VOC RotaFlush Anaesthetic Unit Operating Manual by DLC AUSTRALIA PTY LTD

Trolley Model

Wall Mount

Contact Details Melbourne Office 17-19 Horne St, Hoppers Crossing, VIC, 3029 Ph. 03 9360 9700 Fax. 03 9360 9994 Toll Free. 1300 785 405 E. info@dlc.com.au

Queensland Office Unit 6/1 Lear-Jet Dr, Caboolture, QLD, 4510 Ph. 07 5428 3666 Fax. 07 5428 3777 Toll Free. 1300 785 401 E. qld@dlc.com.au

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Manual — VOC RotaFlush

FEATURES of the KOMESAROFF ROTA FLUSH™ SMALL ANIMAL ANAESTHETIC MACHINE TROLLEY MODEL (AN-VOC-RFTR) WALL MOUNT MODEL (AN-VOC-RFWM)

KAB™ Circular Carbon Dioxide Absorber. 4 Registered Designs. USA Patent No. 5,666,669. USA 510k. AUST L 44952. Unique APL exhaust valve. Tough cylindrical polycarbonate construction. Autoclavable. Easier filling. Asymmetrical divider and fluted grate holes minimizes 'channeling'. Carbon dioxide is absorbed in two cycles: during expiration as the expired gases are directed to the breathing bag and again during inspiration: together with the minimal channeling this provides greater efficiency of carbon dioxide absorption. 400g of soda lime has a life in excess of 6 hours at low flows in small animals. *NOTE: Soda Lime 1Kg pack

ith 400g capacity filler and adapter supplied

RotaFlush™ FLOWMETER Provides accurately metered oxygen flows between 0-4L/min and incorporates an OXYGEN FLUSH to rapidly inflate the breathing bag when required. NOTE: When the OXYGEN BYPASS is operated, the oxygen enters the circuit distal to the vaporizer.

Stainless steel base with mounting slots for an out-of-circuit vaporizer

23mm Taper Fittings for out-of-circuit vaporizer

OUT-OF-CIRCUIT VAPORIZER (optional)

Breath-Alert™ Breathing Monitor (BMMK4)

Pulse-Alert™ pulse monitor (Optional)

Venturi Suction System (Optional)

Pressure Relief Valve with manual override (Optional)

10.

2 litre and 1/2 litre re-breathing bags

11.

Washington T-Piece circuit

12.

Universal `F’ Hose in Hose' breathing circuit (2)

13.

'Smoothbore' twin hose and Y-piece assembly (Optional)

14.

Wall Mount Assembly (Powder coated white)

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Manual - VOC RotaFlush

KOMESAROFF VOC ROTAFLUSH™ ANAESTHETIC MACHINE TABLE OF CONTENTS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

INTRODUCTION ..................................................................................... FEATURES ............................................................................................. ASSEMBLY ............................................................................................. OPERATING INSTRUCTIONS ............................................................... NOTES .................................................................................................... BREATH-ALERT™MK4 Breathing Monitor ............................................. OXI-vac™ SUCTION SYSTEM (Optional) ............................................. PULSE-ALERT™ Pulse Monitor (Optional) ........................................... TROLLEY ............................................................................................ MAINTENANCE ...................................................................................... PRECAUTIONS ...................................................................................... SPECIFICATIONS …………………………………………………………… ………. WEEKLY TEST PROCEDURE ............................................................... REFERENCES........................................................................................ GUARANTEE .....................................................................................

2 2 4 5 6 7 7 7 7 7 8 8 8 8 10

APPENDICES 1 2 3 4 5 6 7

Washington T Assembly ...................................................................... Breath-Alert™ Mark 4 Breathing Monitor ................................................ Trolley Cylinder Support (Optional) Assembly Instructions .................... Packlist ..................................................................................................... Brief Operating Instructions ...................................................................... Komesaroff Voc Rotaflush™ Small Animal Anaesthetic Machines .......... Komesaroff Veterinary Anaesthetic Machines ........................................

11 12 17 18 19 20 21

INSERTS "A New Method of Closed Circuit Anaesthesia Utilising Halothane and Methoxyflurane" "Low Flow Anaesthesia — An Australian Devotee's Perspective" KAB ™ Circular CO2 Absorber Universal 'F' Circuit Clare Ventilator

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1. INTRODUCTION The Komesaroff ROTA FLUSH™ Anaesthetic Machine is a conventional anaesthetic machine with an out-of-circuit vaporizer. A metered flow of oxygen passes through a precision vaporizer situated out-of-circuit (VOC). A known concentration of volatile agent is introduced into the patient's circuit. However, because of mixing with expired gases and an unknown amount exhausted into the atmosphere, the concentration in the inspiratory limb is less. Capital and running costs are higher than closed circuit systems (VIC) and a scavenging system should be used to avoid pollution.

Manual - VOC RotaFlush

Baum published a detailed paper on low flow anaesthesia in 19954 and a text 'Low Flow Anaesthesia' by Baum & Nunn was published in 20015. Several international symposia have been held. In April 1996 a section of the 5th World Congress on Anaesthesia was devoted to low flow and closed circuit anaesthesia6. SEE REFERENCES 1. Reference 9 2. Reference 14 3. Reference 15 4. Reference 21 5. Reference 16

2. FEATURES The alternative closed circuit technique utilizes low (basal) flow rates of oxygen with a low resistance vaporizer in the inspiratory limb of the circuit (VIC). Dosage is measured by volume using a uniquely calibrated vaporizer bowl. Capital and running costs are low and there is little or no pollution of the operating theatrel.

