Gas monitoring system

using ultrasound sensors

KARL WEISSER

Master’s Degree Project in

Electrical Measurement Technology
XR-EE-MST 2011:002
Stockholm, Sweden 2011
 Gas monitoring system using ultrasound sensors

Karl Weisser [email protected]

April 2011

This master thesis purpose is to study the possibility of measuring and monitoring
anesthesia agent concentration delivered from a vaporizer using ultrasound technique.
Abstract
This thesis reports a collaboration between KTH Microsystem Technology Labs and Maquet
critical care. Maquet is a company that produces medical ventilators and anesthesia
machines.

In an anesthesia machine it is important to monitor the anesthesia concentration that is

delivered so that the delivered anesthesia concentration does not deviate from the desired
concentration. Furthermore, in case of fail function there is a need to stop the delivery of
anesthesia to the patient and flush the system.
The anesthetic agent concentration is presently monitored with an infrared spectrometer.
By using ultrasound technology it is possible to determine the volume concentration of a gas
mixture by knowing the sound speed in the gases. Maquet has an ultrasound sensor that is
developed to measure the oxygen concentration in air. This sensor was modified in order to
measure nitrous oxide and anesthesia. The anesthesia concentration was measured by
placing sensors upstream and downstream from the vaporizer.
Using this ultrasound sensor system one can observe that the average discrepancy of the
entire concentration range is ±0.84 % for Desflurane and 0.17 % for Isoflurane in relation to
the infrared spectrometer sensor that is presently used in the anesthesia machine to
monitor the anesthetic agent.
Measurements show that the rise time of the ultrasound sensor varies when placing the
sensor in different orientations with respect to the airway flow. It also show that by placing a
flow restrictor that is used to force the airway flow in to the sensors measurement chamber
reduces the rise time to a tenth of its previous value.

Karl Weisser
Stockholm, April 2011

i
ii
Acknowledgments
This thesis has been possible due to all the help and support from the people that have
contributed with their knowledge and support during this time. During my time in Maquet I
have learned a lot of valuable knowledge that will benefit me during my whole life.

I would like to give a big thanks to Pär Emtell and Lars Wallén who has been my supervisors
during my thesis for their support, encouragement and guidance from beginning to end.

A very big and special thanks to Åke Larsson who has given his support and valuable
knowledge and understanding of various problems. And also for having the patience of
correcting and reading my rapport during his weekends and free time.

Thanks to Kiomars Fathollahzadeh how is an expert on the vaporizer module. Kiomars

sheared his expertise on the vaporizer module from how it works and how to make a
realistic test setup for high anesthetic concentrations.

Thanks to Hans Sohlström who is my supervisor at KTH. Thanks for your good advice on how
to write my rapport and for the fast feedback.

Thanks to Nebojsa Covic, whose expertise on software and hardware gave me a better
understanding of how the ultrasound sensor works from hardware to its C-code.

Thanks to Leif Back, his soldering expertise helped us when we needed to make small
changes on the ultrasound sensors PBC.

A very big thanks goes out to my partner in this journey, Sheng Yee Pang, whose quick
contradictions to my proposals made me think beyond my original thought and think outside
the box.

Thanks to Magnus Hallbäck, PhD, whose expertise in equations and fluid mechanics helped
us understand the complexity of the different gas behavior.

A thanks goes out to Mario Loncar, who is the manager of the research team at Maquet.
Thanks for the support and the comments on my rapport.

Last but not least, a big thanks to all the helpful and supporting colleagues and managers at
Maquet. Thanks for the fun time and Godspeed.

iii
Index
Abstract ................................................................................................................................ i
Acknowledgments.............................................................................................................. iii
1. Introduction ............................................................................................................................ 1
1.1. Goal .................................................................................................................................. 1
1.2. Ultrasound technique ...................................................................................................... 1
1.3. Technical prerequisites .................................................................................................... 2
1.4. Requirements .................................................................................................................. 2
1.5. Overview of the master thesis......................................................................................... 2
2. Background ............................................................................................................................. 4
2.1. Ventilator ......................................................................................................................... 4
2.2. Servo-i .............................................................................................................................. 4
2.3. The Anesthesia Machine ................................................................................................. 5
2.4. Flow-i ............................................................................................................................... 5
2.5. The vaporizer module ...................................................................................................... 6
2.6. Present technology for measuring anesthesia gases ...................................................... 7
2.7. Methods for measuring Anesthesia and Earlier work on the O2 sensor ........................ 7
3. Ventilator modes and settings ............................................................................................... 9
3.1. General description ......................................................................................................... 9
3.2. Ventilation modes ........................................................................................................... 9
3.3. Pressure controlled ventilation ..................................................................................... 10
3.4. Volume controlled ventilation ....................................................................................... 10
3.5. The Anesthesia machine and Flow-i .............................................................................. 11
3.6. The Bias gas flow ........................................................................................................... 12
3.7. Ventilator settings in Servo-i and Flow-i ....................................................................... 12
4. Principle of gas concentration measurement with ultrasound ........................................... 14
4.1. Physical relationship ...................................................................................................... 14
4.2. The ideal gas law............................................................................................................ 14
4.3. Sound velocity in a gas................................................................................................... 15
4.4. Calculating the heat capacity for Air, O2, N2O, and anesthesia ................................... 16
4.5. Determining the volume concentration of anesthesia in a fresh gas mixture.............. 17

iv
5. The Dual Gas Sampling System concept .............................................................................. 19
5.1. The O2 sensor ................................................................................................................ 19
5.2. The DGS system ............................................................................................................. 20
6. The BGA module ................................................................................................................... 22
6.1. The BGA’s pulse detection ............................................................................................. 22
6.2. The BGA´s hardware description ................................................................................... 23
6.3. The BGA’s chamber design ............................................................................................ 24
6.4. The resolution of Anesthesia agent concentration measurement ............................... 24
7. Implementation of the Dual Gas Sampling System .............................................................. 28
7.1. Implementation of the DGS system .............................................................................. 28
7.2. The DGS systems Software description ......................................................................... 29
7.3. Calculating the Anesthesia concentrations using the DGS system ............................... 32
8. Monitoring the Anesthetic Agent with the Dual Gas Sampling System .............................. 34
8.1. System Setup ................................................................................................................. 34
8.2. Monitoring the anesthesia concentration ..................................................................... 35
8.3. Mixing chamber after the vaporizer unit ...................................................................... 37
8.4. Transient problem occurring when changing fresh gas mixture ................................... 38
8.5. Transient problem Algorithms....................................................................................... 39
8.6. Monitoring the anesthesia concentration with one sensor .......................................... 41
9. Measurements ..................................................................................................................... 43
9.1. The Accuracy of the DGS system ................................................................................... 43
9.2. Rise, Response and Reaction time................................................................................. 45
9.3. The DGS systems Rise time ............................................................................................ 46
9.4. Response time ............................................................................................................... 51
9.5. Reaction time of the DGS system .................................................................................. 52
9.6. Optimizing the volume .................................................................................................. 53
9.7. Flow restrictor ............................................................................................................... 54
9.8. Position of the sensor .................................................................................................... 56
9.9. Effect of pressure variations on the DGS system .......................................................... 57
9.10. Effects of high concentrations in the DGS system ...................................................... 58
10. Suggestions for Improvement ............................................................................................ 62
10.1. Conclusion ................................................................................................................... 62

v
11. References .......................................................................................................................... 64
Appendix ........................................................................................................................... 65

vi
1.Introduction
Maquet is an internationally known company that develops ventilators and anesthesia
machines for treatment of patients under surgery and critical care. A medical ventilator is a
machine that is designed to mechanically assist a patient to breath and/or to replace the
patient’s spontaneous breathing mechanism by pushing breathable air into the lungs of the
patient when the patient is physically unable to breathe or breathing insufficiently. The
anesthesia machine additionally has the ability to anaesthetize the patient; this is done by
adding anesthetic agent vapor from a vaporizer to the fresh gas mixture.

1.1.Goal
The main purpose of this master´s thesis is to investigate whether it is possible to find an
improved way to measure and monitor the anesthesia concentration added by a vaporizer in
the anesthesia machine. The solution adopted in this thesis to measure the anesthesia
concentration is based on two ultrasound sensors that are presently used to measure the
oxygen concentration in medical ventilators produced by Maquet, one sensor measures the
properties of the gas before the addition of the anesthetic agent and one after.

1.2.Ultrasound technique
This thesis focuses on the concept of measuring the anesthetic agents using ultrasound
sensors upstream and downstream from the vaporizer. It is also investigates how accuracy is
affected by the different anesthesia drugs (Desflurane, Isoflurane and Sevoflurane). The
thesis also focuses on creating an anesthetic agent monitoring system and implementing it
in an anesthesia machine. This master’s thesis was done in parallel with Sheng Yee Pang [1],
where the parallel thesis focuses on modifying an existing O2 sensor in order to make it
useful also to measure anesthesia and Nitrous Oxide.

The goal of the master thesis is to investigate and describe the technical and theoretical
requirements for determining anesthesia concentration, also to design, produce and
evaluate a model to demonstrate the measurement. All gases passing the measurement
points are assumed to be dry meaning there is no H2O vapor. The assignment also includes
to investigate whether it is possible to monitor anesthetic concentration with only one
sensor located downstream from the vaporizer. The system can be used in two different
ways depending on its performance, it can either be used to determine the anesthetic
concentration after the vaporizer or it can be used to detect a failure of the vaporizer.
Depending on which of the application one selects the performance is focused either on
accuracy or on response time.

