Exposure to anaesthetic hazards is one among the occupational exposures in manipulating toxic agents or inhaling toxic gases during anaesthetic practices.

Toxic gases mainly nitrous oxide, is one of the most gaseous anaesthetic agents that constitutes an important source of pollution. One of the safe and effective technics used in anaesthesia and reducing the amount of pollution is the Total Intravenous Anaesthesia (TIVA) which consists of using opioids in analgesia and propofol for the induction and the maintenance of anaesthesia. It refers to the administration intravenously of an anaesthetic, sedative, and/or tranquilizer. A less polluting but not the best way to get rid of the toxic aesthetic agents is the scavenger system that collects and expels the gas outside the medical environment. Yet, this technique still represents a hazard for the environment and still increase the risk of exposure for the health workers and clinical staff.

Fume cupboards are also not recommended to use because of their high pollution potency, mainly of the air resulting in a great harm for medical workers.

Supraglottic airways as well as the Air Changes per Hour technics could be harmful for both patients and health workers, increasing the risks of transmitted diseases, namely nosocomial infections.

Therefore, the Total Intravenous Anaesthesia technique (TIVA) is most likely to be safe and recommended to use.

A paediatric 19G Tuohy catheter is available that is 5cm in length and has 0.5cm markings

18G Tuohy catheters are generally 9 to 10cm to hub

Distal end of catheter is angled (15 to 30 degrees) and closed to avoid puncturing the dura

Epidural mesh are usually 0.2 microns and are used to filter bacteria and viruses to ensure sterility of procedure

Transparent catheters are 90cm long with diameters depending on gauge size. It has 1cm graduations from 5 to 20cm to ensure they have been inserted amply and removed completely. Distal end is smooth which can be open or closed (with lateral openings)

The normal peak inspiratory flow in healthy individuals is 20-30 L/min during each normal tidal ventilation. This is expected to increase with greater respiratory rate and deeper inspiration.

Face masks are used to facilitate the delivery of oxygen from a breathing system to a patient. Face masks can be divided into two types: fixed performance or variable performance devices.

In fixed performance devices (also known as high air flow oxygen enrichment or HAFOE), fixed inspired oxygen concentration is delivered to the patent, independent and greater than that of the patient’s peak inspiratory flow rate (PIFR). No random entrainment is expected to occur at the time of PIFR, hence, the oxygen concentration in HAFOE devices is not dependent on the patient’s respiratory pattern.

Moreover, in HAFOE masks, the concentration of oxygen at a given oxygen flow rate is determined by the size of the constriction; a device with a greater entrainment aperture delivers a lower oxygen concentration. Therefore, a 40% Venturi device will have lesser entrainment aperture when compared to a 31% Venturi. Venturi masks allow relatively fixed concentrations of supplemental oxygen to be inspired e.g. 24%, 28%, 31%, 35%, 40% and 60% oxygen. These are colour coded and marked with the recommended oxygen flow rate.

Variable performance devices deliver variable inspired oxygen concentration to the patient, and is dependent on the PIFR. The PIFR can often exceed the flow rate at which oxygen or an oxygen/air mixture is supplied by the device, depending on a patient’s inspiratory effort. In addition, these masks allow expired air to be released through the holes in the sides of the mask. Thus, with increased respiratory rate, rebreathing of alveolar gas from inside the mask may occur.

A Wrights Respirometer measures the volume of air exhaled over the course of one minute of normal breathing

It is unidirectional and measures tidal volume and minute volume of gas flow in one direction. It is placed at the expiratory side (lower pressure than inspiratory side therefore lower chances of gas leaks)

Slits are arranged such that incoming gas will rotate the vane at a rate of 150 revolutions per litre of flowing gas

The Wright respirometer tends to over-read at high flow rates and under-read at low flows because of mechanical causes like friction and inertia and the accumulation of water vapour

The ideal flow for accurate readings is 2 L/min for the respirometer. The respirometer reads the tidal volume and minute volume with a ±5–10% accuracy within the range of 4–24 L/min.

It’s a minute volume divider – True
The Manley MP3 ventilator is classed as a minute volume divider. The entire fresh gas flow or minute volume is delivered to the patient, having been divided into readily set tidal volumes.

Can efficiently ventilate patients with poor pulmonary compliance – False
Ventilating patients with poor pulmonary compliance is not easily achieved, which makes it an unsuitable ventilator for a modern ICU.

