tidal volume and respiratory rate.

Clinical evaluation of pushover mechanical ventilation with the Ohmeda Universal Portable Anesthesia Complete vaporizer.

Previous studies have not demonstrated the usefulness of a mechanical ventilator with the Universal Portable Anesthesia Complete (UPAC) field anesthesia delivery system in a pushover mode. This study demonstrated that the Lifecare PLV-100 ventilator can function effectively in a practical pushover configuration with the UPAC vaporizer. By comparison, vaporizer output followed the patterns of documented concentration curves for isoflurane at a given dial setting and minute ventilation. Measured airway pressures in the breathing circuit were within physiological parameters.

Gastrointestinal pharmacology review and anesthetic application to the combat casualty.

Pulmonary aspiration of gastric content remains the number one cause of anesthetic mortality. The combat casualty due to the nature of wounds inflicted is at risk for pulmonary aspiration on induction and emergence from anesthesia. The use of gastrointestinal pharmacology agents can reduce this risk significantly. Histamine-2 receptor blocking agents Cimetidine or Ranitidine in combination with metaclopramide, which enhances LES tone, facilitate management of induction and emergence in the traumatized patient.