Breathing gas

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Breathing gas
Trimix label.png
Trimix scuba cylinder label
UsesGas used for human respiration
Related items Air, Heliox, Nitrox, Oxygen, Trimix, Gas blending for scuba diving, Diving cylinder, Scuba set, Rebreather
Sailors check breathing devices at sea. Flickr - Official U.S. Navy Imagery - Sailors check breathing devices at sea..jpg
Sailors check breathing devices at sea.

A breathing gas is a mixture of gaseous chemical elements and compounds used for respiration. Air is the most common and only natural breathing gas, but other mixtures of gases, or pure oxygen, are also used in breathing equipment and enclosed habitats. Oxygen is the essential component for any breathing gas. Breathing gases for hyperbaric use have been developed to improve on the performance of ordinary air by reducing the risk of decompression sickness, reducing the duration of decompression, reducing nitrogen narcosis or allowing safer deep diving.

Contents

Description

A breathing gas is a mixture of gaseous chemical elements and compounds used for respiration. Air is the most common and only natural breathing gas. Other mixtures of gases, or pure oxygen, are also used in breathing equipment and enclosed habitats such as scuba equipment, surface supplied diving equipment, recompression chambers, high-altitude mountaineering, high-flying aircraft, submarines, space suits, spacecraft, medical life support and first aid equipment, and anaesthetic machines. [1] [2] [3]

Contents

Oxygen is the essential component for any breathing gas, at a partial pressure of between roughly 0.16 and 1.60 bar at the ambient pressure, occasionally lower for high altitude mountaineering, or higher for hyperbaric oxygen treatment. The oxygen is usually the only metabolically active component unless the gas is an anaesthetic mixture. Some of the oxygen in the breathing gas is consumed by the metabolic processes, and the inert components are unchanged, and serve mainly to dilute the oxygen to an appropriate concentration, and are therefore also known as diluent gases.

Most breathing gases therefore are a mixture of oxygen and one or more metabolically inert gases. [1] [3] Breathing gases for hyperbaric use have been developed to improve on the performance of ordinary air by reducing the risk of decompression sickness, reducing the duration of decompression, reducing nitrogen narcosis or allowing safer deep diving. [1] [3] The techniques used to fill diving cylinders with gases other than air are called gas blending. [4] [5]

Breathing gases for use at ambient pressures below normal atmospheric pressure are usually pure oxygen or air enriched with oxygen to provide sufficient oxygen to maintain life and consciousness, or to allow higher levels of exertion than would be possible using air. It is common to provide the additional oxygen as a pure gas added to the breathing air at inhalation, or though a life-support system.

For diving and other hyperbaric use

A closed bell used for saturation diving showing emergency gas supply cylinders Closed diving bell 20151203 132327.jpg
A closed bell used for saturation diving showing emergency gas supply cylinders

A safe breathing gas for hyperbaric use has four essential features:

These common diving breathing gases are used:

Commonly accepted breathing gas container colour coding in the offshore diving industry. [18]
GasSymbolTypical shoulder coloursCylinder shoulderQuad upper frame/
frame valve end
Medical oxygenO2
IMCA Oxygen shoulder.svg
WhiteWhite
Oxygen and helium mixtures
(Heliox)
O2/He IMCA Heliox shoulder quartered.svg IMCA Heliox shoulder.svg Brown and white
quarters or bands
Brown and white
short (8 inches (20 cm))
alternating bands
Oxygen, helium and nitrogen
mixtures (Trimix)
O2/He/N2 IMCA Trimix shoulder quartered.svg IMCA Trimix shoulder.svg Black, white and brown
quarters or bands
Black, white and brown
short (8 inches (20 cm))
alternating bands
Oxygen and nitrogen mixtures
(Nitrox) including air
N2/O2 IMCA Nitrox shoulder quartered.svg IMCA Nitrox shoulder.svg Black and white
quarters or bands
Black and white
short (8 inches (20 cm))
alternating bands

Breathing air

Breathing air is atmospheric air with a standard of purity suitable for human breathing in the specified application. For hyperbaric use, the partial pressure of contaminants is increased in proportion to the absolute pressure, and must be limited to a safe composition for the depth or pressure range in which it is to be used.