The ROTAFLUSH™ anaesthetic machine is light, portable and attractive with a white, powder coated steel base fitted to a wall mount or a stainless steel base mounted to a mobile trolley. The MK4 BreathAlert™ breathing monitor is included as standard equipment. The OXI-vac™ venturi suction system and the PulseAlert™ pulse monitor are available as options. Oxygen is introduced into the RotaFlush™ Flowmeter by an oxygen hose line (included). The set flowrate of oxygen enters the anaesthetic circuit via the VOC vaporizer. All controls are readily accessible and can be viewed whilst operating, particularly important for the sole practitioner.

2.1 The VOC Vaporizer The front panel base of the Komesaroff ROTAFLUSH™ Anaesthetic Machine has mounting slots for an out-of-circuit vaporizer. The 23mm inlet and outlet taper fittings are supplied. Oxygen enters the anaesthetic circuit through a 23mm female tapered fitting that inserts into the inlet side of the VOC vaporizer. A 23 mm male tapered connector, with a narrower vertical (bottom) nipple and a wider horizontal nipple is fitted to the vaporizer outlet. The white oxygen hose from the Oxygen Flush outlet of the RotaFlush™ Flowmeter is attached to the narrower nipple. One end of the fresh gas hose (black) is fitted to the wider nipple; the other end connects into the rear of the KAB absorber via a fitted 15mm male connector.

In recent years there has been a gradual change in human anaesthetic techniques from high to low flow and closed circuit anaesthesia, prompted by the high cost of modern volatile anaesthetic agents and the requirement to scavenge excess gases to prevent pollution of the atmosphere. A comprehensive textbook by Ernst & Lowe2 has received wide acclaim. A symposium on low flow anaesthesia was published in the Anaesthesia & Intensive Care Journal August in 19943.

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Manual - VOC RotaFlush

2.2 KAB™ CO 2 Absorber™ The KAB™ Circular Carbon Dioxide Absorber has design registrations and patents. It is seethrough and autoclavable. Manufactured from tough medical grade polycarbonate it is further strengthened by the circular design. The integrated uni-directional silicone valves are vertically orientated and large in diameter to reduce resistance to breathing. The new adjustable pressure limiting (APL) exhaust valve is also an integral part of the absorber and includes a 30mm scavenging port. In accordance with Australian and International Standards, the valve closes by turning CLOCKWISE. When OPEN (1 turn only ANTI-CLOCKWISE) the central spindle has free movement and excess gases in the breathing circuit are automatically vented.

During expiration the uni-directional silicone valves direct the gas through the soda lime in the right side of the absorber. On inspiration the gas is drawn through the remainder of the soda lime producing an efficient DOUBLE absorption effect.

NOTE: With the APL (exhaust) valve open, the spindle automatically maintains the volume of gas in the breathing bag without adjustment, even at low flowrates (0.1L/min). This is particularly advantageous in small patients breathing spontaneously.

*NOTE: In the corresponding International Standard the breathing bag port is designated as a 22mm male port. To comply with this standard the 22/22 mm male elbow provided should be permanently fitted.

During operation the soda lime becomes warm and the indicator gradually changes colour. To prevent staining of the absorber, particularly if repeatably autoclaved, the PINK to WHITE indicating soda lime is preferred to soda lime which changes from WHITE to VIOLET. The KAB™ CO2 absorber mounts onto a 22mm male taper post secured to the vertical panel of the white steel base. The aluminium adapter (see below) fits onto the 'INHALE' side of the KAB™ Carbon Dioxide Absorber. The `INHALE' port (hard plastic portion) of the Universal 'F'* breathing circuit fits onto the 22mm M taper of the aluminium adapter (see below). The 'EXHALE' side of the absorber has a 22mm male taper for attachment of the expiratory limb of the Universal 'F' breathing circuit. The breathing bag mount is a 22mm female port to conform to the Australian Standard. A 22mm male/male elbow fitting is provided for connection to the breathing bag either directly or via an extension hose.

CAUTION: The control knob of the exhaust valve must not be forced. It operates fully between open and closed positions within 1 full turn. The KAB™ CO2 absorber is filled through the opening at the rear, after removing the neoprene bung. It holds approximately 400g of soda lime when full with a duration of action in excess of 6 hours in small animals. The asymmetrical divider and the fluted openings in the grates minimize 'channeling' to increase the efficiency of absorption. This can be verified by the even change of colour of the indicator in the soda lime during use.

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Manual - VOC RotaFlush

2. 3 O xygen Suppl y Oxygen enters the RotaFlush™ Flowrneter™ via the colour coded white oxygen hose line (supplied). The white oxygen hand wheels at each end are diameter indexed for oxygen only. One hand wheel fits to the self-seal valve beneath the RotaFlush™ Flowmeter™. The other hand wheel* fits to a wall outlet or to a regulator fitted to a large supply cylinder.

2.6 Stainless Steel Base Stainless steel base mounted on a trolley or powder coated white for easy cleaning secured to a wall mount assembly. The horizontal 22mm male taper support post inserts into the rear of the KAB™ CO 2 absorber. The 15mm male taper metal fitting on the vertical panel supports the patient end of the breathing circuit when not in use.

* Wall outlet and regulator fittings may vary in different countries: if so remove the white oxygen hand wheel assembly from one end and replace with the appropriate fittings.

3. ASSEMBLY

2.4 RotaFlush™ Flowmeter Oxygen flow rates are accurately calibrated between 0-4L/min. The OXYGEN FLUSH button is depressed to rapidly inflate the breathing bag as required. When the OXYGEN FLUSH is operated, the oxygen enters the circuit, distal to the vaporizer, through the white oxygen hose which attaches to the narrower nipple of the 23mm connector (See 2.1). The pressure gauge has a range of 0-600kPa. The operating pressure is 400kPa or 350kPa depending on the country*. *NOTE: The flowrates are calibrated at 400kPa unless 350kPa is specified when ordering.