Can generate tidal volume up to 1500ml – False
It can generate tidal volumes up to 1000 ml (not 1500 ml), and the inflation pressure can be adjusted by sliding a weight along a rail.

Functions like a Mapleson A system during spontaneous ventilation – False
The ventilator functions like a Mapleson D breathing system (not Mapleson A) during spontaneous ventilation.

Has three sets of bellows – False
The fresh gas flow drives the ventilator which allows rapid detection of gas supply failure. It has two sets of bellows (not three) and three unidirectional valves.

Dinamap continuously measures the systolic, diastolic and mean arterial pressure along with pulse rate, thereby providing a continuous monitoring of the blood pressure using the osscillitonometric principle of measurement.

The device loses accuracy towards the extremes of BP and is more accurate with systolic compared with diastolic pressure. In arrhythmias such as AF, the devices are also inaccurate due to the major fluctuations associated with the individual pulse pressure variations.

The manual BP device is still the gold standard for BP measurement and monitoring.

A single chamber pacemaker was implanted in the patient. In VVI mode, a pacemaker paces and senses the ventricle while being inhibited by a perceived ventricular event. The most likely electrical hazard from diathermy is electromagnetic interference (EMI).

EMI has the potential to cause the following: Inhibition of pacing
Asynchronous pacing
Reset to backup mode
Myocardial burns, and
Trigger VF.

Diathermy entails the implementation of high-frequency electrical currents to produce heat and either make incisions or induce coagulation. Monopolar cautery involves disposable cautery pencils and electrosurgical diathermy units. In typical monopolar cautery, an electrical plate is placed on the patient’s skin and acts as an electrode, while the current passes between the instrument and the plate. Monopolar diathermy can therefore interfere with implanted metal devices and pacemaker function.

Bipolar diathermy, where the current passes between the forceps tips and not through the patient and is less likely to generate EMI.

Whilst the presence of a CVP line may in theory predispose the patient to microshock, the use of prerequisite CF electrical equipment makes this very unlikely. The presence of a CVP line and pacemaker does not therefore unduly increase the risk of an electrical hazard.

Isolating transformers are used to protect secondary circuits and individuals from electrical shocks. There is no step-up or step-down voltage (i.e. there is a ratio of 1 to 1 between the primary and secondary windings).

A ground (or earth) wire is normally connected to the metal case of an operating table to protect patients from accidental electrocution. In the event that a fault allows a live wire to make contact with the metal table (broken cable, loose connection etc.) it becomes live. The earth will provide an immediate path for current to safely flow through and so the table remains safe to touch. Being a low resistance path, the earth lets a large current flow through it when the fault occurs ensuring that the fuse or RCD will quickly blow. Without an operating table earth, the patient is not at more risk of an electrical hazard because of the pacemaker.

The following are the colour codes for medical gas cylinders:

Oxygen cylinder has a dark body with white shoulders.

Nitrous oxide is French blue. Air encompasses a grey body with dark and white quarters on the shoulders.

Entonox contains a French blue body with white and blue quarters on the shoulders.

Carbon dioxide barrels are grey in colour.

Microshock refers to ventricular fibrillation caused by miniscule amounts of currents or voltages (100-150 microamperes) passing through the myocardial tissue from external cables arising from electrical components within the cardiac muscle, for example, pacemaker electrodes or saline filled venous catheters.
The risk of shock changes with the construction of electrical equipment in question. The main classes of electrical equipment include: I: Appliances have a protective earth connected to an outer casing which prevents live elements from coming in contact with conductive elements. A fault in this equipment class will result in live elements coming in contact with the outer casing and allowing electrical flow into the protective earth. This triggers the protective fuse to disconnect the electric supply to the appliance.
II: These appliances have reinforced insulation. In the event of a fault which causes the first layer of insulation to fail, the second layer is able to prevent contact of live elements with outer casing.
III: These appliances have no insulation to provide safety, and rely solely on the use of separated extra low voltage source (SELV) which limits voltage to 25V AC or 60V DC allowing for a person to come in contact with it without risk of a shock under normal dry conditions. Under wet conditions, voltage supply should be lowered to reduce risk of shock. These devices have no risk of macroshocks, but some risk of microshocks.
Class I and II electrical appliances are further divided into subtypes developed to limit current leakage in the event of a singular fault:
B (body): Upper limit of current leakage is 500 µA. This current can cause skin tingling and microshocks, but is not sufficient to cause injury.
BF (body floating): These appliances have an isolating capacitor or transformer which separate the secondary circuit from the protective earth. The upper limit of current leakage is the same as type B.
CF (cardiac floating): Upper limit of leakage current during a singular fault is 50 microamps. It is least likely to result in a microshock