1
 1.3.Technical prerequisites
By measuring the speed of sound in a binary gas mixture (in this case Air/Oxygen or Nitrous
Oxide/Oxygen), it is possible to calculate the mixing ratio of the included gases provided that
one know the molecular weights M and the heat capacity of the gases included in the
mixture. It is also necessary to know the temperature of the included gases very accurately
since the speed of sound in a gas mixture is highly temperature dependent.

If the speed of sound is measured before and after that an anesthesia agent has been
applied, one can then theoretically calculate the anesthetic drug concentration.

This is due to that anesthetic vapor has a sound conduction velocity that is significantly
different from Air/O2 and N2O/O2.

1.4.Requirements
o The code and design should be well documented so that it can be maintained by
someone other than the original creator.
o The system accuracy should be better than accuracy over the concentration
range for the different anesthesia agents compared with the CGA1.
o The system should have a maximum of accuracy for Air, Oxygen and Nitrous
Oxide compared with the CGA.
o The functional model should be a stand-alone system consisting of dedicated
components.
o The Volume that passes the sensor before detecting a change in anesthesia
concentration should not exceed 34 ml. This is the volume between the vaporizers
output and the safety valve that is used to flush the system in case of high anesthesia
concentration in Flow-i.
o The rise time of ultrasound sensor should be faster than CGA, 0.7s.
o Measurement range for O2 shall be from 21% to 100% with good accuracy.
o Measurement range for N2O shall be up to at least 79% with good accuracy.
o Measurement range for Isoflurane shall be up to at least 5% with good accuracy.
o Measurement range for Sevoflurane shall be up to at least 8% with good accuracy.
o Measurement range for Desflurane shall be up to at least 18% with good accuracy.

1.5.Overview of the master thesis

1
CGA stands for Control Gas Analyzer and is a module that is used in Flow-i to measure the different gas
concentrations.

2
Chapter 2 Gives some theory on how the ventilator and anesthesia machines work. This
chapter gives an understanding of how the gases are delivered in these
machines and also gives a basis for how the lab environment is set up to
measure the anesthetic agents. The aim of this chapter is to provide the reader
with some understanding of the conditions and demands that are placed on
the monitoring system.

Chapter 3 Gives the reader an understanding of the different settings and modes in the
anesthesia machine and medical ventilator.

Chapter 4 The aim of this chapter aim is to give some understanding of the physical
relationships on how the gases are measured using ultrasound technique.

Chapter 5 This chapter introduces the Dual Gas Sampling System (DGSS) concept that this
thesis is based on. It gives some understanding on how the system works and
how it uses two sensors for measuring anesthesia.

Chapter 6 This chapter focuses on the Binary Gas Analyzer (BGA) sensor that is used in
the DGS system. It also focuses on how the BGA sensor detects the sound
speed in a anesthesia agent.

Chapter 7 This chapter explains how the DGS system is implemented in a anesthesia
machine (Flow-i). It also focus on how the concentration of the anesthetic
agent is calculated using the DGS system.

Chapter 8 Its aim is to explain how the DGS system is used to monitor the anesthetic
agent concentration. It also explains some basic problems that may occur when
monitoring the anesthetic agent concentration using the Dual Gas Sampling
System.

Chapter 9 Evaluates the DGS systems reliability, rise time, response time, reaction time
and accuracy. It also gives some proposals on how to improve the systems
reaction time.

Chapter 10 Gives a conclusion and a discussion on how the Dual Gas sampling system can
be improved and the advantages of using ultrasound technique for anesthetic
agent monitoring.

3
2.Background
The purpose of this chapter is to give the reader an understanding of how Maquet´s latest
anesthesia machine works.

2.1.Ventilator
A medical ventilator is a machine that is designed to mechanically assist a patient to breath
and/or to replace the patient’s spontaneous breathing mechanism by pushing breathable air
into the lungs of the patient when the patient is physically unable to breathe or breathing
insufficiently.

A medical ventilator can be used in intensive care, home care or in emergency medicine as a
standalone unit. Medical ventilators are also used in anesthesia delivery systems as a
component in the anesthesia machine. Modern medical ventilators are controlled
electronically by embedded systems in order to adapt the systems pressure and flow
characteristics to suite the individual patients need.

2.2.Servo-i
The latest intensive care ventilator product from Maquet is the Servo-i. It is an intensive care
ventilator that is capable of treating patients of all ages, from infants to adults. (see Figure
2.1)

Servo-i is capable of mixing two gases, air and oxygen (O2). There is a requirement to
monitor the resulting oxygen concentration. The Servo-i ventilator uses an O2 sensor located
in the inspiration channel. There are two different types of Oxygen sensors that can be used
in Servo-i. The first one is based on electrochemical sensing technology and the other one is
based on ultrasound technology. These sensors monitors the concentration of the O2
delivered to the patient so that the delivered amount of O2 does not deviate from the O2
setting. If this would be the case, the device will sound an alarm in order to notify the
operator.

In a ventilator the breathing gas is delivered to the patient and then released to the ambient,
thus it is a non-rebreathing system where it is sufficient to primarily monitor the gas
delivered to the patient only.

4
 Figure 2.1: Picture of Servo-I, an Intensive Care Ventilation product

2.3.The Anesthesia Machine

In an anesthesia machine there are more gases added in the breathing system. In addition to
air and oxygen the anesthesia machine can also deliver nitrous oxide to the patient. The
anesthesia machine can deliver two different gas combinations to the patient, air/oxygen or
nitrous oxide/oxygen. These gas combinations are also called fresh gas mixtures. The
anesthesia machine additionally has the ability to anaesthetize the patient; this is done by
adding anesthetic agent vapor from a vaporizer to the fresh gas mixture. The anesthetic
agents that are used in the anesthesia machine are Isoflurane, Desflurane and Sevoflurane.

Since the gas delivery to the patient is a complex process, there is a need not only to monitor
the gases to the patient but also to monitor the so called fresh gas mixture that is used to
replenish the recycled gas.

2.4.Flow-i
The latest anesthesia machine from Maquet is called Flow-i (see Figure 2.2). It is an
anesthesia machine with the same technical advantages as Servo-i with the difference that it
is also able to deliver N2O and different anesthetic agents to the patient. In Flow-i there is a
need to measure the anesthesia concentration after the vaporizer where the anesthetic
agents are introduced.

This is done in order to monitor that the desired anesthetic concentration that is set by the
machine operator is delivered to the patient, and to be able to turn off the delivery of
anesthesia and flush the system in case of any fault such as high anesthesia agent
concentration. The anesthetic agent´s in Flow-i are at present measured by a infrared OEM
module.

5
The ultrasound technology used today for expiratory flow measurement in Flow-i and the
oxygen concentration measurement in Servo-i has been identified as a possible technical
solution for anesthesia concentration monitoring that will be examined more closely in this
study.

Figure 2.2: Picture of Flow-i

2.5.The vaporizer module

The vaporizer module (see Figure 2.3 and Figure 2.4 below) is a module that is incorporated
in Flow-i. The module controls the addition of anesthetic drug to the fresh gas and ensures a
fast vaporization of the liquid anesthesia.

The anesthesia agent is retained in liquid form inside a container, a valve connects the
container to the vaporization chamber via a spray injector. The spray injector delivers the
anesthetic drug into the vaporization chamber in small pulsations; the frequency of the
pulsation depends on the fresh gas flow and the set anesthetic concentration in Flow-i.
Inside the vaporization chamber the liquid anesthesia is heated up to its vaporization
temperature by thin heater film that surrounds the walls of the vaporization chamber. In the
vaporization chamber the fresh gas mixes with the vaporized anesthesia agent, and then
transfers back to the circle system.

6
 Figure 2.3: Pictures of a Anesthesia vaporizers

Heater film
Fresh gas
inlet

Temp
measurement

Vaporizer Heater film

chamber

Agent spray

Fresh gas
outet

Spray Injector

Figure 2.4: schematic figure over the vaporizer module used in Flow-i

2.6.Present technology for measuring anesthesia gases

In Flow-i the anesthesia concentration measurement module uses infrared spectrometry
based on the fact that different molecules absorb specific frequencies that are characteristic
for their structure. This module is connected side-stream where it takes two gas samples,
one before the vaporizer and one after the vaporizer using a pump. This arrangement is
used in order to measure high anesthesia peek concentration.

There is a need to study a potentially faster, more precise and cheaper technology for
anesthesia concentration measurements. Also, the side stream pump technology gives a
sample lag that negatively affects the response time of the supervisory system.

2.7. Methods for measuring Anesthesia and Earlier work on the O2

sensor
It is important to be able to determine the anesthetic concentration in an anesthetic
machine. In year 1986, the American Society of Anesthesiologist (ASA) first approved a
standard for basic intraoperative monitoring. This standard was last updated in 2010 [2]. The

7
methods used for measuring the anesthetic agent concentration today are based on infrared
spectrometry (AION), RAMAN spectrometry, infrared photoacoustic spectrometry and
piezoelectric crystal agent analysis [3]. This thesis focuses on ultrasound technology for
measuring the anesthetic concentration. Earlier work on the ultrasound sensor in Maquet
showed that it is possible to measure the concentration of oxygen in an air/oxygen mixture.
It also showed that the oxygen concentration measurements worked well during both
pressure and temperature variations. This previous work on ultrasound technique led to the
developing of the binary gas analyzer sensor from start to finished product and integrated
with an inspiration channel in Servo-i.