2.5

Black Delrin Adapter: Pressure Relief Valve The black delrin adapter fits into the 'INHALE' side of the KAB™ CO 2 absorber. A relief valve, which limits the pressure in the circuit to approximately 40cm of water, is incorporated. It has a manual override for the rare circumstances when high circuit pressures are required (for example in asthma).

On delivery carefully unpack the machine and place it on a solid table. Care should be taken to ensure that the machine is correctly assembled prior to use and that all parts are connected securely to provide an airtight circuit. Carefully assemble the Rotafush™ Flowmeter (See Appendix A). After fitting the vaporizer secure the machine to the wall mount assembly using the four Soren nuts supplied. Check that the oxygen pressure gauge, KAB™ CO 2 absorber, breathing circuits and breathing bags are undamaged. 3.1 KAB™ CO 2 Absorber* Fill the KAB™ CO2 Absorber Remove the neoprene bung from the back of the absorber, empty the used soda lime granules and lay the writwamisrnam --- absorber face down. Insert the 400g capacity plastic filler (fitted with the white cylindrical adapter) into the opening until it touches the opposite wall. Pour soda lime from the 1Kg pack into the filler up to the 'circle' at the base of the filler (level with the top of the label). Holding the KAB™ absorber and filler securely, turn the absorber semi-vertically and gradually withdraw the filler to release the granules. Manipulate the granules up to the level of the top grates on both sides of the divider. Carefully remove the filler and replace the neoprene bung. Remove excess particles and wipe clean with a disposable paper towel.

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soon up[ OKAIRING P

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Fit the rear of the KAB™ absorber to the horizontal support post fitted to the front panel of the white base. Ensure the exhaust valve lies vertically. Fit the aluminium adapter onto the 'INHALE' side of the KAB™ absorber and secure with a firm twisting movement. Insert the 22/22mm male elbow into the breathing bag port (bottom right opening) and connect the breathing bag to it. Attach the solid plastic section of the Universal 'F' breathing circuit to the aluminium adapter and the short flexible corrugated hose to the 'EXHALE' port of the KAB™ CO2 absorber respectively.

NOTE: 1. Autoclavable 'Smoothbore' breathing hoses connected by a polycarbonate Y-piece are available as an option. 2. An extension hose can be inserted between the absorber and the breathing bag if required. This hose is available as an optional accessory. 3.2. Controls Check that the RotaFlush™ Flowmeter flow control, the vaporizer control and the exhaust valve of the KAB™ CO2 absorber rotate freely. 3.3 Testing for Leaks Check the integrity of the circuit after assembly. As the connections are tapered only a gentle twisting action is needed. Do not use excessive force. Leak test with the exhaust valve closed and the vaporizer in both the ‘ON’ and 'OFF' settings as follows: 1.

Open the oxygen cylinder valve 1 full turn & set the RotaFlush™ Flowmeter to zero.

Place a thumb over the patient end of the Universal ‘F’ Hose to seal the breathing circuit and depress the OXYGEN BYPASS of the RotaFlush™ Flowmeter to rapidly fill the breathing bag. When the breathing bag is full, it should remain fully inflated even when very firm pressure is applied to it with the free hand. Listen carefully for leaks. If the bag slowly collapses, check all the connections, pushing home with a firm twisting action. Look for tiny holes in the breathing bag and the breathing circuit.

Manual - VOC RotaFlush

4. OPERATING INSTRUCTIONS 4.1 Fill the VOC vaporizer* (observe the level of liquid in the viewing glass) & close the plug. WARNING: The filling plug of the VOC vaporizer must be closed before inducing anaesthesia. *NOTE: As different VOC vaporizers can be mounted, refer to the manufacturer of the VOC vaporizer for operating and maintenance instructions 4.2 Connect the breathing circuit and tighten all connections with a twisting action. Rotate the cap of the APL (exhaust) valve CLOCKWISE to the 'closed' position, place a thumb over the patient end of the breathing circuit and rapidly fill the system by depressing the OXYGEN FLUSH. Compress the breathing bag to test for leaks. 4.3 Initially set the RotaFlush™ Flowmeter to 3L/min. 4.4 Induce anaesthesia in the usual manner e.g. thiopentone intravenously. Alternatively a facemask induction can be used. It is preferable to intubate the patient and connect the patient end of the breathing circuit to the endotracheal tube. 4.4.1 Spontaneous Ventilation Gradually increase the vaporizer setting (usually to about 3%). Allow about 4 breaths at each setting. Assist ventilation gently until the patient is breathing adequately. When the required depth of anaesthesia has been reached (after 4-5 minutes) reduce the concentration setting to usually 1-1.5% for maintenance. The oxygen flow rate may be reduced as necessary. (This varies depending on the response of the patient). Turn the vaporizer off 5-10 minutes before the end of the operation, depending on the duration of the operation and the depth of the anaesthesia. 4.4.2 Controlled Ventilation (I.P.P.R.) It is preferable to add a muscle relaxant and control ventilation manually (or use an automatic Ventilator*) to intermittently compress the breathing bag, the rate and depth depending on the patient.

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Manual â&#x20AC;&#x201D; VOC RotaFlush

5. NOTES 5.1 15mm Taper Connections The 15mm connection in the endotracheal tube fits directly into the elbow of the Universal breathing circuit (or into the polycarbonate Ypiece if 'Smoothbore' hoses are used).

A 22mm M/M connector is included to attach to the 15mm male taper of the Washington T if needed. This will be required if the neck of the 1/2 litre breathing bag has a 22mm female port. If the breathing bag has a 15mm female port this connector is not required.

Alternatively the endotracheal tube can be attached indirectly via a flexible corrugated endotracheal tube adapter (not supplied): one end has a female 22mm port which fits over the 22mm male taper of the elbow or Y-piece. The other end has a plastic 15mm female taper connector for attachment to the 15mm connection in the endotracheal tube.