Classification by oxygen fraction

Breathing gases for diving are classified by oxygen fraction. The boundaries set by authorities may differ slightly, as the effects vary gradually with concentration and between people, and are not accurately predictable.[ citation needed ]

Normoxic
where the oxygen content does not differ greatly from that of air and allows continuous safe use at atmospheric pressure. [19]
Hyperoxic, or oxygen enriched
where the oxygen content exceeds atmospheric levels, generally to a level where there is some measurable physiological effect over long term use, and sometimes requiring special procedures for handling due to increased fire hazard. The associated risks are oxygen toxicity at depth and fire, particularly in the breathing apparatus.[ citation needed ]
Hypoxic
where the oxygen content is less than that of air, generally to the extent that there is a significant risk of measurable physiological effect over the short term. The immediate risk is usually hypoxic incapacitation at or near the surface. [20]

Individual component gases

Breathing gases for diving are mixed from a small number of component gases which provide special characteristics to the mixture which are not available from atmospheric air.

Oxygen

Oxygen (O2) must be present in every breathing gas. [1] [2] [3] This is because it is essential to the human body's metabolic process, which sustains life. The human body cannot store oxygen for later use as it does with food. If the body is deprived of oxygen for more than a few minutes, unconsciousness and death result. The tissues and organs within the body (notably the heart and brain) are damaged if deprived of oxygen for much longer than four minutes.

Filling a diving cylinder with pure oxygen costs around five times more than filling it with compressed air. As oxygen supports combustion and causes rust in diving cylinders, it should be handled with caution when gas blending. [4] [5]

Oxygen has historically been obtained by fractional distillation of liquid air, but is increasingly obtained by non-cryogenic technologies such as pressure swing adsorption (PSA) and vacuum swing adsorption (VSA) technologies. [21]

The fraction of the oxygen component of a breathing gas mixture is sometimes used when naming the mix:

  • hypoxic mixes, strictly, contain less than 21% oxygen, although often a boundary of 16% is used, and are designed only to be breathed at depth as a "bottom gas" where the higher pressure increases the partial pressure of oxygen to a safe level. [1] [2] [3] Trimix, Heliox and Heliair are gas blends commonly used for hypoxic mixes and are used in professional and technical diving as deep breathing gases. [1] [3] A minimum operating depth may be assigned to a hypoxic gas mixture, based on the depth at which the partial pressure is equal to the minimum oxygen partial pressure acceptable to the person or organisation using the gas.
  • normoxic mixes have the same proportion of oxygen as air, 21%. [1] [3] The maximum operating depth of a normoxic mix could be as shallow as 47 metres (154 feet). Trimix with between 17% and 21% oxygen is often described as normoxic because it contains a high enough proportion of oxygen to be safe to breathe at the surface.
  • hyperoxic mixes have more than 21% oxygen. Enriched Air Nitrox (EANx) is a typical hyperoxic breathing gas. [1] [3] [10] Hyperoxic mixtures, when compared to air, cause oxygen toxicity at shallower depths but can be used to shorten decompression stops by drawing dissolved inert gases out of the body more quickly. [7] [10]

The fraction of the oxygen determines the greatest depth at which the mixture can safely be used to avoid oxygen toxicity. This depth is called the maximum operating depth. [1] [3] [7] [10]

The concentration of oxygen in a gas mix depends on the fraction and the pressure of the mixture. It is expressed by the partial pressure of oxygen (PO2). [1] [3] [7] [10]

The partial pressure of any component gas in a mixture is calculated as:

partial pressure = total absolute pressure × volume fraction of gas component

For the oxygen component,

PO2 = P × FO2

where:

PO2 = partial pressure of oxygen
P = total pressure
FO2 = volume fraction of oxygen content

The minimum safe partial pressure of oxygen in a breathing gas is commonly held to be 16  kPa (0.16 bar). Below this partial pressure the diver may be at risk of unconsciousness and death due to hypoxia, depending on factors including individual physiology and level of exertion. When a hypoxic mix is breathed in shallow water it may not have a high enough PO2 to keep the diver conscious. For this reason normoxic or hyperoxic "travel gases" are used at medium depth between the "bottom" and "decompression" phases of the dive.

The maximum safe PO2 in a breathing gas depends on exposure time, the level of exercise and the security of the breathing equipment being used. It is typically between 100 kPa (1 bar) and 160 kPa (1.6 bar); for dives of less than three hours it is commonly considered to be 140 kPa (1.4 bar), although the U.S. Navy has been known to authorize dives with a PO2 of as much as 180 kPa (1.8 bar). [1] [2] [3] [7] [10] At high PO2 or longer exposures, the diver risks oxygen toxicity which may result in a seizure. [1] [2] Each breathing gas has a maximum operating depth that is determined by its oxygen content. [1] [2] [3] [7] [10] For therapeutic recompression and hyperbaric oxygen therapy partial pressures of 2.8 bar are commonly used in the chamber, but there is no risk of drowning if the occupant loses consciousness. [2] For longer periods such as in saturation diving, 0.4 bar can be tolerated over several weeks.