8
3.Ventilator modes and settings
The purpose of this chapter is to get the reader acquainted with the different settings of the
ventilator. It gives a basic understanding of the demands and performance of the various
tests that are performed in this thesis. It also gives an understanding of how the placement
of the sensor plays a crucial part in measuring the anesthesia concentration.

3.1.General description
Maquet currently produces two different medical ventilator machines, Servo-i and Servo-s. A
medical ventilator (also known as a respirator) is used to maintain the breathing mechanism
in a patient who has lost or has a reduced capability to breathe. The inspiration valves
controls a flow of gas to the patients lungs. The gas is usually Air with a varied proportion of
Oxygen. The figure below shows an overview of the ventilator control system.

Inspiration valves Ventilator

O2
Mixing chamber Y-piece

Patient
Insp
Air or
O2-sensor test lung
Exp

Expiration valve

Figure 3.1: Overview picture of a ventilator

3.2.Ventilation modes
The ventilator has two different types of modes in Servo-i, controlled breathing and assisted
breathing. In assisted breathing the ventilator assists the patient in his attempts to breathe.
In controlled breathing the ventilator controls the entire breathing process of the patient.

The controlled inhalation or inspiration can according to the ventilation principle in Servo-i
work under both pressure controlled and volume controlled ventilation. Expiration and
exhalation works in the same way for both volume-controlled and pressure-controlled
ventilation.

9
 3.3.Pressure controlled ventilation
In pressure controlled ventilation a constant pressure in inspiration is provided to the
patient. The breathing frequency and duration of the inspiration cycle remains constant at a
selected preset value. The inspiratory pressure above the PEEP level is set by the operator
and will remain constant during the inspiratory phase. The beginning of the inspiration
phase can be made smoother by changing the set rise time of the pressure level. The flow
depends on the airway pressure and will be at its highest at the beginning of the inspiration
phase and is then decreased. The typical pressure and flow conditions are showed in the
figure below.
Breathing cycle
Insp. Exp.
Pressure

PEEP

Flow Time

Time
Figure 3.2: Pressure controlled ventilation

3.4.Volume controlled ventilation

In volume controlled ventilation, the ventilator delivers a preset flow of gas to the patient in
every breath during a set time. The ventilator controls all the timing parameters with the
difference that the patient can trigger the start of a new inspiration; a pause time can be set
in-between the end of the inspiration cycle and the beginning of the expiration cycle. The
figure below shows the typical pressure and flow curves set in volume controlled ventilation.
Breathing cycles
Insp. Pause Exp.
Pressure

PEEP
Time
Flow

Time

Figure 3.3: Ideal volume controlled ventilation

10
 3.5.The Anesthesia machine and Flow-i
The anesthesia machine can in addition to fresh gas also deliver anesthetic gas that is
capable to anesthetize the patient.

An anesthetic machine is a so called rebreathing system. Since the different anesthetic

agents that are used in the anesthesia machine are expensive and can be considered as
pollutions, the system is made to partially recycle and reuse these gases.

In Flow-i rebreathing system stores some of the patient’s expired gas in a volume reflector,
the rest of the gas that is not stored in the volume reflector exits the system by the
expiration valve, see Figure 3.4.The gas from the reflector passes through a soda-lime
absorber before it is introduced back to the patient. The purpose of the soda-lime absorbers
is to cleanse the rebreathed gas from any CO2 residues from the patient’s expiratory gas.

Mixer Vaporizer

V
·Anesthesia concentration
Air / N O
2
FA

VO2
monitoring

V freshgas
Vdrivegas
P P Valve Safety valve

Volume reflector Vrefl Absorber P PInsp

PATIENT
Reflection fraction Exsp-Insp P PExp
Exp Valve

Figure 3.4: Overview of a Anesthesia machine

11
 3.6.The Bias gas flow
The bias flow is a flow that is always present under all expiratory phase in the different
ventilation modes. The purpose of this flow is to trigger the breathing apparatus in volume
control and pressure control ventilation system. The flows magnitude varies depending if the
patient setting is adult or neonatal, for neonatal the bias flow is 0,3 liters per minute and for
adult it is 2 liters per minute.

3.7.Ventilator settings in Servo-i and Flow-i

The purpose of this section is to give the reader a basic understanding of the typical settings
in Servo-i and Flow-i. It also gives an understanding of the limitations of the test
environment since the tests are conducted using a modified Flow-i machine in order to
create an as realistic test environment as possible.

Following are the main settings for Servo-i and Flow-i.

Patient type Two different patient types can be set: adult and neonatal. This
setting affects the monitoring alarm profiles, maximum flow and
pressure, as well as the continuous bias flow of: Adult 2 l/min and
neonatal 0.5 l/min.

Respiration rate Number of ventilation controlled breaths during controlled

ventilation mode. Range of 4-100 breaths/min.

Inspiration time The proportion of a respiratory cycle for an inspiration. Range: 10-
80% of the respiratory cycle.

Pause time The pause time between the end of inspiration and the beginning
of expiration can be adjusted in volume controlled ventilation
mode. Range: 0-30% of the respiratory cycle.

Insp. rise time The time it takes for the flow or pressure to rise to the set value
from the beginning of an inspiration. Range: 0-20% of breathing
cycle time.

PEEP Positive expiratory pressure. Range: 0-50 mbar.

Pressure above PEEP level The airway pressure level of PEEP in pressure
controlled ventilation mode. Range: 0-100 mbar.

Tidal volume Breathing volume. Range: 20-2000 ml.

O2 conc. (air/O2) Oxygen concentration in air/O2 mode. Range: 21-100%.

12
The following anesthesia agent settings are only available in Flow-i.

O2 conc. (O2/N2O) Oxygen concentration in O2/N2O mode. Range: 28-100%.

Isoflurane Isoflurane concentration. Range: 0-5%

Sevoflurane Sevoflurane concentration. Range: 0-8%

Desflurane Desflurane concentration. Range: 0-18%

13
4.Principle of gas concentration measurement with
ultrasound
This chapter’s purpose is to give the reader a basic understanding of the physical
relationship of gas concentration measurement with ultrasound [4, 7,9].

4.1.Physical relationship
The speed of sound is dependent on the medium of its propagation. By measuring the speed
of sound in a fresh gas mixture (a mixture composed of two different gases) one can
determine the proportion of each of the components in the gas mixture if the molecular
weight is known. The temperature is also a crucial factor since the speed of sound in a
medium is highly dependent on the medium’s temperature.

The calculations and formulas used in the sections below are based on thermodynamic
relations and the ideal gas law. These formulas and relations are then used to determine the
concentration of the component in the gas mixtures.

4.2. The ideal gas law

The molecules in a gas are relatively mobile in relation to each other. The total volume of the
gas mass is large relative to the volume that the molecules occupy. When molecules collide
with a wall a force is created which constitutes to a gas pressure. In the case when the
pressure approaches zero one has an ideal gas, ref [4, 7,9].

The ideal gas law gives the following equations:

Where

is the pressure in
is the volume in
is the absolute temperature in
is the gas constant in

The gas constant, R is different for different gases and is calculated as:

Where

is the general gas constant

is the molecular weight in

14
 4.3.Sound velocity in a gas

The velocity of sound is defined as the speed which a small change of pressure is
propagating in the medium. √( ) [ ] [4.1]

where ( ) is the derivation of the pressure with respect of density at constant entropy.

For an ideal gas that goes through an isentropic process2:

Where

is the heat capacity at constant pressure in

is the heat capacity at constant volume in

Since , we get the following expression ( ) [4.2]

The following expression is derived from equation 1.2 with respect to :

( ) ( )

With

( )

This means that the speed of sound for an ideal gas with constant entropy, equation 4.1 can
be written as

√ [4.3]

Since and , we can rewrite equation 4.3 as:

√ [4.4]

2
An isentropic change of state (isentropic process) means that the process is adiabatic and reversible. Adiabatic means that
no heat exchange takes place with the surroundings. A reversible process means that there are no losses in the system and
that there is always equilibrium during a change of state, ref [4,7].

15
 4.4.Calculating the heat capacity for Air, O2, N2O, and anesthesia
The table below gives the molecular weight for the different gases in the mixtures, ref [Error!
Reference source not found.]

Molecular weight [ ]
Air
Oxygen
Nitrous Oxide
Desflurane
Isoflurane
Sevoflurane
Table 4.1

for an ideal gas [4.5]

( ) { } [4.6]

By knowing that , and estimated can be solve

using equation 4.6:

[4.7]

Equation [4.7] is inserted in equation [4.5] to solve . This leads to:

[4.8]

16
 4.5.Determining the volume concentration of anesthesia in a fresh gas
mixture
The following indexes are used in the formula:

1 –Anesthetic agent
2 – Fresh gas mixture

The sound velocity in a gas mixture can be written as

√ [4.9]

Where and in a gas are replaced with values corresponding to a mixture of gases.
The new magnitudes and are dependent on the relationship between gases.

In a binary mixture of ideal gases with volume proportion applies:

[4.10]

[4.11]

[4.12]

[4.13]

The volume concentration of the anesthetic agent is then resolved using equation 4.9-
4.13 as:

(
(

) ) ( ) [4.14]

Since equation [4.14] calculates the added anesthesia concentration to a fresh gas mixture
which itself is a binary mixture one needs to know the concentration proportions of this
mixture, the molecular weight and the specific heat capacity of the mixture. This is done by
replacing in equation [4.14] with

[4.15]

and

17
Where and are the fractions of the gas components of the fresh gas mixture. These
fractions can be determined from an ultrasound analysis upstream of the vaporizer.