5.4.2 Assembly Detach the Universal 'F' Circuit from the aluminium adapter and connect the 22mm female connector in the end of the green hose line. The other end of the green hose line is attached to the Washington T-piece. As higher oxygen flowrates (1-3 L/min) are required for this system, ensure a scavenging system is in place to prevent pollution of the operating area.

5.2 Dead Space There has been confusion regarding dead space in circle anaesthesia systems. Apart from the facemask or endotracheal tube, the apparatus dead space in a circle system is approximately half the volume of the outlet of the Universal 'F' circuit, or if twin hoses are used, half the volume of the part of the Y-piece beyond the V junction. Providing the circle is intact, it is independent of the length of the breathing (corrugated) hoses. 5.3 Scavenging Excess gases should be vented to avoid pollution of the operating room. The APL (exhaust) valve is fitted with a scavenge connector for attaching an exhaust hose. 5.4 Washington T Circuit* A Washington T Assembly is included as standard equipment in all models of the Komesaroff Small Animal Anaesthetic Machines. This is a non-breathing circuit for use only in very small animals.

The 15mm male connector in an endotracheal tube fits into the 15mm female port at the larger end of the Washington T. The other end of the Washington T fits directly, or indirectly via a short wider bore hose (not supplied), into the 1/2 litre breathing bag with the tail of the bag OPEN (or partially clamped to maintain an adequate volume). 5. 4. 3 Techni que 1. Set the flowrate to 3L/min or 220mL/kg 2. Gradually turn the VOC vaporizer ON allowing 2-3 breaths between settings 3. After anaesthesia is achieved reduce the vaporizer settings to maintain anaesthesia Notes: 1. For tiny patients (e.g. birds) use a transparent hood or similar container. Detach the green hose liner from the Washington T-piece and place it under the hood. 2. Excess gases should be vented to avoid pollution of the operating theatre.

5.4.1 Components The Washington T connector consists of a 22/15 M/F taper at one end, a 15mm male taper at the other end and an angled side port for the attachment of 1.5m of 6mm green tubing. The other end of the green tubing is fitted with a 22mm female connector.

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Manual — VOC RotaFlush-TR&WM

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6 . B R E A T H - AL E R T ™ M K 4 B r e a t h i n g 9 . T R O L L E Y Monitor 9.1 Trolley Assembly See appendix

1. Firmly twist tapered end of the post into the trolley base. 2. Position the aluminium collar on the underside of the stainless steel base onto the spiral insert in the top post ensuring the grub screw hole lines up with the vertical groove. Secure by tightening the grub screw in the aluminium collar using the Allen key supplied.

OXI-vac™ Suction System (Optional)

9.2 Wall Mount Assembly 1. Secure the wall mount assembly to a wall using 4 appropriate bolts (not supplied). 2. Position the circular wall mount screws so that the flanges and screws slot into the groove of the crossbar and into the holes in the rear vertical face of the white base respectively. 3. Secure the ROTAFLUSH™ anaesthetic machine to the wall mount using the knurled chrome plated 'SOREN' nuts.

8. PULSE-ALERT™ Pulse Monitor (Optional) Position the PULSE-ALERT™ to be clearly visible during operative procedures. It is fitted with visual and audible alarms and continuously monitors the pulse rate and rhythm. 8.1 Blood Pressure Measurement To measure the blood pressure, secure the sensor of the PULSE-ALERT™ pulse monitor to a small shaved area of a limb; fit a blood pressure cuff above it. Turn the PULSEALERT™ on and inflate the cuff until the pulse beat is obliterated. Now slowly release the pressure in the cuff and note the gauge reading when the pulse beat reappears. This represents the systolic blood pressure.

10. MAINTENANCE The ROTAFLUSH™ Anaesthetic Machine is designed to be virtually maintenance free but the following points will help maintain the equipment in full working order. 10.1 Cleaning The KAB™ Circular CO2 Absorber that incorporates the unidirectional and APL (exhaust) valves can be autoclaved. Alternatively cold sterilize with chlorhexidene ('Hibitaine') in alcohol and then rinse thoroughly with water. Remove excess moisture by shaking and allowing to stand: alternatively a hair drier can be used. Use a cloth moistened with ‘Hibitaine’ in alcohol to clean metal surfaces. 10.2 Storing the Machine If the machine is not to be used for some time, empty the vaporizer. Store the machine in a convenient place.

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11. PRECAUTIONS 1. 2.

4. 5.

6. 7.

8. 9

Manual - VOC RotaFlush

12. SPECIFICATIONS

Regularly recheck the circuit for leaks. The Komesaroff KAB™ CO2 Absorber rarely needs replacing; however a spare absorber, breathing circuit and breathing bag should always be available. The control knob of the exhaust valve of the KAB™ CO2 must not be forced. It operates fully between open and closed positions within 1 full turn. Trichloroethylene ('Trilene) must NEVER be used with soda lime. Care must be taken to place the correct volatile agent in the appropriately labeled vaporizer. Controlled ventilation with should be used cautiously. When turning on the oxygen supply cylinder, open the oxygen valve slowly. Naked flames must not be used in the vicinity of the apparatus. Do not put oil or grease on any oxygen connections. Supply pressure The RotaFlush™ Flowmeter is normally factory calibrated to a supply pressure of 400kPa. A 0-600kPa pressure gauge is fitted: when the oxygen supply is turned ON the gauge should register between 370430kPa (60p.s.i.). In some countries, notably the USA, the oxygen supply pressure is nominally 350kPa (50psi). To ensure the RotaFlush™ Flowmeter is correctly calibrated it is essential to specify the supply pressure when ordering. Turn the oxygen supply OFF at the source after use.