Oxygen analysers are used to measure the oxygen partial pressure in the gas mix. [4]

Divox is breathing grade oxygen labelled for diving use. In the Netherlands, pure oxygen for breathing purposes is regarded as medicinal as opposed to industrial oxygen, such as that used in welding, and is only available on medical prescription. The diving industry registered Divox as a trademark for breathing grade oxygen to circumvent the strict rules concerning medicinal oxygen thus making it easier for (recreational) scuba divers to obtain oxygen for blending their breathing gas. In most countries, there is no difference in purity in medical oxygen and industrial oxygen, as they are produced by exactly the same methods and manufacturers, but labeled and filled differently. The chief difference between them is that the record-keeping trail is much more extensive for medical oxygen, to more easily identify the exact manufacturing trail of a "lot" or batch of oxygen, in case problems with its purity are discovered. Aviation grade oxygen is similar to medical oxygen, but may have a lower moisture content. [4]

Diluent gases

Gases which have no metabolic function in the breathing gas are used to dilute the gas, and are therefore classed as diluent gases. Some of them have a reversible narcotic effect at high partial pressure, and must therefore be limited to avoid excessive narcotic effects at the maximum pressure at which they are intended to be breathed. Diluent gases also affect the density of the gas mixture and thereby the work of breathing.

Nitrogen

Nitrogen (N2) is a diatomic gas and the main component of air, the cheapest and most common breathing gas used for diving. It causes nitrogen narcosis in the diver, so its use is limited to shallower dives. Nitrogen can cause decompression sickness. [1] [2] [3] [22]

Equivalent air depth is used to estimate the decompression requirements of a nitrox (oxygen/nitrogen) mixture. Equivalent narcotic depth is used to estimate the narcotic potency of trimix (oxygen/helium/nitrogen mixture). Many divers find that the level of narcosis caused by a 30 m (100 ft) dive, whilst breathing air, is a comfortable maximum. [1] [2] [3] [23] [24]

Nitrogen in a gas mix is almost always obtained by adding air to the mix.

Helium
2% Heliox storage quad. 2% oxygen by volume is sufficient at pressures exceeding 90 msw. Helium Quad 20151203 133932.jpg
2% Heliox storage quad. 2% oxygen by volume is sufficient at pressures exceeding 90  msw.

Helium (He) is an inert gas that is less narcotic than nitrogen at equivalent pressure (in fact there is no evidence for any narcosis from helium at all), and it has a much lower density, so it is more suitable for deeper dives than nitrogen. [1] [3] Helium is equally able to cause decompression sickness. At high pressures, helium also causes high-pressure nervous syndrome, which is a central nervous system irritation syndrome which is in some ways opposite to narcosis. [1] [2] [3] [25]

Helium mixture fills are considerably more expensive than air fills due to the cost of helium and the cost of mixing and compressing the mix.[ citation needed ]

Helium is not suitable for dry suit inflation owing to its poor thermal insulation properties – compared to air, which is regarded as a reasonable insulator, helium has six times the thermal conductivity. [26] Helium's low molecular weight (monatomic MW=4, compared with diatomic nitrogen MW=28) increases the timbre of the breather's voice, which may impede communication. [1] [3] [27] This is because the speed of sound is faster in a lower molecular weight gas, which increases the resonance frequency of the vocal cords. [1] [27] Helium leaks from damaged or faulty valves more readily than other gases because atoms of helium are smaller allowing them to pass through smaller gaps in seals.

Helium is found in significant amounts only in natural gas, from which it is extracted at low temperatures by fractional distillation.

Neon

Neon (Ne) is an inert gas sometimes used in deep commercial diving but is very expensive. [1] [3] [11] [17] Like helium, it is less narcotic than nitrogen, but unlike helium, it does not distort the diver's voice. Compared to helium, neon has superior thermal insulating properties. [28]

Hydrogen

Hydrogen (H2) has been used in deep diving gas mixes but is very explosive when mixed with more than about 4 to 5% oxygen (such as the oxygen found in breathing gas). [1] [3] [11] [14] This limits use of hydrogen to deep dives and imposes complicated protocols to ensure that excess oxygen is cleared from the breathing equipment before breathing hydrogen starts. Like helium, it raises the timbre of the diver's voice. The hydrogen-oxygen mix when used as a diving gas is sometimes referred to as Hydrox. Mixtures containing both hydrogen and helium as diluents are termed Hydreliox.