18
5.The Dual Gas Sampling System concept
The purpose of this chapter is to give the reader an understanding of the dual gas sampling
system using an binary gas analyzer ( modified O2- sensor, see below) upstream and
downstream of the vaporizer. This system is created in order to measure and monitor the
different anesthetic agents used in Flow-i.

5.1.The O2 sensor
The O2 sensor (see Figure 5.1 and Figure 5.2 below) is used in Servo-i to monitor the oxygen
concentration of the gas delivered to the patient. It measures the time of flight for an
ultrasonic pulse over a given distance and can thus calculate the speed of sound in the gas
sample. Since the speed of sound is dependent of the combined molecular weight of the gas,
the gas concentration can be calculated assuming that it is a mixture of two known gases, a
so called binary mixture.

The speed of sound is then converted to a gas concentration using the fact that the gas
mixtures molecular weight has a unique speed of sound that does not overlap with each
other. The O2 sensor is designed so that it has a side stream measurement chamber where it
takes a sample of the main stream gas flow.

The speed of sound is dependent on the gas sample´s temperature as well as the molecular
weight. The O2-sensor design is specifically made to minimize pressure related temperature
variations that regularly occurs during ordinary ventilation. Since the speed of sound has a
strong temperature dependency, temperature variations caused by pressure swings that
affect the sound speed measurement, therefore an accurate temperature measurement is
required.

Two ultrasound transducers are placed in the semi side stream chamber; one of these emits
an ultrasound pulse and the other acts as a receiver. Since the length of the chamber house
is fixed, the time that it takes for the pulse to reach the receiver is dependent on the gas
mixture in the chamber house. The pulse repetition rate of the O2 sensor is 400 Hz.

In order to measure more than just Air/O2 i.e. N2O/O2 and/or anesthetic agent the O2-sensor
had to be modified, this is reported in a separate thesis [1]. Since the O2-sensor was
modified to measure more than just Air/O2, the sensor is from this point on called a binary
gas analyzer or BGA.

19
 Figure 5.1: Pictures of the O2 sensor in different angles

Measurement chamber

Measurement distance

Transmitter Receiver

Main flow
channel

Flow obstruction forcing a flow dependent

side stream into the O2-sensor

Figure 5.2: O2-sensor conceptual overview

5.2.The DGS system

There are six different gas compound combinations in Flow-i, two different fresh gas mixture
(Air/O2 or N2O/O2) and three different anesthesia agents, Desflurane, Sevoflurane and
Isoflurane. In order to monitor these gases a system had to be made in which this thesis is
based on.

A system was created by placing a BGA sensor upstream of the vaporizer and one after the
vaporizer in order to collect thee parameters that are necessary to calculate the anesthesia
concentration.

This system of having a BGA sensor upstream and one after the vaporizer is from this point
called DGS system (Dual Gas Sampling system). The purpose of this system is to measure and
monitor fresh gas mixture and the anesthesia concentrations. An illustration of the DGS
system is shown in Figure 5.3.

20
 Measuring the sound speed
Measuring the sound speed of fresh gas mixture with
of the fresh gas mixture added anesthesia agent

Vaporizer
Fresh gas mixture Fresh gas mixture with
Of O2/N2O or Air/O2 added anesthesia agent

Anesthesia agent

Figure 5.3: An schematic overview of the DGS system using two BGA´s

21
6.The BGA module
This chapter´s purpose is to give the reader a better understanding of how the BGA module
works, from pulse detection to its chamber design.

6.1.The BGA’s pulse detection

The speed of sound for the different gas mixtures is measured by using ultrasound technique.
This ultrasound is produced by having two piezo element transducers in a gas measurement
chamber where one of them acts as a transmitter and the other as a receiver. The
transmitter transducer is excited by three voltage pulse resulting in an ultrasound pulse
emitted from the transducer, see Figure 6.1. The response pulse is propagated in the gas
mixture and detected by the receiver transducer.

When the amplitude of the response pulse passes the threshold level, a detection window
opens and lets the CPU log a time value (timestamp value). This detection window opens
when a zero crossing has been detected. The threshold level is used to filter the structural
born noise in the signal and is regulated by software in the BGA sensors using the CPU´s built
in D/A converter. The detection window is activated when the response pulse is high enough
and it passes below the threshold level. An algorithm is used in the sensor to detect the
noise level of the response pulse, this is done by opening a detection window a after the
transmitted pulse. The transducer on the receiving end reads the amplitude level of the
noise during this detection window. The reference voltage is the set with an offset that is
higher than the noise level, this is done in order to ensure that the zero crossing of the noise
maintains undetected.
Detection window for zero crossing
Hold Hold Hold

First pulse transit time detected 1 2 3

Zero crossing 4
5 67

2.4V
Undetected pulse

Threshold level
0V
Excitation Group 1 Group 2 Group 3
pulse

Figure 6.1: A schematic figure over the binary gas analyzer pulse response and excitation pulse

22
 6.2.The BGA´s hardware description
The binary gas analyzer software controls threshold voltage using the DAC3 level that is built
in to the sensors CPU. The threshold voltage is kept above the noise level by using an
regulation algorithm to detect the nose level of the received pulse response and placing the
threshold voltage above this level in order to filter unwanted structure-borne noise.

When the response pulses voltage amplitude level is above the threshold level a detection
window opens that lets the CPU log a timestamp value.

The time stamp value is logged when a zero crossing of the response pulse is detected, in
other words when the response pulse crosses the reference voltage that is set to 2.4V. This
detection of the zero crossing is during the active phase of the detection window. The
detection is based on that a comparator compares the voltage level of the response pulse
with the reference pulse (see Figure 6.2). When the response pulse crosses the reference
voltage during an active detection window, the BGA´s microprocessor saves a time value.
The detection window have a built in hold delay, this delay is the delay until that the
detection window will close when the voltage level of the response pulse is not high enough.
The delay of the detection window is determined by a resistor and a capacitor (R1 and C1 in
Figure 6.2).

Detection window Zero crossing detection

+3.3V

CPU Comp 1 R1 Comp 2

p0 EN
X X<Y
DAC X X<Y
Y GND C1 Y GND

Received signal

+2.4V

Figure 6.2: A schematic figure of the binary gas analyzers detection window and zero crossing detection

3
DAC; Digital to analog conversion.

23
 6.3.The BGA’s chamber design
Measuring the speed of sound is a fast process; the response time is determined by how fast
the gas inside the sensor chamber house is replaced with a new gas. A large chamber
volume design would lead to a longer time for the gas to be replaced and is therefore
undesirable. The transducers in the chamber are positioned in such a manner that the
ultrasound pulse covers the entire detection window, this window has to cover the entire
time difference that occurs when measuring one gas and replacing it with another.

The pulse-train moves when changing gas in the chamber, its position increases or decreases
depending on the gas mixture. If the excitation pulse of the previous pulse-train is still
present when the gas has changed the new pulse-train will overlap the previous pulse-train
resulting in incorrect time measurement. To prevent this from happening the pause time
between the excitations has to be sufficiently long. The minimum pause time between two
excitations pulses is approximately 1.7 ms [1]. The distance between the transducers in the
measurement chamber is approximately 18mm (see Figure 6.3).

18 mm

Figure 6.3: The optimal transducer distance.

6.4.The resolution of Anesthesia agent concentration measurement

The resolution of the measured gas concentration (in this case anesthesia agent), depends
on the resolution of the time measurement. The resolution can be increased by increasing
the time to be measured, i.e. the length of the measurement chamber. The time
measurement depends in this case on the internal clock frequency of the binary gas analyzer
microprocessor.

The calculations below are done to estimate whether a god enough resolution of the
anesthesia agent concentration is detectable in the binary gas analyzer sensors first zero
crossing. The calculations are also made in order to know if the sensors cycle time is fast
enough to capture the time changes in the anesthetic agent concentration. By knowing the
physical properties of the different anesthesia agents such as the heat capacity at constant
pressure, the heat capacity at constant volume and the molecular weight, the speed of
sound is calculated using equation [6.1] and plotting it in Matlab for the concentration range
of 0-100% of the anesthetic gases.

24
The temperature was varied in these speeds of sound calculations from 288 to 328K in order
to get a larger overview on its impact on the resolution see Figure 6.4. The propagation time
is extracted from the general speed of sound equation for the binary gas analyzer using
equation [6.1], since the length is known in this case the distance between the transducers
in the camber house. This propagation time is then plotted for the different temperatures
and increasing concentrations from 0-100 %, see Figure 6.4 and appendix I.

In order to estimate the propagation time of the different anesthesia agents, the slope of
the propagation time graph is extracted in the concentration range of 20-40%. This range is
selected since it is the most linear region of the slope (see Figure 6.4). This interval is then
divided by the ranges percent value, in this case 20% (equation [6.2]) which gives the system
sensitivity for one percent of the anesthetic agent. This system sensitivity for the different
anesthesia agents is then divided by the sensors internal processor clock cycle time, this is
done in order to get the ticks resolution as described in equation [6.3]. A tick is in this case
the minimum resolution of the internal timer. The smallest possible detectible increment of
the gas concentration is calculated in equation [6.4]. These values are represented in
concentration per ticks.

Figure 6.4; A Matlab plot of the anesthetic concentrations time variation.

The time resolution is extracted in order to get an overview of how many cycles it takes to
measure the concentration of the different anesthesia agents. The cycle time is determined
by the internal clock frequency of the sensors microprocessor that operates at 25MHz
resulting in a cycle time of 40 ns.

