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Connecting a reservoir to the intake valve helps prevent the entrainment of room air. The bag is refilled by flow through the fresh gas inlet and across the intake valve. This valve closes during bag compression, permitting positive-pressure ventilation. The compressible, self-refilling ventilation bag also contains an intake valve. Rebreathing is prevented by venting exhaled gas to the atmosphere through exhalation ports in this valve. The patient valve opens during controlled or spontaneous inspiration to allow gas flow from the ventilation bag to the patient. High concentrations of oxygen can be delivered to a mask or tracheal tube during spontaneous or controlled ventilation if a source of high fresh gas flow is connected to the inlet nipple. Bag compression during controlled ventilation will vent expired gas through the APL valve, conserving absorbent.

Resistance to exhalation is decreased by locating the reservoir bag in the expiratory limb.

Positioning of the APL valve in this location (ie, before the absorber) helps to conserve absorption capacity and minimizes the venting of fresh gas.

The APL valve is usually placed between the absorber and the expiratory valve and close to the reservoir bag.

Furthermore, inhalation anesthetics may be absorbed or released by soda lime granules, thus slowing induction and emergence. Fresh gas introduced between the expiratory valve and the absorber would be diluted by recirculating gas. Positioning it downstream from the inspiratory valve would allow fresh gas to bypass the patient during exhalation and be wasted.

The fresh gas inlet is placed between the absorber and the inspiratory valve.

However, unidirectional valves are not placed in the Y-piece, as that makes it difficult to confirm proper orientation and intraoperative function.

Unidirectional valves are relatively close to the patient to prevent backflow into the inspiratory limb if a circuit leak develops.

Newer absorbers are used until CO 2 is found in the inhaled gas on the anesthetic-gas monitor, at which time the canister(s) are replaced. A trap at the base of the absorber collects dust and moisture. Channeling through areas of loosely packed granules is minimized by a baffle system, which directs gas flow through the center, thereby allowing greater utilization of the absorbent. Absorbent exhaustion typically occurs first where exhaled gas enters the absorber and along the canister’s smooth inner walls. Indicator dye color is monitored through the absorber’s transparent walls. To ensure complete absorption, a patient’s tidal volume should not exceed the air space between absorbent granules, which is roughly equal to 50% of the absorber’s capacity. Although bulky, double canisters permit more complete CO 2 absorption, less frequent absorbent changes, and lower gas flow resistance.

Together, this unit is called an absorber (Figure 3-9). The granules of absorbent are contained within one or two canisters that fit snugly between a head and base plate. Commercial soda lime has a water content of 14% to 19%. Additional water is added to absorbent during packaging to provide optimal conditions for carbonic acid formation. 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.

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The hydroxide salts are irritating to the skin and mucous membranes. The granules commonly used as CO 2 absorbent are between 4 and 8 mesh the number of mesh corresponds to the number of holes per square inch of a screen. Granule size is a compromise between the higher absorptive surface area of small granules and the lower resistance to gas flow of larger granules. Although exhausted granules may revert to their original color if rested, no significant recovery of absorptive capacity occurs. Absorbent should be replaced when 50% to 70% has changed color. A pH indicator dye (eg, ethyl violet) changes color from white to purple as a consequence of increasing hydrogen ion concentration and absorbent exhaustion (Table 3-5).