Unwelcome components of breathing gases for diving

Many gases are not suitable for use in diving breathing gases. [5] [29] Here is an incomplete list of gases commonly present in a diving environment:

Argon

Argon (Ar) is an inert gas that is more narcotic than nitrogen, so is not generally suitable as a diving breathing gas. [30] Argox is used for decompression research. [1] [3] [31] [32] It is sometimes used for dry suit inflation by divers whose primary breathing gas is helium-based, because of argon's good thermal insulation properties. Argon is more expensive than air or oxygen, but considerably less expensive than helium. Argon is a component of natural air, and constitutes 0.934% by volume of the Earth's atmosphere. [33]

Carbon dioxide

Carbon dioxide (CO2) is produced by the metabolism in the human body and can cause carbon dioxide poisoning. [29] [34] [35] When breathing gas is recycled in a rebreather or life support system, the carbon dioxide is removed by scrubbers before the gas is re-used.

Carbon monoxide

Carbon monoxide (CO) is a highly toxic gas that competes with dioxygen for binding to hemoglobin, thereby preventing the blood from carrying oxygen (see carbon monoxide poisoning). It is typically produced by incomplete combustion. [1] [2] [5] [29] Four common sources are:

  • Internal combustion engine exhaust gas containing CO in the air being drawn into a diving air compressor. CO in the intake air cannot be stopped by any filter. The exhausts of all internal combustion engines running on petroleum fuels contain some CO, and this is a particular problem on boats, where the intake of the compressor cannot be arbitrarily moved as far as desired from the engine and compressor exhausts.
  • Heating of lubricants inside the compressor may vaporize them sufficiently to be available to a compressor intake or intake system line.
  • In some cases hydrocarbon lubricating oil may be drawn into the compressor's cylinder directly through damaged or worn seals, and the oil may (and usually will) then undergo combustion, being ignited by the immense compression ratio and subsequent temperature rise. Since heavy oils don't burn well – especially when not atomized properly – incomplete combustion will result in carbon monoxide production.
  • A similar process is thought[ by whom? ][ original research? ] to potentially happen to any particulate material, which contains "organic" (carbon-containing) matter, especially in cylinders which are used for hyperoxic gas mixtures. If the compressor air filter(s) fail, ordinary dust will be introduced to the cylinder, which contains organic matter (since it usually contains humus). A more severe danger is that air particulates on boats and industrial areas, where cylinders are filled, often contain carbon-particulate combustion products (these are what makes a dirt rag black), and these represent a more severe CO danger when introduced into a cylinder.[ citation needed ]

Carbon monoxide is generally avoided as far as is reasonably practicable by positioning of the air intake in uncontaminated air, filtration of particulates from the intake air, use of suitable compressor design and appropriate lubricants, and ensuring that running temperatures are not excessive. Where the residual risk is excessive, a hopcalite catalyst can be used in the high pressure filter to convert carbon monoxide into carbon dioxide, which is far less toxic.

Hydrocarbons

Hydrocarbons (CxHy) are present in compressor lubricants and fuels. They can enter diving cylinders as a result of contamination, leaks,[ clarification needed ] or due to incomplete combustion near the air intake. [2] [4] [5] [29] [36]

  • They can act as a fuel in combustion increasing the risk of explosion, especially in high-oxygen gas mixtures.
  • Inhaling oil mist can damage the lungs and ultimately cause the lungs to degenerate with severe lipid pneumonia [37] or emphysema.

Moisture content

The process of compressing gas into a diving cylinder removes moisture from the gas. [5] [29] This is good for corrosion prevention in the cylinder but means that the diver inhales very dry gas. The dry gas extracts moisture from the diver's lungs while underwater contributing to dehydration, which is also thought to be a predisposing risk factor of decompression sickness. It is also uncomfortable, causing a dry mouth and throat and making the diver thirsty. This problem is reduced in rebreathers because the soda lime reaction, which removes carbon dioxide, also puts moisture back into the breathing gas, [9] and the relative humidity and temperature of exhaled gas is relatively high and there is a cumulative effect due to rebreathing. [38] In hot climates, open circuit diving can accelerate heat exhaustion because of dehydration. Another concern with regard to moisture content is the tendency of moisture to condense as the gas is decompressed while passing through the regulator; this coupled with the extreme reduction in temperature, also due to the decompression, can cause the moisture to solidify as ice. This icing up in a regulator can cause moving parts to seize and the regulator to fail or free flow. This is one of the reasons that scuba regulators are generally constructed from brass, and chrome plated (for protection). Brass, with its good thermal conductive properties, quickly conducts heat from the surrounding water to the cold, newly decompressed air, helping to prevent icing up.