Length: Width: Height: Weight: Weight:

510mm 255mm 2mm 7.5kg without vaporizer 13.5kg with vaporizer

13. WEEKLY TEST PROCEDURE 13.1 RotaFlush™ Flowmeter 13.1.1Oxygen Flush Close the exhaust valve, place a thumb over the patient outlet of the breathing circuit, depress the FLUSH BUTTON of the RotaFlush™ Flowmeter and observe that the breathing bag fills rapidly. 13.1.2 Rotate the flow control knob of RotaFlush™ Flowmeter and observe the movement of the ball. 13.2 Test for Leaks Ensure all connections are firmly attached. Fill the breathing bag until full and compress very firmly. Feel and listen for leaks. 13.3 Test Suction System 250mL (8ozs) of water should be aspirated from a glass within 4 seconds. 13.4 Test OXYGEN FLUSH Turn oxygen supply OFF. Depress OXYGEN FLUSH button and observe that the contents gauge returns to zero. Ensure a spare full oxygen cylinder fitted with a regulator is available.

14. REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Komesaroff, D. and Williamson, W. (1968), "Methoxyflurane as an alternative to Nitrous Oxide in Relaxant Anaesthesia, Using a Goldman Vaporiser in Circuit'. Med. J. Aust. 2:391. Komesaroff, D. (1969), "A Simplified Portable Anaesthetic Machine". Proceedings of 28th Annual Meeting Australian Society of Anaesthetists P.112. Komesaroff, D. (1972), "The Emergency Management of Airway Obstruction and Tension Pheumothorax". Australian Family Physician 1:65. Komesaroff, D. (1972), "A New Concept in Emergency Resuscitation: The Oxy-Resuscitator" Papers and Abstracts, 5th World Conference on General Practice 1:21. Komesaroff, D. (1973), "A New Anesthetic Machine and Technic with Particular Application to Developing Areas". Anesth. & Analg. 52:605. Komesaroff, D. (1973), "A Critical Appraisal of Methoxyflurane and its Place in Modern Anaesthesia" Komesaroff, D. (1973), "A Critical Appraisal of Current Anaesthetic and Resuscitation Techniques". Preprinted Papers, Fourth Asian and Australasian Congress of Anaesthesiologists. P.216. Cust, R.E. (1974), "A New Method of Closed Circuit Anaesthesia Utilizing Halothane and Methoxyflurane". Aust. Vet. J. 51:32. Lowe, H.J. and Ernst, E.A. (1981), The Quantitative Practice of Anesthesia. Use of Closed Circuit. Publishers: Williams & Wilkins, Baltimore, London. Komesaroff, D. (19),"Cardio-Pulmonary Resuscitation". Publishers Royal Australian College of General Practitioners".

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11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.

Manual - VOC RotaFlush

Komesaroff, D.(1986), "Anaesthesia for the Non-Specialist". Text Book. Williams, Wilkins-Adis, Sydney. Holm, H. & Nielsen, S.(1963) "Registration of the Pulse by Means of a Pulse Monitor". Nord. Vet. Med. 7-8, 552-556. Nielsen.S. (1981). "An Improved Technique in Inhalation Anaesthesia in Small Animals". Dansk.Vet Tidsskr. 64, 2,15/1. Komesaroff, D. (1994). "Low Flow Anaesthesia - An Australian Devotee's Perspective". Low Flow and Closed Circuit Anaesthesia Symposium: Anaesth IntensCare, 22:331-434 Baum, J.A. Aitkenhead, A.R. (1995) "Low-Flow Anaesthesia". Anaesthesia, 50:37-44 Komesaroff, D. (1996) The Cost of High Flow Anaesthesia". Read at the 5th World Congress on Anaesthesia, Sydney, Australia. April 1996 Komesaroff, D.(1996) 'Disposable and Autoclavable Anaesthetic Circuits: The Future is Now'. Anaesth Intens Care, 24:173-175 White, D. and Royston, B. (1998), "Respiratory Feedback Effects On Vaporisers In Circle Systems". Anaesthesia, 53:555-559 Brosnan, S. Royston, B. and White, D. (1998), "Isoflurane Concentrations Using Uncompensated Vaporizers Within Circle Systems". Anaesthesia, 53:560-564 Wright, D. Brosnan, S. Royston, B, and White, D. (1998), "Controlled Ventilation using Isoflurane with an In-Circle Vaporiser. Anaesthesia, 53:650-653 Laredo, FG. Sanchez-Valverde, MA. Cantalapiedra, AG. Pereira, JL. Agut, A: (1998), Efficacy of the Komesaroff anaesthetic machine for delivering isoflurane to dogs. Veterinary Record 143,437-440 Komesaroff, D. (1998), The KAB: A new compact disposable or autoclavable carbon dioxide absorber. Poster: ASM American Society of Anesthesiologists, October 1998 Baum, JA & Nunn, G: Low Flow Anaesthesia. Publishers Butterworth Heinemann. 2nd Edition. (2001)

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Manual - VOC RotaFlush

15. GUARANTEE Medical Developments International Limited (MDI) warrants to the original purchaser that any part or parts, which on examination by MDI, prove to be defective within 24 months from the date of delivery to the original purchaser, will be replaced free of charge. This warranty does not include freight costs, consumables, plastic and perishable items. MDI will not be responsible for labour or transportation charges incidental to the replacement of any part or parts. This warranty is in lieu of all other warranties, obligations or liabilities expressed or implied. MDI neither assume nor authorize any other person to assume liability in connection with the sale. This warranty will not apply to any product that has been subject to accident, abuse or misuse. The warranty is not applicable when unauthorized repairs or modifications have been attempted, or when entire units or parts are damaged by accident, misuse or improper handling procedures When returning the product under warranty, please include the following details: Manufactured by: MEDICAL DEVELOPMENTS INTERNATIONAL LIMITED ABN 14 106 340 667

Factory 7, 56 Smith Road Springvale, Victoria 3171 Australia Tel: (61) (3) 9547 1888 Fax: (61) (3) 9547 0262 Web: www.medicaldev.com Email: mdi@medicaldev.com

Purchaser:……………………………………………………………………….. Address: ...................................................................................................... Post Code: .................... Country:……………………………………………….. Model: .................. Serial No:…………………Date of Purchase:……………… Invoice No: ................................ Supplier: ...........................................................