The general speed of sound equation is given by;

25
 [6.1]

The system sensitivity per 1% for the anesthetic agent is extracted by using the relation;

[6.2]

The time resolution for 1% of anesthesia is obtained by the equation;

[6.3]

The lowest resolution for the different anesthesia agents in percent is calculated using the
equation;

[6.4]

With equation [5.1-5.4] the following tables are achieved;

Desflurane (C3H2F6O) in O2
Chamber length [mm]
[ ] [ ] [ ]

18

54

Isoflurane (C3H2CIF5O) in O2
Chamber length [mm]
[ ] [ ] [ ]

18

54

26
 Sevoflurane (C4H3F7O) in O2
Chamber length [mm]
[ ] [ ] [ ]

18

54

Table 6.1

The table above shows the result of the calculations. The length of the chamber is 18 mm as
a result of sending a pulse and detecting it right away without bouncing in the camber.
These simulations are also made to find out if the resolution would improve by sending a
pulse, letting it reflect in the camber and detecting it after the third bounce in the camber
with an effective length of 54mm.

As a result it was proven that using a chamber length of approximately 18 mm is satisfactory

for the resolution of the different anesthetic gases. This is good since a chamber length of 54
mm has a damping effect on the signal. The damping effect on the signal due to N 2O is
threated in a separate thesis [1].

27
7.Implementation of the Dual Gas Sampling System
This chapter’s purpose is to give the reader an understanding of how the dual gas sampling
system (DGSS) is implemented in Flow-i in order to monitor the anesthetic agent
concentration and oxygen concentration.

7.1.Implementation of the DGS system

The first sensor that is located upstream of the vaporizer see Figure 7.1, measures the pulse
transit time value and temperature of the fresh gas mixture. This information is then sent via
a I2C4 to USB converter NI-8451 (Figure 7.2) device connected to the lab computer and there
processed in LabView5 .

In LabView, a formula node6 was created where the time stamp value measured from the
first sensor is converted into a value for the speed of sound. Since the length of the BGA
sensor chamber is known the sound speed is easily calculated (this is explained in section
6.3). This sound speed value is then converted into a concentration using the equations
described in the section 4.5. These equations were first calculated in Maple before
implementing them in the formula nodes. The ratio of the gas components in the fresh gas
mixture is also calculated in this formula node. The second sensor that is located right after
the vaporizer measures the time stamp value and temperature of the same gas mixture as
the first thus with added anesthetic agent. The timestamp value for the second sensor is
then converted in to a concentration value in the same way as for the fresh gas mixture
concentration measured by the first sensor.

4 2
I C stands for inter-integrated circuit and is a multi-master single ended computer bus.
5
LabView is a developer platform and visual programing language developed by National instruments commonly used for
data acquisition and instrument control.
6
The Formula Node is a convenient text-based node that one can use to perform mathematical operations on the block
diagram. Formula Nodes are useful for equations that have many variables or are otherwise complicated and for using
existing text-based code.

28
 Labview
NI-8451
2
IC
O2

Sensor 1 Vaporizer
Sensor 2 Patient

Anesthesia

Air/ Fresh gas Fresh gas mixture plus

N2O mixture added anesthesia

Figure 7.1: A schematic figure over the DGS System.

In Flow-i three different anesthesia agents need to be monitored and two different fresh gas
flow mixtures (Air/O2 or N2O/ O2). This leads to a total of six different equation combinations.

2
Figure 7.2: NI-8451, a USB to I C communication interface

7.2.The DGS systems Software description

The fresh gas concentration and the anesthesia agent concentration are both calculated
using LabView version 9.0.1.

· Calculating the anesthesia concentration in LabView.

In LabView a formula nodes is created where the equations for calculating the speed of
sound for the anesthesia agent concentration are implemented. The in-parameter in this
formula node is the time of flight (timestamp value) measured by the binary gas analyzer.
Since the length of the sensor measurement chamber is known the speed of sound is
calculated for the fresh gas mixture with added anesthesia.

The speed of sound and the temperature measured by the sensor are then fed to a second
formula node that calculates the concentration of the anesthetic gas using the equations in
section 4.5. The sensor that measures the fresh gas concentration sends the information of
the fresh gas molar fraction and the speed of sound to the anesthesia agent concentration
formula node. All constant parameters that are needed in order to calculate the anesthetic
concentration are also fed to this formula node.

29
 Binary gas analyzer Temperature Binary gas analyzer Temperature
sensor 1 sensor 1 sensor 2 sensor 2

Time of flight, t Resistance, R Time of flight, t Resistance, R

Calculating the Calculating the Calculating the

Calculating the Calculating the
speed of sound for speed of sound for speed of sound
temperature, T1 temperature, T2
air/O2 mixture, c N2O/O2 mixture, c for anesthesia, c

Calculating
concentration of
gas compounds

Concentration O2 Concentration N2O Concentration AA

Figure 7.3: A schematic overview of how the anesthetic concentration is calculated in a LabView formula node

· Monitoring the anesthesia concentration in LabView.

The monitoring system is implemented in LabView in the same way as the calculation of the
anesthesia concentration but with the difference that it uses the flow value information
from Flow-i The instantaneous flow value is needed in order to calculate the delivered
volume of anesthesia to the patient. The anesthesia concentration and the flow value are
fed to a formula node where the delivered volume of anesthesia is calculated. This volume
is then used in the alarm profiles algorithms in order to monitor the anesthetic agent
concentration.

30
 Binary gas analyzer Temperature Binary gas analyzer Temperature
sensor 1 sensor 1 sensor 2 sensor 2

Time of flight, t Resistance, R Time of flight, t Resistance, R

Calculating the Calculating the Calculating the

Calculating the Calculating the
speed of sound for speed of sound for speed of sound
temperature, T1 temperature, T2
air/O2 mixture, c N2O/O2 mixture, c for anesthesia, c

Calculating
concentration of
gas compounds

Flow information
Concentration O2 Concentration N2O Concentration AA
from FLOW-i

Calculate the
delivered volume
of anesthesia

Alarm profiles

Figure 7.4: A schematic figure of the implementation of the alarm system in LabView

The alarm profile controls the level of delivered volume of anesthesia with the different
alarms, if the level exceeds the tolerated amount of anesthesia agent for a certain setting
the alarm profile activates the alarm.

Alarm
profiles

Check slow larm Check medium larm Check fast larm

No Yes Yes No Yes No

System failure,
Sound alarm

System OK!

Figure 7.5: A schematic overview of how the alarms are activated using the alarm profile

31
 7.3.Calculating the Anesthesia concentrations using the DGS system
In order to calculate the added anesthetic agent in a fresh gas mixture using the DGS system,
the concentrations of the two gases in the fresh gas mixture are required as described in
equation [4.15]. This is done by measuring the speed of sound of the fresh gas mixture with
the first sensor that is located upstream of the vaporizer, this speed of sound will be used to
calculate the concentration of the gases in the fresh gas mixture using a formula that is
implemented in LabView. This proportion is then used in equation [4.15] as x3 and x4. More
information about how this calculation is made is described in a separate thesis [1]. Figure
7.6 below shows a schematic overview example of how the anesthetic concentration is
calculated in LabView.

Sensor 1 Sensor 2

c1

No C>=330 m/s?

Yes
C of fresh gas plus Desflurane, M1= 168,00984
N2O/O2 Air/O2 added anesthesia Sevoflurane, M1=184,492396
Mixture Mixture And temperature T Isoflurane, M1=200,054842

c2, T M1

X3=30% X3=30%
X4=1-X3=70% X4=1-X3=70%
M3= 28.97kg/(k*mol) (Air) M3= 28.97kg/(k*mol) (Air)
M4= 44.1028 kg/(k*mol)(N2O) M4= 31.9988 kg/(k*mol)(O2)

Formula node

AA concentration

Figure 7.6: A schematic overview example of how the anesthetic concentration is calculated in a LabView formula node
in order to monitor the anesthesia agent concentration

The molecular weights of the fresh gas mixtures are also needed in order to calculate the
added anesthetic agent concentration as described in equation [4.15] (M2= M3* x3 + M4* x4).
Since the different molecular weights are known for the different gases in the fresh gas
mixture (see Table 4.1), the solution to this problem requires information of which fresh gas
mixture is currently in use in order to select the right molecule weight as M3 and M4.

Since the different fresh gas mixtures have a unique speed of sound in room temperature,
the speed of sound measured by the first sensor is used as an indicator to determine
whether the fresh gas mixture is an Air/O2 or a N2O/O2 mixture. If the fresh gas mixture is an
Air/O2 mixture the sound speed is above 330 m/s and if the mixture is N2O/O2 the speed of
sound is below 330 m/s, this is at normal room temperature and is illustrated in Figure 7.7.

32
 282 m/s 330 m/s 346 m/s

72% N2O/28%O2 100% O2 79%Air/21%O2

Figure 7.7: The sound speed variation of the different fresh gas compositions in room temperature

For example, if the first sensor gives a speed of sound of 340 m/s, as illustrated in Figure 7.7
indicates that the fresh gas mixture is an Air/O2 mixture with M3=28.97(Air) and
M4=31.9988(O2). This information along with the concentration values described above,
leads to the combined molecule weight M2 in equation [4.15]. All of these calculations are
done in LabView using a formula node; this is illustrated in Figure 7.6.