Gas analysis

Electro-galvanic fuel cell as used in a diving rebreather Electro-galvanic fuel cell.jpg
Electro-galvanic fuel cell as used in a diving rebreather

Gas mixtures must generally be analysed either in process or after blending for quality control. This is particularly important for breathing gas mixtures where errors can affect the health and safety of the end user. It is difficult to detect most gases that are likely to be present in diving cylinders because they are colourless, odourless and tasteless. Electronic sensors exist for some gases, such as oxygen analysers, helium analyser, carbon monoxide detectors and carbon dioxide detectors. [2] [4] [5] Oxygen analysers are commonly found underwater in rebreathers. [9] Oxygen and helium analysers are often used on the surface during gas blending to determine the percentage of oxygen or helium in a breathing gas mix. [4] Chemical and other types of gas detection methods are not often used in recreational diving, but are used for periodic quality testing of compressed breathing air from diving air compressors. [4]

Breathing gas standards

Standards for breathing gas quality are published by national and international organisations, and may be enforced in terms of legislation. In the UK, the Health and Safety Executive indicate that the requirements for breathing gases for divers are based on the BS EN 12021:2014. The specifications are listed for oxygen compatible air, nitrox mixtures produced by adding oxygen, removing nitrogen, or mixing nitrogen and oxygen, mixtures of helium and oxygen (heliox), mixtures of helium, nitrogen and oxygen (trimix), and pure oxygen, for both open circuit and reclaim systems, and for high pressure and low pressure supply (above and below 40 bar supply). [39]

Oxygen content is variable depending on the operating depth, but the tolerance depends on the gas fraction range, being ±0.25% for an oxygen fraction below 10% by volume, ±0.5% for a fraction between 10% and 20%, and ±1% for a fraction over 20%. [39]

Water content is limited by risks of icing of control valves, and corrosion of containment surfaces – higher humidity is not a physiological problem – and is generally a factor of dew point. [39]

Other specified contaminants are carbon dioxide, carbon monoxide, oil, and volatile hydrocarbons, which are limited by toxic effects. Other possible contaminants should be analysed based on risk assessment, and the required frequency of testing for contaminants is also based on risk assessment. [39]

In Australia breathing air quality is specified by Australian Standard 2299.1, Section 3.13 Breathing Gas Quality. [40]

Diving gas blending

Air, oxygen and helium partial pressure gas blending system Gas blending equipment.JPG
Air, oxygen and helium partial pressure gas blending system
Nitrox continuous blending compressor installation Nitrox continuous blending compressor installation P8160005.jpg
Nitrox continuous blending compressor installation

Gas blending (or gas mixing) of breathing gases for diving is the filling of gas cylinders with non-air breathing gases.

Filling cylinders with a mixture of gases has dangers for both the filler and the diver. During filling there is a risk of fire due to use of oxygen and a risk of explosion due to the use of high-pressure gases. The composition of the mix must be safe for the depth and duration of the planned dive. If the concentration of oxygen is too lean the diver may lose consciousness due to hypoxia and if it is too rich the diver may develop oxygen toxicity. The concentration of inert gases, such as nitrogen and helium, are planned and checked to avoid nitrogen narcosis and decompression sickness.

Methods used include batch mixing by partial pressure or by mass fraction, and continuous blending processes. Completed blends are analysed for composition for the safety of the user. Gas blenders may be required by legislation to prove competence if filling for other persons.

Density

Excessive density of a breathing gas can raise the work of breathing to intolerable levels, and can cause carbon dioxide retention at lower densities. [6] Helium is used as a component to reduce density as well as to reduce narcosis at depth. Like partial pressure, density of a mixture of gases is in proportion to the volumetric fraction of the component gases, and absolute pressure. The ideal gas laws are adequately precise for gases at respirable pressures.

The density of a gas mixture at a given temperature and pressure can be calculated as:

ρm = (ρ1 V1 + ρ2 V2 + .. + ρn Vn) / (V1 + V2 + ... + Vn)

where

ρm = density of the gas mixture
ρ1 ... ρn = density of each of the components
V1 ... Vn = partial volume of each of the component gases [41]

Since gas fraction Fi (volumetric fraction) of each gas can be expressed as Vi / (V1 + V2 + ... + Vn )

by substitution,

ρm = (ρ1 F1 + ρ2 F2 + .. + ρn Fn)

Hypobaric breathing gases

Astronaut in an Orlan space suit, outside the International Space Station Iss009e29620.jpg
Astronaut in an Orlan space suit, outside the International Space Station

Breathing gases for use at reduced ambient pressure are used for high altitude flight in unpressurised aircraft, in space flight, particularly in space suits, and for high altitude mountaineering. In all these cases, the primary consideration is providing an adequate partial pressure of oxygen. In some cases the breathing gas has oxygen added to make up a sufficient concentration, and in other cases the breathing gas may be pure or nearly pure oxygen. Closed circuit systems may be used to conserve the breathing gas, which may be in limited supply – in the case of mountaineering the user must carry the supplemental oxygen, and in space flight the cost of lifting mass into orbit is very high.