There are two types of defibrillators
AC defibrillator
DC defibrillator

AC defibrillator,
consists of a step-up transformer with primary and secondary winding and two switches. Since secondary coil consists of more turns of wire than the primary coil, it induces larger voltage. A voltage value ranging between 250V to 750V is applied for AC external defibrillator. And used to enable the charging of a capacitor.

DC defibrillator,
consists of auto transformer T1 that acts as primary of the high voltage transformer T2. Is an iron core that transfers energy between 2 circuits by electromagnetic induction. Transformers are used to isolate circuits, change impedance and alter voltage output. transformers do not convert AC to DC.

Diode rectifier composed of 4 diodes made of semiconductor material allows current to flow only in one direction. Alternating current (AC) passing through these diodes produces direct current (DC). Capacitor stores the charge in the form of an electrostatic field.

Capacitor is used to convert the rectified AC voltage to produce DC voltage but capacitors do not directly convert AC to DC.

Inductor induces a counter electromotive force(emf) that reduces the capacitor discharge value.

In step-down transformer primary coils has more turns of wire than secondary coil, so induced voltage is smaller in the secondary coil.

Mapleson classified breathing systems into A, B, C, D and E. Jackson-Rees subsequently modified the Mapleson E by adding a double-ended bag to the end of the reservoir tubing, creating the Mapleson F. A Mapleson E or T-piece does not have a reservoir bag.

A Mapleson A system is a very efficient system for use during spontaneous ventilation. However, it is not suitable for use with patients less than 25 kg, due to the increased dead space at the distal / patient end. This system can be modified into a Lack system or coaxial Mapleson A, where the fresh gas flows through an outer tube (30 mm) and exhaled gases flow through the inner tube (14 mm).

The adjustable pressure limiting valve (APL) or expiratory valve allows exhaled gas and excess fresh gas to leave the breathing system. It is a one-way, adjustable spring-loaded valve, and gases escape when the pressure in the system exceeds the valve opening pressure. During spontaneous ventilation a pressure of less than 1 cm of water (0.1 kPa) is needed when the valve is in the open position (not 2 cm of H2O).

The reservoir bag is highly compliant and when over inflated, the rubber bag can limit the pressure in the system to about 40 cm of H2O.

This is due to the law of Laplace, which states that the pressure will fall as the radius of the bag increases:

Pressure = 2 x tension/radius.

End-tidal carbon dioxide (ETCO2) monitoring has been an important factor in reducing anaesthesia-related mortality and morbidity. Hypercarbia, or hypercapnia, occurs when levels of CO2 in the blood become abnormally high (Paco2 >45 mm Hg). Hypercarbia is confirmed by arterial blood gas analysis. When using capnography to approximate Paco2, remember that the normal arterial–end-tidal carbon dioxide gradient is roughly 5 mm Hg. Hypercarbia, therefore, occurs when PETco2 is greater than 40 mm Hg.

The most likely explanation for the changes in capnograph is either exhaustion of the soda lime and a progressive rise in circuit dead space.

Inspect the soda lime canister for a change in colour of the granules. To overcome soda lime exhaustion, the first step is to increase the fresh gas flow (FGF) (Option A). Then, if need arises, replace the soda lime granules. Other strategies that can work are changing to another circuit or bypassing the soda lime canister, but remember that both these strategies are employed only after increasing FGF first. Exclude other causes of equipment deadspace too.

There are also other causes for hypercarbia to develop intraoperatively:
1. Hypoventilation is the most common cause of hypercapnia. A. Inadequate ventilation can occur with spontaneous breathing due to drugs like anaesthetic agents, opioids, residual NMDs, chronic respiratory or neuromuscular disease, cerebrovascular accident.
B. In controlled ventilation, hypercapnia due to circuit leaks, disconnection or miscalculation of patient’s minute volume.
2. Rebreathing – Soda lime exhaustion with circle, inadequate fresh gas flow into Mapleson circuits and increased breathing system deadspace.
3. Endogenous source – Tourniquet release, hypermetabolic states (MH or thyroid storm) and release of vascular clamps.
4. Exogenous source – Absorption of CO2 from pneumoperitoneum.