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Manual - VOC RotaFlush

Appendix 1

Washington T Assembly

A Washington T Assembly is now included as standard equipment in all models of the Komesaroff Small Animal Anaesthetic Machines. This is a non-breathing circuit for use only in very small animals.

Components The Washington T Assembly connector consists of: 1. A connector with 22/15 M/F taper at one end, a 15mm male taper at the other end and an angled side port for the attachment of 1.5m of 6mm green tubing. 2. Breathing Bag assembly consists of a 1/2 litre breathing bag (with a removable plug) fitted with a connector with a internal 15mm female taper to attach to the 15mm male end of the Washington T 3. Green tubing (1.5m) fitted with a 15mm male plastic connector with a knurled rim.

Circuit Remove the breathing circuit from the KAB™ Absorber but ensure the breathing bag remains in place. Remove the black delrin adapter from the INHALE' side of the KAB™ absorber. Connect the green tubing fitted with a 15mm male plastic connector into the 'INHALE' side of the KAB™ CO2 Absorber.

Washington T The larger end of the Washington T (22mm male/15mm female) is connected to a 15mm male connector in the endotracheal tube. Alternatively a facemask can be attached.

Technique 1. 2. 3. 4. 5. 6.

Depress the OXYGEN FLUSH to test the integrity of the circuit Turn the flowrate to 3L/min or 220 ml/kg Gradually turn the vaporizer ON allowing 2-3 breaths between settings Remove the plug from the breathing bag and control the volume in the bag by an adjustable clamp or intermittently manually occluding the outlet After anaesthesia is achieved reduce the vaporizer settings to maintain anaesthesia For very tiny patients (e.g. birds) use a transparent hood or similar container. Detach the green hose line from the Washington T-piece and place it under the hood.

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Manual - VOC RotaFlush

Appendix 2

2 Breath-Alert™ Mark 4 Breathing Monitor

Key Features

    

Large digital display Alarm system for breath is present; no breath and low battery Apnoea settings for 5, 10, 15, 20, 25 or 30 seconds Automatically sets to the last used apnoea time Incorporates Alarm and Charging multifunction lights Pause button to reset apnoea time: screen flashes. Alarm is silenced but breathing beep continues Select button to set required apnoea time Mute button. Cancels the beep during breathing. Breath light and Alarm system remain active Volume and 'Sensitivity' controls Alarm reset optical sensor Preset apnoea time is counted up. If apnoea time is exceeded, alarm is activated Built-in automatic charging circuit — stops charging when battery is full Long battery life with four NiMH 1.2V/2500mAh AA cells

<<<<<<< CHARGE BATTERIES FOR AT LEAST 7 HOURS BEFORE INITIAL USE>>>>>>

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Breath-Alert™ Mark 4 Breathing Monitor (Continued) Operation 1. Plug sensor lead into the Breath Alert™ Mark 4 (rear panel) 2. Connect the sensor into the breathing port in the elbow adapter supplied. A Y-piece with a port for the breathing sensor is available as an option (If a Universal 'F' breathing circuit hose is used the sensor plugs into the port adjacent to the patient) 3. Switch the device by setting Power switch at rear to On 4. Set Volume control to mid range 5. Set Sensitivity control to mid range 6. To select apnoea time: Press Pause button — the display will flash Press Select button to set the desired apnoea time Press Pause button again, the unit will now operate, counting up from the 0 to set time 7. Adjust Volume and Sensitivity as required 8. If the Breath Alert™ alarms, touching or passing the palm of a hand over the Alarm Reset optical sensor in the top of the unit, or a breath by the patient, will stop the alarm. The system automatically resets to the preset apnoea time. Alternatively, press the Pause button to silence the alarm (display flashes). Push the Pause button again to restart 9. During the operation the 'Alarm' light indicates different conditions as shown below:

Flashes GREEN- breath pulses are registered (short single beeps are emitted) Flashes AMBER- no breath alarm (series of 3 rapid beeps; digital display is flashing) Flashes REDlow battery alarm (series of single long beeps; digital display is flashing) 10. The Mute button (red decimal dot on digital display next to the Mute button is on) cancels only the breathing beeps. The breathing light continues and the alarm system remains active. The Breath Alert™ Mk 4 can be secured with the 3-point wing screw (supplied) into the standard tripod thread in the base.

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Breath-Alert™ Mark 4 Breathing Monitor (Continued) Precautions Use any 9V DC power plug pack (adaptor) for charging. The plug pack must be capable to deliver at least 150-200mA of output current. Central pin of the 2.5mm output jack must be positive (+) During recharging the colour of the 'Charging' light shows the battery state: Amber/Yellow —charging in progress Green — battery is full; charging is completed There are no user serviceable parts within the Breath-Alert™ Mk 4 apart from the sensor. The unit has been designed to avoid the need for re-calibration. If malfunction does occur please contact your distributor. Specifications Apnoea times —5, 10, 15, 20, 25 or 30 seconds Sensor — Heat sensitive Sensor lead — 2m, plugs into rear panel Digital display —2 digit Dimensions — W129 x H38 x D133 mm Weight — 0.38kg, including battery Power Input — 9V DC @ 300mA. 2.5mm plug positive (+) central pin Battery — 4 x AA NiMH cells Fully charged Duration up to 120 hours (depending on quality and condition of the AA cells) Sensitivity and volume controls Alarm and Charging lights Pause Select push buttons Mute push button and light Electromagnetic Compatibility The Breath-Alert Breathing Monitor Mark4 has been tested and certified as complying with Australian Electromagnetic Compatibility requirements, New Zealand Electromagnetic Compatibility requirements, European Directive 2004/108/EC and USA Federal Communication Commission (FCC) - Part 15 requirements

Warning: This equipment may be affected by electromagnetic disturbances which may exist in the intended operating environment. The user is cautioned that certain electromagnetic disturbances may result in erroneous indications, which may not be obvious. The equipment should be placed at least 3m from mobile phones and other RF transmitters.