Medical breathing gases

Medical use of breathing gases other than air include oxygen therapy and anesthesia applications.

Oxygen therapy

A person wearing a simple face mask for oxygen therapy Simple face mask.jpg
A person wearing a simple face mask for oxygen therapy

Oxygen is required by people for normal cell metabolism. [42] Air is typically 21% oxygen by volume. [43] This is normally sufficient, but in some circumstances the oxygen supply to tissues is compromised.

Oxygen therapy, also known as supplemental oxygen, is the use of oxygen as a medical treatment. [44] This can include for low blood oxygen, carbon monoxide toxicity, cluster headaches, and to maintain enough oxygen while inhaled anesthetics are given. [45] Long term oxygen is often useful in people with chronically low oxygen such as from severe COPD or cystic fibrosis. [46] [44] Oxygen can be given in a number of ways including nasal cannula, face mask, and inside a hyperbaric chamber. [47] [48]

High concentrations of oxygen can cause oxygen toxicity such as lung damage or result in respiratory failure in those who are predisposed. [45] [43] It can also dry out the nose and increase the risk of fires in those who smoke. The target oxygen saturation recommended depends on the condition being treated. In most conditions a saturation of 94-98% is recommended, while in those at risk of carbon dioxide retention saturations of 88-92% are preferred, and in those with carbon monoxide toxicity or cardiac arrest the saturation should be as high as possible. [44]

The use of oxygen in medicine become common around 1917. [49] [50] It is on the World Health Organization's List of Essential Medicines. [51] [52] The cost of home oxygen is about US$150 a month in Brazil and US$400 a month in the United States. [46] Home oxygen can be provided either by oxygen tanks or an oxygen concentrator. [44] Oxygen is believed to be the most common treatment given in hospitals in the developed world. [53] [44]

Anaesthetic gases

A vaporizer holds a liquid anesthetic and converts it to gas for inhalation (in this case sevoflurane) Vaporizer Sevoflurane 001 JPN.jpg
A vaporizer holds a liquid anesthetic and converts it to gas for inhalation (in this case sevoflurane)
An anaesthetic machine. Maquet Flow-I anesthesia machine.jpg
An anaesthetic machine.
Bottles of sevoflurane, isoflurane, enflurane, and desflurane, the common fluorinated ether anaesthetics used in clinical practice. These agents are colour-coded for safety purposes. Note the special fitting for desflurane, which boils at room temperature. Fluranebottles.jpg
Bottles of sevoflurane, isoflurane, enflurane, and desflurane, the common fluorinated ether anaesthetics used in clinical practice. These agents are colour-coded for safety purposes. Note the special fitting for desflurane, which boils at room temperature.

The most common approach to general anaesthesia is through the use of inhaled general anesthetics. Each has its own potency which is correlated to its solubility in oil. This relationship exists because the drugs bind directly to cavities in proteins of the central nervous system,[ clarification needed ] although several theories of general anaesthetic action have been described. Inhalational anesthetics are thought to exact their effects on different parts of the central nervous system. For instance, the immobilizing effect of inhaled anesthetics results from an effect on the spinal cord whereas sedation, hypnosis and amnesia involve sites in the brain. [54] :515

An inhalational anaesthetic is a chemical compound possessing general anaesthetic properties that can be delivered via inhalation. Agents of significant contemporary clinical interest include volatile anaesthetic agents such as isoflurane, sevoflurane and desflurane, and anaesthetic gases such as nitrous oxide and xenon.

Administration

Anaesthetic gases are administered by anaesthetists (a term which includes anaesthesiologists, nurse anaesthetists, and anaesthesiologist assistants) through an anaesthesia mask, laryngeal mask airway or tracheal tube connected to an anaesthetic vaporiser and an anaesthetic delivery system. The anaesthetic machine (UK English) or anesthesia machine (US English) or Boyle's machine is used to support the administration of anaesthesia. The most common type of anaesthetic machine in use in the developed world is the continuous-flow anaesthetic machine, which is designed to provide an accurate and continuous supply of medical gases (such as oxygen and nitrous oxide), mixed with an accurate concentration of anaesthetic vapour (such as isoflurane), and deliver this to the patient at a safe pressure and flow. Modern machines incorporate a ventilator, suction unit, and patient monitoring devices. Exhaled gas is passed through a scrubber to remove carbon dioxide, and the anaesthetic vapour and oxygen are replenished as required before the mixture is returned to the patient.[ citation needed ]

See also

Related Research Articles

Nitrox refers to any gas mixture composed of nitrogen and oxygen. This includes atmospheric air, which is approximately 78% nitrogen, 21% oxygen, and 1% other gases, primarily argon. In the usual application, underwater diving, nitrox is normally distinguished from air and handled differently. The most common use of nitrox mixtures containing oxygen in higher proportions than atmospheric air is in scuba diving, where the reduced partial pressure of nitrogen is advantageous in reducing nitrogen uptake in the body's tissues, thereby extending the practicable underwater dive time by reducing the decompression requirement, or reducing the risk of decompression sickness.