Pulse oximeters combine the principles of oximetry and plethysmography to noninvasively measure oxygen saturation in arterial blood. A sensor containing two or three light emitting diodes and a photodiode is placed across a perfused body part, commonly a finger, to be transilluminated. Oximetry depends on oxyhaemoglobin and deoxyhaemoglobin, and their ability to absorb the beams of light produced by the light emitting diodes: red light at 660 nm and infrared light at 960 nm.

The isosbestic point is the point wherein two different substances absorb light to the same extent. For oxyhaemoglobin and deoxyhaemoglobin, the points are at 590 nm and 805 nm. These are considered reference points where light absorption is independent of the degree of saturation.

Non-constant absorption of light is often due to the presence of an arterial pulsation, whilst constant absorption of light is seen in non-pulsatile tissues.

Most pulse oximeters are inaccurate at low SpO2, but is accurate at +/- 2% within the range of 70% to 100% SpO2. All pulse oximeters demonstrate a delay in between changes in SaO2 and SpO2, and display average readings every 10 to 20 seconds, hence they are unable to detect acute desaturation episodes.

The operating theatre is an unusual place with several applications of electrical equipment to the human body. This can lead to potential dangers associated with it that need to be prevented. Electrical safety in the operation theatre is the understanding of how these potential dangers can occur and how they can be prevented.

Electricity can cause morbidity or mortality by one of the following ways:
(i) electrocution
(ii) burns
(iii) ignition of a flammable material, causing a fire or explosion.

Electrocution is dependant on factors like duration of contact with electric current, the current pathway and the frequency and size of current.

Option A: The higher the frequency, the less effects of electrocution on the body.

Option B & D: Equipment can be classified in classes and types.
The class designation describes the method used for protection against electrocution. Class I is basic protection, class II is double insulation and class III is safety extra low voltage.
The type designation describes the degree of protection based on the maximum permissible leakage currents under normal and fault conditions.
Type B:
can be class I, II or III but the maximum leakage current must not exceed 100 µA. It is therefore not suitable for direct connection to the heart.
Type BF
Similar to type B, but uses an isolated (or floating) circuit.
Type CF
Only type CF protect against microshock as they allow leakage currents of 0.05 mA per electrode for class I and 0.01 mA for class II. Microshock is a small leakage current that can cause harm because of direct connection to the heart via transvenous lines or wires, bypassing the impedance of the skin, leading to ventricular fibrillation. Microshock current of 100 ?A is sufficient to cause VF.

Option C: A 75mA electrocution can cause ventricular fibrillation. Use the following as a general guide to understand the effect of current size on the body.
1 mA – tingling pain
5 mA – pain
15 mA – tonic muscular contraction
50 mA – respiratory muscle paralysis
75 mA – ventricular fibrillation.

Option E: Wet skin reduces the resistance to current flow and therefore increases the effects of electrocution.

Flowmeters measure the rate at which a specific gas, that the flowmeter has been calibrated for, passes through. This calibration is done at room temperature and standard atmospheric pressure with an accuracy of +/- 2%.

Reading the flowmeter is done from the top of a bobbin (the midpoint of a ball). Oxygen is the last gas to be added downstream to the mixture delivered to the back bar as a safety feature. This prevents delivery of a hypoxic mixture.

Inaccurate flow measurements occur when the bobbin sticks to the inside wall of the flowmeter. Stannic oxide has been used as a successful antistatic substance thus, reducing the aforementioned risk.

Carbon dioxide being easily delivered is found on some older machines, but those attached flowmeters are limited by a maximum flow of 500 ml /min. Thus avoiding the delivery of a hypercarbic mixture.

Tracheal tubes are made of either disposable plastic or reusable red rubber.

The tube size refers to the internal diameter (ID) in mm which is marked on the outside of the tube (some manufacturers mark the external diameter on the outside).

Plastic tubes have a radiopaque line spanning the entire length of the tube, which allows their position to be identified on x-rays. The bevel located at the end of the tube is left-facing and oval in shape, which improves the view of the vocal cords during intubation.