The other parameter that is needed to calculate the anesthetic concentration that is applied
to the fresh gas mixture is the anesthetic agent’s molecular weight M1 in equation [4.14].
Since Flow-i uses three different anesthetic agents, selecting the wrong molecule weight in
equation [4.14] would lead to miscalculations of the anesthetic concentration. This is
handled in LabView by presetting the right molecular weight M1 for the selected anesthesia
agent as an input to the formula node.

Since the second sensor measures the speed of sound and temperature after the anesthetic
drug is applied, this speed of sound and temperature are fed to the same formula node as
the pre-selected anesthetic molecular weight M1. In this way all the parameters that are
needed in order to calculate the anesthetic agent concentration are fed to a formula node.
As a result the anesthetic concentration can be analyzed and monitored.

33
8.Monitoring the Anesthetic Agent with the Dual Gas
Sampling System
This chapter’s purpose is to give the reader an understanding of how the monitoring system
was made and applied in Flow-i.

8.1.System Setup
In order to optimize the monitoring of the anesthetic agent, a system was made using the
DGS system concept as illustrated in Figure 8.1. Two BGA sensors were mounted in the Flow-
i by modifying two already existing gas line pipes, Figure 8.2. A first BGA sensor was placed
on the pipe that connects the fresh gas mixture gas flow with the vaporizer and the second
sensor was placed in the pipe which connects the vaporizers outgoing gas flow to the circle
system.

These modifications were made in order to place the sensors in the mainstream flow and
minimize the time it takes to flush the sensor chamber when changing the gas mixture due
to the sensors side stream design, this is described in section 6.3.

In theory, the measured difference in sound propagation time between these two sensors
should be the result of the added of anesthetic agent in the fresh gas flow, thus creating a
binary mix of two known gases.

An oscilloscope was connected in the first and second sensor immediately after the
amplification of the received signal, in order to monitor the characteristic of the transmitted
pulse from the transducers and to verify that the correct zero crossing was found by the
software in the BGA. The data information from the measurements was collected and
processed in LabView.

Data can be collected from the CPU nods of the Flow-i uses Ethernet with UDP
communication. Ethernet can be used to gather information and change settings in Flow-i. In
the monitoring system Ethernet is used to gather information of the gas flow and to
automate the changes of the anesthetic agent concentration using its UDP communication in
a LabView VI.

34
 NI-8451 LabView
Fresh gas
mixture

2
IC
O2

Senso1 Vaporizer Sensor 2 Patient

Anesthesia
Air/
N2O
Oscilloscope Flow-i Oscilloscope

UDP

Figure 8.1: An schematic over the system setup to monitor anesthesia concentration

Figure 8.2: picture of a modified pipe with mounted BGA sensor

8.2.Monitoring the anesthesia concentration

A LabView VI was created in order to monitor the anesthesia concentration delivered to the
patient. The delivery of the anesthesia agent from the vaporizer is based on short pulsations
of anesthesia frequently introduced in fresh gas flow under the inspiration phase. During the
pause and expiration phase the vaporizer delivers fewer pulses just to keep the anesthesia
concentration constant throughout the entire breathing cycle, see Figure 8.3.

35
To increase the concentration of the anesthesia agent the frequency of pulsations in the
vaporizer increases. The amount of pulsations varies depending on the set concentration
value of the anesthesia agent and fresh gas flow in Flow-i.

Since the breathing cycle is a complex function of inspiration, pause and expiration phases
one needs to know exactly what amount of anesthesia is delivered to the patient at any time.
This is done by integrating the instantaneous gas flow and the fraction of anesthesia
concentration over time.

The amount of anesthesia delivered to the patient can be calculated during a period of time
as;

∫ [8.1]

where is the delivered amount of anesthesia vapor in[ ] to the patient, is the
instantaneous gas flow in and is the fraction of anesthesia agent.

Since is very small, the integration is done by taking the instantaneous gas flow
continuously.

This leads to the simpler and more manageable expression;

. [8.2]

Since the flow is in , the fraction in and can be expressed in seconds the
delivered amount of anesthesia is in

concentration.

36
 respiration cycle.
Pause
Pressure Insp. . Exp.

PEEP

Time

Flow

Vaporizers pulsations Time

Anesthesia concentration
Time

Insp. Exp Time

Figure 8.3; An schematic figure of the anesthesia .delivery under volume control ventilation.

8.3. Mixing chamber after the vaporizer unit

When the fresh gas enters the vaporization chamber it mixes with the applied vaporized
anesthetic agent. The vaporization chamber volume is 63 ml, this volume is not sufficient for
the fresh gas to mix completely with the anesthesia agent during high fresh gas flow
operation. The mixing time between the anesthetic agent and the fresh gas is reduced when
operating Flow-i with high fresh gas flows. This is due to that a fresh gas with greater flow
magnitude passes through the vaporization camber faster than a fresh gas with lower flow
magnitude.

Driving a fresh gas with a higher magnitude flow leads to stratifications between the
anesthetic agent and the fresh gas, causing changes on a relatively small timescale in the
pulse response detected by the sensor.

Observations were made by analyzing the anesthesia agent concentration in LabView, and
the anesthetic agents pulse response using an oscilloscope connected to the sensors pulse
response signal.

When increasing the fresh gas flow one could observe that the response pulse shifted in
time during the expiration phase in volume controlled ventilation, this shifting of the pulse
decreased when decreasing the fresh gas flow.

37
The anesthesia agent concentration was monitored during this observation and one could
observe that the concentration value of the anesthesia agent did not vary significantly, since
the response pulse have to vary more for the anesthesia agent to change in concentration.

The variations in concentration were only of the magnitude of ±0.02-0.05% percent of

measured value independent of the set anesthesia concentration value when having gas
flows of 15-20 l/minute.

In order to prevent this shifting of the response pulse and reduce the stratifications
occurring due to the unmixed gases, and to perfect the anesthesia agent concentration, an
additional mixing chamber was produced and placed between the vaporizers output and the
sensor. This additional mixing chamber creates a turbulent gas flow mixing the fresh gas flow
with the applied anesthesia. This mixing chamber was modified from the inspiration cassette
in Servo-i where it serves a purpose as an Air/O2 fresh gas flow mixer.

Figure 8.4: A picture of the modified mixing chamber

The conclusion of this observation using the additional mixing chamber after the vaporizer
was that the fluctuations in the pulse response caused by the stratifications between the
two gases were reduced but not significantly. Placing an extra volume in between the
vaporizer and the sensor would lead to longer reaction time thus reducing the sensors ability
to measure quick changes in the anesthetic concentration.

8.4.Transient problem occurring when changing fresh gas mixture

When changing the gas concentration from one fresh gas mixture to another e.g. from
Air/O2 to N2O/O2 or vice versa the first sensor that is located before the vaporizer detects a
gas concentration that the second sensor has yet not detected.

This transient problem leads to that the second sensor gets false information on which fresh
gas concentration it should use from the first sensor and therefore miscalculates the
anesthesia concentration. This error is very flow dependent since a high gas flow leads to
that the new fresh gas reaches the second sensor faster. A schematic figure of this problem
is illustrated below.

38
 N2O/O2 Air/O2 plus added anesthesia

Sensor 1
Vaporizer Sensor 2

Measures the speed of sound for Measures the speed of sound for the previous fresh gas
the current fresh gas mixture and mixture (Air/O2) with added anesthesia, but calculates
sends the information to the second the anesthesia concentration based on wrong data from
sensor. the first sensor (N2O/O2).

Figure 8.5: A schematic figure over the transient problem

8.5.Transient problem Algorithms

Since the transient problem causes miscalculations in the anesthesia concentration and
affects the monitoring of the anesthesia concentration, an algorithm that corrects and
compensates this fault is therefore necessary.

The miscalculation varies depending on the changed fresh gas mixture and can accidently
trigger the alarm system due to the miscalculation of the anesthesia concentration. Different
approaches have been made addressing the issue to find the most effective way to solve this
problem and in this section below two different algorithms are presented as suggested
solutions.

The first algorithm is based on that one knows or calculates the volume between the two
sensors.
Since the fresh gas flow value in Flow-i is known using the information from UDP the volume
between the two sensors is easily calculated by measuring the time difference from that the
first sensor detects a change in the fresh gas concentration until the other sensor detects the
same change.
This time difference is then multiplied with the gas flow resulting in the constant volume
as shown in the equation below.

, where the volume is in liter [ ] [8.6]

This volume has then been confirmed by estimating the volume between the two sensors
and including the vaporizer chamber volume.

Assuming that this volume between the two sensors is known, the time difference between
the two sensors can be calculated the same way for any fresh gas flow as;

39
 [8.7]

As a result the time difference between the two sensors is known for any variation in the set
gas flow. When changing the fresh gas concentration from one mixture to another the speed
of sound measured by the first sensor differs significantly from the previous mixture.

This information is then used to trigger the countdown of the time difference from that the
first sensor detects a new fresh gas mixture until this new fresh gas mixture reaches the
second sensor. This results in that during this countdown one can allow certain high
anesthesia agent concentration by increasing the alarm systems high concentration trigger
level.

The second algorithm is based on that one analyses the change in timestamp value
measured by the first sensor.

Since the timestamp value is almost fixed (with small variations) for a certain fresh gas
mixture one can log this value.

When changing this fresh gas mixture to another mixture one can log the new fresh gas
mixtures timestamp value and take the absolute value of the first timestamp value
subtracted with the second timestamp value. This value indicates the rate of concentration
change.

Since the miscalculation is flow dependent the fresh gas flow value is also needed in this
algorithm, therefore the flow value is also logged.

These two values are then logged as an array as;

⃑ [ ] [8.8]

Where are the different timestamp values and is the instantaneous gas flow value.