<span class="mw-page-title-main">Nitrogen narcosis</span> Reversible narcotic effects of respiratory nitrogen at elevated partial pressures

Narcosis while diving is a reversible alteration in consciousness that occurs while diving at depth. It is caused by the anesthetic effect of certain gases at high partial pressure. The Greek word νάρκωσις (narkōsis), "the act of making numb", is derived from νάρκη (narkē), "numbness, torpor", a term used by Homer and Hippocrates. Narcosis produces a state similar to drunkenness, or nitrous oxide inhalation. It can occur during shallow dives, but does not usually become noticeable at depths less than 30 metres (98 ft).

<span class="mw-page-title-main">Trimix (breathing gas)</span> Breathing gas consisting of oxygen, helium and nitrogen

Trimix is a breathing gas consisting of oxygen, helium and nitrogen and is used in deep commercial diving, during the deep phase of dives carried out using technical diving techniques, and in advanced recreational diving.

<span class="mw-page-title-main">Technical diving</span> Extended scope recreational diving

Technical diving is scuba diving that exceeds the agency-specified limits of recreational diving for non-professional purposes. Technical diving may expose the diver to hazards beyond those normally associated with recreational diving, and to a greater risk of serious injury or death. Risk may be reduced via appropriate skills, knowledge, and experience. Risk can also be managed by using suitable equipment and procedures. The skills may be developed through specialized training and experience. The equipment involves breathing gases other than air or standard nitrox mixtures, and multiple gas sources.

<span class="mw-page-title-main">Oxygen toxicity</span> Toxic effects of breathing oxygen at high partial pressures

Oxygen toxicity is a condition resulting from the harmful effects of breathing molecular oxygen at increased partial pressures. Severe cases can result in cell damage and death, with effects most often seen in the central nervous system, lungs, and eyes. Historically, the central nervous system condition was called the Paul Bert effect, and the pulmonary condition the Lorrain Smith effect, after the researchers who pioneered the discoveries and descriptions in the late 19th century. Oxygen toxicity is a concern for underwater divers, those on high concentrations of supplemental oxygen, and those undergoing hyperbaric oxygen therapy.

<span class="mw-page-title-main">Saturation diving</span> Diving decompression technique

Saturation diving is diving for periods long enough to bring all tissues into equilibrium with the partial pressures of the inert components of the breathing gas used. It is a diving mode that reduces the number of decompressions divers working at great depths must undergo by only decompressing divers once at the end of the diving operation, which may last days to weeks, having them remain under pressure for the whole period. A diver breathing pressurized gas accumulates dissolved inert gas used in the breathing mixture to dilute the oxygen to a non-toxic level in the tissues, which can cause potentially fatal decompression sickness if permitted to come out of solution within the body tissues; hence, returning to the surface safely requires lengthy decompression so that the inert gases can be eliminated via the lungs. Once the dissolved gases in a diver's tissues reach the saturation point, however, decompression time does not increase with further exposure, as no more inert gas is accumulated.

<span class="mw-page-title-main">Gas blending for scuba diving</span> Mixing and filling cylinders with breathing gases for use when scuba diving

Gas blending for scuba diving is the filling of diving cylinders with non-air breathing gases such as nitrox, trimix and heliox. Use of these gases is generally intended to improve overall safety of the planned dive, by reducing the risk of decompression sickness and/or nitrogen narcosis, and may improve ease of breathing.

Diving disorders, or diving related medical conditions, are conditions associated with underwater diving, and include both conditions unique to underwater diving, and those that also occur during other activities. This second group further divides conditions caused by exposure to ambient pressures significantly different from surface atmospheric pressure, and a range of conditions caused by general environment and equipment associated with diving activities.

Argox is the informal name for a scuba diving breathing gas consisting of argon and oxygen. Occasionally the term argonox has been used to mean the same mix. The blend may consist of varying fractions of argon and oxygen, depending on its intended use. The mixture is made with the same gas blending techniques used to make nitrox, except that for argox, the argon is added to the initial pure oxygen partial-fill, instead of air.