Oxford tubes are L-shaped and have a bevel that faces posteriorly. They have thick walls that increase the external diameter, making for a wider internal diameter.

RAE (Ring, Adair, and Elwyn) tubes are preformed and can either be north or south facing and cuffed or uncuffed. The cuffed RAE tubes have one Murphy eye, whereas the uncuffed has two Murphy eyes. Uncuffed tubes are primarily used in paediatric anaesthesia and the two Murphy eyes ensure adequate ventilation- should the tube be too long.

A thermocouple, or a thermal junction, is temperature measuring device consisting of a pair of dissimilar metal (bimetallic) wires or strips joined together. Typically, copper and constantan (an alloy of 55% copper and 45% nickel) are used. When there is contact between these metals, a small voltage is generated in the order of millivolts. The magnitude of the thermojunction electromotive force (emf) is proportional to applied temperature (the Seebeck effect). This physical principle is applied in the measurement of temperature. The electromotive force at the measuring junction is proportional to temperature.

Two wires with different coefficients of expansion, joined together, can be used as a switch for thermostatic control.

Semiconductors are NOT used in thermocouple. The resistance of the measuring junction of a thermocouple is irrelevant.

Warming, humidifying, and filtering inspired anaesthetic gases is done by heat and moisture exchangers (HME) and breathing system filters. They are made of glass fibres materials and are supported by a sturdy frame. Pleating increases the surface area to reduce resistance to air flow and boost efficiency.

Filters’ effectiveness is determined by the amount and size of particles they keep out of the patient’s airway. The efficiency of filters might be classified as 95, 99.95, or 99.97 percent. Pores with a diameter of 0.2 µm are common. The following are examples of typical particle sizes:
Red blood cell – 5 µm
Lymphocyte – 5-8 µm
Viruses – 0.02-0.3 µm
Bacteria – 0.5-1 µm
Depending on particle size, gas flow speed, and charge, particles are collected via a number of processes. Mechanical sieve, interception, diffusion, electrostatic filtration, and inertial impaction are some of the options:

Sieve:
The diameter of the particle the filter is supposed to collect is smaller than the apertures of the filter’s fibres.

Interception:
When a particle following a gas streamline approaches a fibre within one radius of itself, it becomes attached and captured.
Diffusion:

A particle’s random (Brownian) zig-zag path or motion causes it to collide with a fibre.
By attracting and capturing a particle from within the gas flow, it generates a lower-concentration patch within the gas flow into which another particle diffuses, only to be captured. At low gas velocities and with smaller particles (0.1µm diameter), this is more common.

Electrostatic:

These filters use large diameter fibre media and rely on electrostatic charges to improve fine particle removal effectiveness.

Impaction due to inertia:

When a particle is too large to respond fast to abrupt changes in streamline direction near a filter fibre, this happens. Because of its inertia, the particle will continue on its original course and collide with the filter fibre. When high gas velocities and dense fibre packing of the filter media are present, this sort of filtration mechanism is most prevalent.

When the emergency oxygen flush is pressed, 100% oxygen is supplied from the common gas outlet. This gas bypasses BOTH flowmeters and vaporisers. The flow of oxygen is usually 45 l/min at a PRESSURE OF 400 kPa.

There is an increased risk of pulmonary barotrauma when the emergency flush is pressed, especially when anaesthetising paediatric patients.

The inappropriate use of the flush causes dilution of anaesthetic gases and this increases the possibility of anaesthetic awareness .

The Drager Oxylog® 1000 is a pneumatically powered, time-dependent, volume-titrated emergency ventilator with a pressure limit. It is compatible with CD cylinder oxygen. The CD cylinder is a strong and lightweight cylinder usually composed of aluminium or Kevlar. The internal cylinder volume is 2 litres, and the pressure of a full cylinder is 230 bar. The volume of the full cylinder is determined by applying Boyle’s law: P1 × V1 = P2 × V2

Where:
P1= pressure of a full cylinder (230 bar)
V1= volume of oxygen at that pressure (2 litres)
P2= final pressure (1 bar), and
V2= volume of oxygen in the full cylinder.

Substituting values into the equation:

230 × 2 = 1 x V2
V2 = 460 litres. The flow of fresh gas is 4 litres/minute + 1 litre/minute required by the control, making a total of 5 litres/minute. The amount of time it takes for the cylinder to empty would be the total volume of oxygen in the full cylinder divided by the amount of oxygen expelled per minute: 460/5 = 92, meaning it would take 92 minutes for the cylinder to empty.