This array value is then list in form of a matrix for the different changes in the fresh gas
mixture, flow variations and for each value its corresponding miscalculation in anesthesia
concentration.

When changing fresh gas mixture the first sensor sends this array value to the second sensor,
this value is then compared with the listed values and as a result an estimation of the
miscalculation can be made and corrected during a certain period of time.

The first algorithm would probably be the most effective since it would be easier for the
monitoring system due to its simplicity.

40
 8.6.Monitoring the anesthesia concentration with one sensor
In Flow-i all the information about the different settings such as set anesthesia
concentration, set gas flow, set fresh gas mixture and other useful data can be collected and
analyzed in a LabView VI through Flow-i`s RJ-45 connection using UDP communication. One
can utilize the information of set fresh gas mixture in equation [4.15] and with this
information decide which molecular weight to use as in equation [4.14].

Also the information of which anesthesia agent is currently in use can be utilized as in
equation [4.14]. This results in that instead of getting the information of the unknown
parameters in equation [4.14] from the first sensor one exploit the information from Flow-i´s
settings and theoretically monitor the applied anesthesia concentration to a fresh gas
mixture by only using one sensor placed after the vaporizer.

The transient problem would still be an issue if using a signal sensor monitoring system.
Since switching gas causes a delay time from that a gas has changed until the second sensor
detects the change, it is therefore necessary to know the volume between the fresh gas
input and the sensor. By knowing the volume between the second sensor and the fresh gas
input the time delay can be calculated and compensated for by utilizing equation [8.7].
Additionally, this would compensate for any miscalculations that this time delay may cause
when monitoring the anesthetic agent concentration.

Volume between the LabView

sensor and the fresh gas Flow-i
output. NI-8451
UDP

O2 2
IC

Vaporizer Sensor 2 Patient

Anesthesia
Air/
N2O
Oscilloscope

Figure 8.6: An schematic figure over an monitoring system using one sensor

41
Using only one sensor to monitor the anesthetic agent concentration would lead to a more
robust system, this is because the DGS system inherits the error from the first sensor that
when calculating the anesthetic agent concentration.

42
9.Measurements
To effectively use the BGA based system to monitor the anesthesia concentration,
verifications had to be made of the systems and the individual sensors accuracy, rise time
and response time to be able to more accurate estimate the monitoring systems total fault
tolerant.

9.1. The Accuracy of the DGS system

In order to determine the accuracy of the DGS system it had to be tested contra Flow-i´s
built in control gas analyzer (CGA), since the accuracy of the CGA is known (see appendix II).

A LabView VI was created to read the values of the different concentrations from the CGA
and to be able to control Flow-i using its Ethernet communication.

A script was created in LabView using this connection in order to increase the delivered
anesthesia concentration agent in Flow-i by 0.1% per measurement and log the
concentration value measured by both the CGA and the DGS system.

These values where then converted to a Microsoft Excel file in order to plot the data and
analyze the curves and tables. The two different anesthesia agents that were selected in this
measurement were Isoflurane and Desflurane.

Figure 9.1 and 9.3 show the measured anesthesia concentration value of the CGA unit and
the DGS system for the different set anesthesia concentration values in Flow-i.

Figure 9.2 and 9.4 shows discrepancy between the CGA and the DGS system (Discrepancy =
CGA-DGSS) for the different set values in Flow-i.

CGA vs DGSS
(Desflurane) in 55%Air/45%O2 fresh gas mixture
20
Measured Anesthesia Concentration [%]

18
16
14
12
10
8 CGA
6 DGSS
4
2
0
7
0
0,7
1,4
2,1
2,8
3,5
4,2
4,9
5,6
6,3

7,7
8,4
9,1
9,8

14
10,5
11,2
11,9
12,6
13,3

14,7
15,4
16,1
16,8
17,5

Set concentration in Flow-i [%]

Figure 9.1: The graph shows CGA and the DGSS measured anesthesia concentration in Flow-i for Desflurane using Air/O2
as a fresh gas mixture

43
 Discrepancy of DGS system VS CGA (Desflurane) in 55%Air/45%O2 fresh gas
mixture
0,8

0,6

0,4

0,2
Discrepancy [%]

0
0 2 4 6 8 10 12 14 16 18 Discrepancy
-0,2
between DGSS
-0,4 and CGA"

-0,6

-0,8

-1

-1,2
Set concentration in Flow-i

Figure 9.2: The graph shows the discrepancy between the CGA and the DGSS for Desflurane using Air/O2 as a fresh gas
mixture

CGA vs DGSS
(Isoflurane) in 55%Air/45%O2 fresh gas mixture
6
Measured Anesthesia Concentration

5
4
3
CGA
[%]

2
DGSS
1
0
0 0,2 0,4 0,6 0,8 1 1,2 1,4 1,6 1,8 2 2,2 2,4 2,6 2,8 3 3,2 3,4 3,6 3,8 4 4,2 4,4 4,6 4,8 5
Set concentration in Flow-i [%]

Figure 9.3: The graph shows CGA and the DGS-system measured anesthesia concentration in Flow-i for Isoflurane using
Air/O2 as a fresh gas mixture

44
 Discrepancyof DGS system VS CGA (Isoflurane) in 55%Air/45%O2 fresh
0,4 gas mixture
0,35
0,3
Discrepancy [%]

0,25 Discrep
ancy
0,2 betwee
0,15 n CGA
and
0,1 DGSS
0,05
0
0 1 2 3 4 5
Set concentration in Flow-i [%]

Figure 9.4: The graph shows the discrepancy between the CGA and the DGS-system for Isoflurane using Air/O2 as a fresh
gas mixture

From the graphs one can see that the accuracy of the DGS system is sufficient to monitor the
anesthetic agent concentration. The accuracy for the whole range is approximated by taking
the highest point of the whole range and adding the absolute value of the lowest point of
the whole range and dividing this value by two. This calculation results in that the accuracy
for the whole range is ±0.84% for Desflurane and ±0.17% for Isoflurane. The accuracy of the
DGS system is not only dependent on the how well the sensors can measure the anesthetic
agent concentration; the accuracy is also affected by other sources such as pressure
variations during normal use and temperature variations.

9.2.Rise, Response and Reaction time

In order to measure how quick DGS system is a series of measurements hade to be made.
Since the DGS systems quickness defines how fast the system is to detect a change in gas
concentration these measurements are a crucial part of this thesis. The systems response
time is defined by the time it takes from the point a concentration has been changed and
detected by the sensor until it reaches 10% of its final value. The systems rise time is defined
by the time it takes for the sensor to detect 10% of the changed gas concentrations final
value to 90% of its final value. The systems reaction time is defined by the time it takes for
the system to detect a change in concentration, until the concentration reaches 90% of its
final value. The difference between the rise time, response time and reaction time is
illustrated in Figure 9.5.

45
 Speed of sound

90% of cFinal cFinal

10% of cFinal
cInitial

Start of tElapse
gas switch Response time Rise time

Reaction time

Figure 9.5: Schematic figure of the different time measurement in this section

9.3.The DGS systems Rise time

In order to measure the rise time of the DGS system the measurement had to be conducted
by first measuring a gas without anesthetic agent and then switching to a gas containing
anesthesia. To carry out these measurements a new lab environment was created as well as
new LabView VI in order to be able to analyses and log the values see Figure 9.8and Figure
9.9. The LabView VI was stripped from any unnecessary functions and calculations in order
to run as fast as possible, its update frequency was timed to approximately 18ms. The
sensors firmware was modified using C-code in order to use the sensors microprocessors
update frequency of 100µs.

The measurements was conducted by using a pneumatic valve (Enfield Technologies SN-
26429) that is connected to two different gas mixers (Siemens Symeon) with manually
activated vaporizer with continuous dosage (Datex Ohmeda Figure 9.6).

Figure 9.6: A Datex Ohmeda Vaporizer

A pulse generator (HP8011A) is connected to the pneumatic valve in order to switch

between the different gas mixtures by sending a signal from the pulse generator. Two
different gas mixtures are selected, the first is used to flush the sensor and the other is a gas
mixture containing anesthesia.

46
 Figure 9.7: A HP8011A pulse generator

The rise time is measured by measuring the stable timestamp value for both gases at steady
state. The lowest time stamp value (in this case the gas without added anesthesia) is used as
the initial value and the gas with the high timestamp value is used as the end value. The rise
time is measured by measuring the stable speed of sound value for both gases at steady
state. The highest speed of sound value (in this case the gas without added anesthesia) is
used as the initial value and the gas with the lowest speed of sound value is used as the end
value. The distance between the sensor and the valve is kept minimal; this is done to reduce
the time it takes for the gas to reach the sensor when switching gas concentration. The
volume between the valve and the sensor is approximately 3ml. The volume between the
sensor and the valve is very small and it is therefore a good enough estimation of the
sensors rise, response and reaction time.

The sensor is mounted on the modified pipe that is use to place the BGA in Flow-i, the mixing
chambers that are used in the monitoring systems is also used before the valve so that the
gas mixture are properly mixed to prevent incorrect measurements occurring when the gas
mixtures don’t blend as described in section 8.3.