In physiology, isobaric counterdiffusion (ICD) is the diffusion of different gases into and out of tissues while under a constant ambient pressure, after a change of gas composition, and the physiological effects of this phenomenon. The term inert gas counterdiffusion is sometimes used as a synonym, but can also be applied to situations where the ambient pressure changes. It has relevance in mixed gas diving and anesthesiology.

Equivalent narcotic depth (END) (historically also equivalent nitrogen depth) is used in technical diving as a way of estimating the narcotic effect of a breathing gas mixture, such as nitrox, heliox or trimix. The method is used, for a given breathing gas mix and dive depth, to calculate the equivalent depth which would produce about the same narcotic effect when breathing air.

<span class="mw-page-title-main">Scuba gas planning</span> Estimation of breathing gas mixtures and quantities required for a planned dive profile

Scuba gas planning is the aspect of dive planning and of gas management which deals with the calculation or estimation of the amounts and mixtures of gases to be used for a planned dive. It may assume that the dive profile, including decompression, is known, but the process may be iterative, involving changes to the dive profile as a consequence of the gas requirement calculation, or changes to the gas mixtures chosen. Use of calculated reserves based on planned dive profile and estimated gas consumption rates rather than an arbitrary pressure is sometimes referred to as rock bottom gas management. The purpose of gas planning is to ensure that for all reasonably foreseeable contingencies, the divers of a team have sufficient breathing gas to safely return to a place where more breathing gas is available. In almost all cases this will be the surface.

<span class="mw-page-title-main">Scuba gas management</span> Logistical aspects of scuba breathing gas

Scuba gas management is the aspect of scuba diving which includes the gas planning, blending, filling, analysing, marking, storage, and transportation of gas cylinders for a dive, the monitoring and switching of breathing gases during a dive, efficient and correct use of the gas, and the provision of emergency gas to another member of the dive team. The primary aim is to ensure that everyone has enough to breathe of a gas suitable for the current depth at all times, and is aware of the gas mixture in use and its effect on decompression obligations, nitrogen narcosis, and oxygen toxicity risk. Some of these functions may be delegated to others, such as the filling of cylinders, or transportation to the dive site, but others are the direct responsibility of the diver using the gas.

Gas blending is the process of mixing gases for a specific purpose where the composition of the resulting mixture is specified and controlled. A wide range of applications include scientific and industrial processes, food production and storage and breathing gases.

<span class="mw-page-title-main">Physiology of decompression</span> The physiological basis for decompression theory and practice

The physiology of decompression is the aspect of physiology which is affected by exposure to large changes in ambient pressure. It involves a complex interaction of gas solubility, partial pressures and concentration gradients, diffusion, bulk transport and bubble mechanics in living tissues. Gas is breathed at ambient pressure, and some of this gas dissolves into the blood and other fluids. Inert gas continues to be taken up until the gas dissolved in the tissues is in a state of equilibrium with the gas in the lungs, or the ambient pressure is reduced until the inert gases dissolved in the tissues are at a higher concentration than the equilibrium state, and start diffusing out again.

Human physiology of underwater diving is the physiological influences of the underwater environment on the human diver, and adaptations to operating underwater, both during breath-hold dives and while breathing at ambient pressure from a suitable breathing gas supply. It, therefore, includes the range of physiological effects generally limited to human ambient pressure divers either freediving or using underwater breathing apparatus. Several factors influence the diver, including immersion, exposure to the water, the limitations of breath-hold endurance, variations in ambient pressure, the effects of breathing gases at raised ambient pressure, effects caused by the use of breathing apparatus, and sensory impairment. All of these may affect diver performance and safety.

Diving support equipment is the equipment used to facilitate a diving operation. It is either not taken into the water during the dive, such as the gas panel and compressor, or is not integral to the actual diving, being there to make the dive easier or safer, such as a surface decompression chamber. Some equipment, like a diving stage, is not easily categorised as diving or support equipment, and may be considered as either.

<span class="mw-page-title-main">Diving rebreather</span> Closed or semi-closed circuit scuba

A Diving rebreather is an underwater breathing apparatus that absorbs the carbon dioxide of a diver's exhaled breath to permit the rebreathing (recycling) of the substantially unused oxygen content, and unused inert content when present, of each breath. Oxygen is added to replenish the amount metabolised by the diver. This differs from open-circuit breathing apparatus, where the exhaled gas is discharged directly into the environment. The purpose is to extend the breathing endurance of a limited gas supply, and, for covert military use by frogmen or observation of underwater life, to eliminate the bubbles produced by an open circuit system. A diving rebreather is generally understood to be a portable unit carried by the user, and is therefore a type of self-contained underwater breathing apparatus (scuba). A semi-closed rebreather carried by the diver may also be known as a gas extender. The same technology on a submersible or surface installation is more likely to be referred to as a life-support system.

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