Carbon dioxide (CO2), is a carbonic gas made up of two dissimilar atoms, namely one carbon atom and two oxygen atoms. Capnography is a technique used to measure carbon dioxide during a respiratory cycle, and it consists in calculating the concentration of the partial pressure of CO2, through the absorption of the infrared light, namely that CO2 absorbs infrared radiation at a wavelength of 4.28 µm.

End-tidal CO2 (ETCO2), referring to the level of the carbon dioxide released at the end of an exhaled breath, is required to be continuously monitored, especially in ventilated patients, as it is a sensitive and a non invasive technique that provides immediate information about ventilation, circulation, and metabolism functions. ETCO2 is normally lower than the arterial partial pressure and varies between 0.6 and 0.7 kPa.

There are two methods used to measure carbon dioxide. The sidestream capnometer method samples gases at a set flow rate (150-200 mL/min) from a sampling area through small diameter tubing, and the mainstream analyser method that uses a direct measurement of the patient exhaled CO2 by a relatively large and heavy sensors. Sidestram method allows the analysis of multiple gases and anaesthetic vapours comparing to the mainstream method that does not allow the measurement of other gases.

Pipeline gases (in the UK this includes: Oxygen, Nitrous oxide, Medical air, and Entonox) are supplied at 4 bar (or 400 kPa), and compressed air is supplied at 7 bar for power tools.

Carbon dioxide and nitric oxide are usually only supplied in cylinders.

The nerve stimulators deliver a stimulus lasting for 1-2 milliseconds (not second) to perform nerve blockage.

There are just 2 leads (not 3); one for the skin and other for the needle.

Prior to the administration of the local anaesthesia, a current of 0.25 – 0.5 mA (not 1-2mA) at the frequency of 1-2 Hz is preferred.

If the needle tip is close to the nerve, muscular contraction could be possible at the lowest possible current.

Insulated needles have improved the block success rate, as the current is only conducting through needle tip.

Stimulus to the femoral nerve which is placed in the mid lingual line causes withdrawer of the quadriceps and knee extension, that’s the dancing patella ( not plantar flexion).

Professor Mapleson classified non-rebreathing circuits based on the position of the APL valve, which controls fresh gas flow.

The Mapleson A (Magill) circuit is most effective in spontaneous breathing, requiring only 70-100 ml/kg (the patient’s minute volume) of fresh gas flow. The patient inhales fresh gas from the reservoir bag and tubing during inspiration. During expiration, the patient adds dead space gas (gas that hasn’t been exchanged) to the tubing and reservoir bag in addition to the fresh gas flow. At the patient’s end, alveolar gas is vented through the APL valve. During the expiratory pause, the fresh gas flow causes more gas to be released.

The Mapleson A is inefficient during controlled ventilation. Venting occurs during inspiration rather than during the expiratory phase, as it does during spontaneous ventilation. As a result, unless a high fresh gas flow of >20 L/minute is used, alveolar gas is rebreathed.

During spontaneous ventilation, the Mapleson D circuit is inefficient.

The oxygen concentration in a Hudson mask is insufficient to allow for adequate pre-oxygenation.

Mapleson breathing system (or circuit) analysed five different arrangements of components of the breathing system:
Mapleson A – It is the most efficient for spontaneous respiration. The flow of fresh gas required is 70-85 ml/kg/min, i.e., approximately 5-6 lit./min fresh gas flow for an average adult.
Mapleson B and C – inefficient for both SV and PPV; requires gas flow of two to three times minute volume (100 ml/kg/min). Not commonly used but category C may be used for emergency resuscitation.
Mapleson D – efficient for PPV at gas flow equivalent to patient’s minute volume; the Bain’s circuit is a coaxial version of the Mapleson D
Mapleson E and F – for paediatric use; requires gas flow at two to three times the patient’s minute volume. The Mapleson F consists of an open-ended reservoir bag (Jackson-Rees modification).

Eye damage is the most common potential hazard associated with laser energy. Everyone in the laser treatment room has the risk of eye exposure when working with a Class 3b or Class 4 healthcare laser system, and damage to various structures in the eye depending on wavelength of the laser if they are unprotected.