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Breath-Alertâ&#x201E;˘ Mark 4 Breathing Monitor (Continued) Changing the battery 1.

Turn the device off. (The Power switch in the OFF position)

Unscrew the two screws from the bottom of the device and remove the top lid

Locate four NiMH AA cells in spring holders on the printed circuit board (PCB) and note their polarity orientation

Remove old NiMH AA cells from their spring holders. (To help with this operation, a small plastic or wooden ruler can be used as a lever) Do not use a screwdriver or other metal objects as a lever the PCB may be damaged

Note the polarity marks (4-) and (-) next to each spring holder on the PCB

Good quality brand name rechargeable NiMH AA cells are recommended, examples: Sanyo, Ansmann, GP, Energizer, Varta, Panasonic, Toshiba, etc Required capacity: 2000 â&#x20AC;&#x201D; 2500mAh or more Do not use alkaline AA 1.5V cells Alkaline AA 1.5vVcells will damage an electronic circuit

Place replacement NiMH AA cells into the spring holders Note: The polarity of the batteries is crucial (See photo) Failing to perform the correct polarity orientation of the cells will blow the SMD 2A fuse (marked 2AF), located on the PCB just bellow a power switch. The resulting damage will require repair by the distributor

Put the top lid back and screw it in place (bottom screws)

Before starting using the device, the batteries must be charged for at least 7 hours

Note: Old NiMH cells must be discarded accordingly to local Government regulations

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Breath-Alertâ&#x201E;˘ Mark 4 Breathing Monitor (Continued) Packing List Breath-Alertâ&#x201E;˘ Mark 4 Sensor assembly Elbow with port for breathing sensor Y-piece with port for breathing sensor (optional) Hose clips (4) Locating knob Manual Charger pack (optional) ABOUT POWER PLUG PACK / CHARGER FOR BREATH ALERT Mk4 External adapter works as a charger for the internal Ni-MH rechargeable battery. For the proper functioning of the internal battery charging circuit customer must use the M9236 Power Plug Pack, which is included in the package. For sales in Europe the package also includes the European adapter for the wall socket. In the extreme case, the consumer may need to use another type of adapter, if it meets the following specifications: Power plug pack type: Input Voltage: Output voltage: Output connector: Output polarity: ATTENTION:

Non-regulated. 220 - 240 V AC. 9V @ 300mA DC. 2.5mm DC Power Jack. Central pin is (+) positive.

If you use a different type of power plug pack, instead of M9236, the correct functioning of the internal battery charging circuit is not guaranteed and "Charging" LED can not be used as an indicator of the end of charging process. In the case of not being the original adapter, the charging time must not exceed 8 hours and the charging process should be monitored visually Do not let a large battery overheating during charging! This significantly reduces the lifetime of the battery.

To use the M9236 Power Plug Pack in local power networks of other countries (with 220 - 240 V AC voltage), the customer may use a Universal Travel Power Plug Adapter similar to shown in the picture below.

For South Africa

For Europe

For UK

NOTES: 1. 2.

A cheaper version of Australia-to-local mains socket adapters can also be used. The M9236 Power Plug Pack can not be used in local power networks of the U.S.A and Japan, even when using the proper adapter for the wall outlet. This is because the electrical networks in these countries have a line voltage 115 - 120 VAC. Although in this case it is possible to recommend the use of 115/240V step-up transformer.

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Appendix 3

3 Trolley Cylinder Support (Optional) Assembly Instructions Cat. No TR-7590-CS

COMPONENTS: 1) TR-CSNR:- Cylinder Support Neck Ring 2) TR-CSBB:- Cylinder Support Base Bracket fitted with screw and U-Bracket

INSTRUCTIONS: 1) 2) 3) 4) 5) 6)

Carefully remove the anaesthetic machine from the trolley Remove the post from the five arm base Pass the smaller opening of the Cylinder Support Neck Ring over the lower (tapered) end of the post and slide upwards. Pass the smaller opening of the Cylinder Support Base Bracket over the lower (tapered) end of the post and slide upwards. Re-insert the post firmly into the five arm base Locate the U-bracket of the Cylinder Support Base Bracket over one of the arms of the base and tighten the screw in the side.

TO SUPPORT THE PORTABLE OXYGEN CYLINDER 1)

Slide the Cylinder Support Neck Ring to the upper section of the post

Position the base of the oxygen cylinder (remove the regulator if necessary) on the Cylinder Support Base Bracket

Slide the Cylinder Support Neck Ring downward onto the top of the neck of the cylinder until it locates firmly

Hand tighten the screw of the side of the Cylinder Support Neck Ring

Attach an oxygen regulator to the cylinder valve

Connect the oxygen hose line from the regulator to the self-seal outlet of the KDK™ or RotaFlush™ Flow Meter.

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Appendix 4 4 Packlist 1 2. 3. 4. 5. 6.