Red and near-infrared light (400-1400 nm) has very high penetration power. The light causes painless burns on the retina after it is absorbed by melanin in the pigment epithelium just behind the photoreceptors.

Infrared radiation (IR), or infrared light (>1060 nm), is a type of radiant energy that’s invisible to human eyes and hence won’t elicit the protective blink.

Ultraviolet light (<400 nm) is also a form of electromagnetic radiation which is can penetrate the cornea and be absorbed by the iris or the pupil and cause burn injuries or cataract occur due to irreversible photochemical retinal damage. Safety eyewear is the best method of providing eye protection and are designed to absorb light specific to the laser being used. Laser protective eyewear (LPE) includes glasses or goggles of proper optical density (OD). The lenses should not be glass or plastic. The LPE should withstand direct and diffuse scattered laser beams. The laser protection supervisor (LPS) or LSO is an individual who is responsible for any clinical area in which lasers are used. They are expected to have a certain level of equipment and determine what control measures are appropriate, for each individual system, but their presence does not guarantee the chances of having an eye injury. Class 1 lasers are generally safe under every conceivable condition and is not likely to cause any eye damage. Class 3b or Class 4 medical laser systems are utilized in healthcare which have their own safety precautions. Polarized spectacles can make your eyes more comfortable by eliminated glare, however, they will not be able to offer any protection against wavelengths at which laser act.
Using short bursts to reduce energy is also not correct as it would still be harmful to eye.

The principle by which a strain gauge works is that when a wire is stretched, it becomes longer and thinner, and as a result, its resistance increases.

A strain gauge, which is used in pressure transducers, acts as a resistor. When the pressure in a pressure transducer changes, the diaphragm moves, changing the tension in the resistance wire and thus changing the resistance.

Changes in current flow through the resistor are amplified and displayed as a pressure change measure.

A Wheatstone bridge, on the other hand, is frequently used to measure or monitor these changes in resistance.

This patient is morbidly obese and has a high risk of developing hypoxia. This will be exacerbated by the patient’s supine position, as a result of:

Functional residual capacity has been reduced (FRC)
Increased closing capacity (CC)
Reduced tidal volume due to increased airway resistance, decreased thoracic cage compliance, and decreased respiratory muscle strength and endurance
Following induction of general anaesthesia, there is a tendency for atelectasis and increased O2 consumption due to the increased workload of respiratory muscles and the overall increase in metabolism.

Pre-oxygenation with 100 percent oxygen via a tight-fitting mask can be done using either tidal volume breaths for three to five minutes or four vital capacity breaths in normal circumstances. In the head-up position, this patient is much more likely to be adequately pre-oxygenated, maximising the FRC and minimising the CC. In spontaneously breathing patients, the Mapleson A and circle systems are both effective, but the Mapleson D requires 160-200 ml/kg/minute to prevent rebreathing.

A higher frequency ultrasound comes with a better resolution of the digital image. Ultrasound with a frequency of 15 MHz is best used in imaging of superficial organs such as the thyroid gland, muscles, tendons and breasts whereas deep organs are better imaged using a lower frequency of 2-7MHz because of its ability for deeper penetration but lower resolution. These low frequency probes are also used to diagnose ascites, pleural effusions or can be used in echocardiography.

The US probe emits and then absorbs a reflected wave. Similar to brightness control, increasing the gain will amplify the return signal which is then attenuated by the tissue. This increases the signal to noise ratio.
A high frame rate, which basically means the number of times an image is updated onto the screen per second, improves the resolution of a moving 3D image which has become more accurate as the computing power has increased.

Widening of the image field can be obtained by altering the penetration depth which is obtained by changing the frequency of the US beam

Two bonded wires of dissimilar metals, iron/constantan or copper/constantan, make up a thermocouple (constantan is an alloy of copper and nickel). At the tip, a thermojunction voltage is generated that is proportional to temperature (Seebeck effect).

All of the other connections are non-linear.

For a single compartment model, the relationship between a decrease in plasma concentration of an intravenous bolus of a drug and time is a washout exponential.

A sine wave is the relationship between current and degrees or time from a mains power source.

A sigmoid curve represents the relationship between efficacy and log-dose of a pure agonist on mu receptors.

The pressure of a fixed mass of gas and its volume (Boyle’s law) at a fixed temperature are inversely proportional, resulting in a hyperbolic curve.