Wall Mount Assembly Trolley (2 parts) & 3mm Allen key (Optional) Trolley cylinder support (Optional) Base: Powder coated white/stainless steel 15 mm tapered support fitted to front right of vertical panel for storing Universal 'F' Circuit VOC vaporizer support block & screws for 'Tec 3 VOC vaporizer (5mm Allen key supplied) 7. VOC 23 mm female inlet adapter with horizontal nipple 8. VOC 23mm male outlet adapter with horizontal and vertical (down) nipples 9. VOC Vaporizer (Optional) 10. RofaFlush™ Flowmeter 0-4L/min with separate outlet for Oxygen Bypass 11a. Oxygen hose line 6m white with 2 handwheels and open nipples or b. Oxygen hose line 1.5m green with 1 handwheel and 1 DISS and open nipples (USA) 11. OXI-vac™ suction system (optional) 12. Support for KAB™ Absorber (KAB-DIKVOC) and Delrin extension block 13. KAB™ CO2 Absorber (KAB-HNIP) 14. Black Delrin Adapter ('ALUMAD') incorporating the Pressure Relief Valve 15. Elbow 22/22mm male for KAB™ Absorber 16. Scavenge connector (30mm female taper) 17. Soda lime pack 1kg 18. Plastic filler fitted with adapter to measure refill quantity of soda lime (400g), 19. 23mm female VOC inlet adapter to VOC vaporizer 20. White oxygen hose from RotaFlush™ flowmeter outlet to the side nipple of the 23mm female VOC inlet adapter 21. White oxygen hose from RotaFlush™ 'OXYGEN FLUSH' (via pipe under base) to the bottom (vertical down) nipple of the 23mm male VOC outlet adapter 22. Hose fitted at one end to the VOC outlet adapter and fitted at the other end with a metal 15mm male fitting to insert into the back of the KAB Absorber 23. Washington 'T' Assembly: 1.5m green therapy tubing with a 15mm male connector, ½L breathing bag with a removable plug and fitted with a 22/22/15mm straight connector 24. Universal 'F' Circuit including 22/15mm elbow, 2 L breathing bag (2) 25. Breath-Alert™ MK4 (Optional). 26. Labels 27. ROTAFLUSH™ Instruction Manual 28. Guarantee: See Instruction Manual 29. Serial Nos: RotaFlush™ Flowmeter ................................ KAB™ Absorber .............................................. VOC Vaporizer .............................................. Breath-Alert™MK4 ........................................ First Check by .................................................Date .......................... Final Check by ................................................Date ..........................

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Appendix 5

5 Brief Operating Instructions MEDICAL DEVELOPMENTS INTERNATIONAL LIMITED ABN 14 106 340 667

Factory 7, 56 Smith Road Springvale, Victoria 3171 Australia Tel: (61) (3) 9547 1888 Fax: (61) (3) 9547 0262 Web: www.medicaldev.com Email: mdi@medicaldev.com

1. Fill the â&#x20AC;&#x2DC;Tec out-of-circuit (VOC) vaporiser with the volatile anaesthetic agent to about Â˝ full. Observe the level in the glass window. 2. Tighten all connections of the breathing circuit with a twisting action and gently rotate the cap of the APL (exhaust) valve clockwise to the 'closed' position. Place a thumb over the outlet of the breathing circuit and rapidly fill the system by depressing the 'OXYGEN FLUSH'. Compress the breathing bag firmly to test for leaks. 3. Dial the flowrate of oxygen to 3L/min 4. Ensure the patient is pre-medicated. Induce anaesthesia in the usual manner e.g. thiopentone intravenously. It is preferable to intubate the patient and then connect the breathing circuit to the endotracheal tube.

CONTROLLED VENTILATION (I.P.P.R)

Manual Ventilation The patient may require a muscle relaxant. The APL (exhaust) valve is closed sufficiently to keep the breathing bag comfortably full after each compression of the breathing bag. Intermittently squeeze the breathing bag manually. The rate and depth of breathing depends on the size of the patient. Automatic Ventilation Remove the breathing bag and elbow from the breathing bag port of the KAB absorber. Connect the ventilator hose from the Clare Ventilator to the KAB absorber breathing bag port. The patient will require a muscle relaxant. The APL (exhaust) valve is closed completely. Now follow the instructions for the operation of the Clare Ventilator. NOTES: 1. The operating pressure is approximately 400kPa. Check the gauge.

SPONTANEOUS VENTILATION OPEN the APL (exhaust) valve one full turn. Depress the 'OXYGEN FLUSH' until the bag is about 7/8 full. Gradually advance the vaporiser settings up to about 3%. Allow about 4 breaths at each concentration setting. Assist ventilation gently until the patient is breathing adequately. When an adequate depth of anaesthesia has been reached, the flowrate is reduced to 1L/Min and the VOC vaporizer setting reduced to say 1- 1.5% (sufficient to keep the patient anaesthetized). The vaporiser concentration will vary depending on the response of the patient. Turn the vaporiser off 5-10 minutes before the end of the operation, depending on the duration of the operation and the depth of the anaesthesia.

Ensure the agent being used to fill the Tec vaporizer is isoflurane.

At the end of the procedure ensure the vaporizer is turned OFF.

DISCLAIMER: These brief instructions are intended as a guide only. Also refer to the Operating Manual. Medical Developments International Limited accepts no responsibility for incorrect operation of the equipment or incorrect management of patients. It is essential that all individuals operating this equipment are fully trained in anaesthetic procedures. COPYRIGHT RESERVED 2007

No part of this manual may be reproduced in any form without written permission

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Appendix 6

6 Komesaroff Voc Rotaflush™ Small Animal Anaesthetic Machines

TROLLEY MODEL

WALL MOUNT

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Appendix 7 7 Komesaroff Veterinary Anaesthetic Machines

LANA Combined Large & Small VOC Animal Anaesthetic Machines

MINI-KOM™ Close Circuit Anaesthetic Machine on Trolley

VOC RotaFlush™ Closed Circuit Anaesthetic Machine Trolley Mount

VOC RotaFlush™ Closed Circuit Anaesthetic Machine Wall Mount

MINI-KOMV1™ Close Circuit Anaesthetic Machine Single Vapouriser

MK5 Closed Circuit Anaesthetic Machine

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