Fresh gas unit 1 Fresh gas unit 2

Anesthesia
Anesthesia
N2O

Air
Air
O2

O
N2
O

Gas mixer Gas mixer

Pneumatic
Labview Pulse generator
valve
Waste gas

Waste gas

Binary gas
analyzer

Figure 9.8: a schematic figure of the lab setup

47
 Figure 9.9: Picture of the lab setup

A TSI flow meter (TSI 4000 series) is connected after the BGA to monitor the gas flow and to
ensure that it is kept constant. Since the TSI flow meter is limited to measure Air or O2 a long
hose of approximately 5l was connected directly after the binary gas analyzer, the TSI flow
meter is connected at the end of the hose. In order to read the right flow value the hose was
first flushed with Air or O2 before switching to the new gas containing anesthesia.

Figure 9.10: A TSI 4000 series flow meter

A trigger signal from the pulse generator is connected to a digital input in the NI-8451, this
signal triggers the start of the measuring of the response time in LabView since this pulse
also switches between the two different gas mixtures. Several tests were conducted varying
the flow of the gas mixtures and keeping the concentration of the different fresh gas mixture
constant for different anesthesia agents. All the measurements were repeated four times in
order to get an average of the rise time. The anesthetic agent selected for these tests was
Sevoflurane since it is the gas with the highest molecule weight and therefore the most
interesting gas to examine when it comes to its rise and response time. The concentration
delivered from the manually activated vaporizer was set to 2.5% due to that these
measurements were repeated numerous times and this concentration was the easiest
concentration to set.

The rise time is calculated as; [9.2]

48
and the average rise time is calculated as ∑ [9.3]

where i=1,..n where n in this case is 4.

The result of these measurements is presented in table below and in the graph presented in
Figure 9.11.

O2 to same O2 concentration with 2,5% added Sevoflurane

Flow
0,32 225,76 230,15 293,67 277,80 256,84
0,58 179,97 183,60 174,63 170,07 177,07
1,00 17,23 16,92 16,78 16,73 16,92
2,00 3,00 3,00 3,01 2,98 3,00
3,00 2,54 2,54 2,55 2,56 2,55
4,16 1,95 2,11 2,19 2,23 2,12
5,11 1,25 1,22 1,22 1,21 1,23
6,12 0,82 0,81 0,81 0,83 0,82
7,12 0,59 0,58 0,60 0,64 0,60
8,00 0,49 0,49 0,47 0,48 0,48
9,07 0,41 0,41 0,42 0,44 0,42
10,06 0,36 0,35 0,35 0,36 0,36
11,05 0,33 0,35 0,32 0,32 0,33
Air to same Air concentration with 2,5% added Sevoflurane
0,30 253,04 292,85 311,24 317,87 293,75
0,50 126,79 122,41 118,91 126,61 123,68
1,02 19,19 18,44 19,41 19,97 19,25
2,06 3,33 3,33 3,29 3,33 3,32
3,09 2,53 2,45 2,49 2,44 2,48
4,09 1,75 1,74 1,76 1,76 1,75
5,04 1,10 1,12 1,12 1,12 1,11
6,08 0,78 0,79 0,80 0,74 0,78
7,03 0,62 0,62 0,63 0,63 0,63
8,09 0,51 0,53 0,54 0,51 0,52
9,03 0,42 0,40 0,42 0,42 0,41
10,10 0,34 0,33 0,33 0,33 0,33
11,06 0,32 0,31 0,32 0,31 0,31
N2O to same N2O concentration with 2,5% added Sevoflurane
0,33 67,15 71,17 73,34 77,37 72,26
0,54 26,32 23,82 24,55 23,99 24,67
1,07 4,21 4,22 4,26 4,37 4,27
2,11 2,52 2,61 2,63 2,55 2,58
3,08 1,17 1,16 1,13 1,14 1,15
4,00 0,82 0,83 0,84 0,82 0,83
5,10 0,62 0,61 0,61 0,61 0,61
6,11 0,49 0,49 0,48 0,50 0,49
7,15 0,40 0,41 0,42 0,42 0,41
8,08 0,34 0,36 0,35 0,36 0,35
9,09 0,30 0,31 0,35 0,30 0,31
10,05 0,27 0,28 0,28 0,30 0,28
15,13 0,17 0,18 0,18 0,18 0,18
Table9.1: The result of the rise time measurements

49
 Rise time of the DGS system
12,00
11,00 O2 to the same O2
10,00 with 2,5% Sevoflurane
9,00
8,00
tr[sec]

7,00 Air to the same Air

6,00 with 2,5% Sevoflurane
5,00
4,00
3,00 N2O to the same N2O
2,00 with 2,5% Sevoflurane
1,00
0,00
0,00 2,00 4,00 6,00 8,00 10,00 12,00
Flow[l/min]

Figure 9.11: The graph of the DGS systems rise time

50
 9.4.Response time
The response time is the time it takes a change in concentration until the new concentration
reaches 10% of its final set value. In order to conduct these measurements a new LabView VI
was created, the VI was stripped of all unnecessary functions and calculations in order to
keep the update frequency as fast as possible. The response time measurements were
conducted in the same way as the rise time measurements, using the same lab setup as for
the rise time measurements. The initial speed of sound value and the set timestamp value
were first measured. The low highest speed of sound value is utilized as the start value and
the lowest speed of sound value as the final value.

The flows of the different gases were kept constant by measuring the flow after the sensor
with a TSI flow meter. The measurements were repeated four times in order to calculate an
average response time.

The results of these measurement series are presented under the section results below, the
graph of these measurements are presented in Figure 9.12 .

O2 to same O2 with added 2,5%Sevoflurane

Flow
0,32 27,33 27,67 28,56 30,12 28,42
0,53 23,18 26,57 26,10 26,86 25,67
1,03 8,29 7,73 7,78 7,59 7,85
2,00 1,20 1,20 1,20 1,21 1,20
3,05 0,72 0,83 0,78 0,76 0,77
4,16 0,53 0,50 0,55 0,54 0,53
5,11 0,39 0,41 0,39 0,37 0,39
6,12 0,33 0,31 0,31 0,31 0,32
7,12 0,28 0,26 0,27 0,27 0,27
8,00 0,21 0,24 0,23 0,24 0,23
9,07 0,19 0,20 0,20 0,20 0,19
10,06 0,17 0,19 0,18 0,15 0,17
11,05 0,15 0,15 0,16 0,14 0,15
Air to same Air with added 2,5%Sevoflurane
0,28 21,71 19,45 23,05 25,55 22,44
0,54 17,14 19,56 19,15 15,66 17,88
1,02 5,76 6,53 6,20 6,46 6,24
2,06 1,26 1,25 1,24 1,27 1,26
3,09 0,68 0,66 0,68 0,66 0,67
4,09 0,46 0,45 0,46 0,48 0,46
5,04 0,36 0,37 0,36 0,36 0,36
6,08 0,30 0,30 0,28 0,30 0,29
7,03 0,25 0,24 0,25 0,29 0,26
8,09 0,22 0,21 0,20 0,21 0,21
9,03 0,17 0,18 0,18 0,17 0,18
10,10 0,16 0,16 0,16 0,16 0,16
11,06 0,16 0,15 0,15 0,14 0,15
N2O to N2O with added 2,5% Sevoflurane
0,33 14,61 13,03 13,23 15,00 13,97
0,54 5,03 5,53 5,86 6,47 5,72

51
 1,07 1,68 1,66 1,74 1,68 1,69
2,11 0,69 0,68 0,72 0,71 0,70
3,08 0,44 0,43 0,47 0,44 0,45
4,00 0,36 0,34 0,36 0,37 0,36
5,10 0,25 0,26 0,23 0,26 0,25
6,11 0,24 0,22 0,22 0,22 0,23
7,15 0,21 0,19 0,20 0,20 0,20
8,08 0,18 0,17 0,16 0,18 0,17
9,09 0,15 0,16 0,15 0,21 0,17
10,05 0,15 0,11 0,14 0,14 0,13
Table 9.2: The result of the response time measurement

O2 to same
12,00
Response time of the DGS system O2 with 2,5%
11,00 Sevoflurane
10,00
9,00
Air to same
8,00
Air with 2,5%
7,00
tr[sec]

Sevoflurane
6,00
5,00
4,00 N2O to same
3,00 N2O with
2,00 2,5%
1,00 Sevoflurane
0,00
0,00 2,00 4,00 6,00 8,00 10,00 12,00
Flow[l/min]

Figure 9.12: A graph of the response time measurement

9.5. Reaction time of the DGS system

The DGS systems reaction time is defined by the time it takes from a change in concentration,
until the concentration reaches 90% of its final value. The reaction time is needed in order to
determine if the DGS system is fast enough to replace the CGA module. The CGA module
uses a pump to withdraw a gas sample from the main stream gas flow; this leads to that the
CGA has a constant reaction time of 0.7 seconds that is independent of the set fresh gas flow.
By adding the DGS systems rise and response time the DGS systems reaction time is
obtained. The CGA´s reaction time is plotted as the black dashed line in Figure 9.13.

In Flow-i there is a need to detect abnormally high concentrations of anesthesia very fast in order to
flush the system and alarm the operator. This is done by opening a safety valve that is located
approximately 34ml from the second sensor, see Figure 3.4.

The transportation time is the time that it takes for the gas to reach the safety valve from
the second sensor, and it is calculated by using the following equation;

52
 , where >0 is the set fresh gas flow. [9.4]

This transportation time is plotted as the red dashed line in Figure 9.13.

The DGS systems reaction time has to be faster than the transportation time in order to
ensure that the safety valve is open in case of fail function.

Reaction time of the DGS system O2 to same O2 with

added
8,00 2,5%Sevoflurane
7,00 Air to the same Air
6,00 with added 2,5%
Sevoflurane
5,00
tr[sec]

N2O to the same

4,00 N2O with added
2,5% Sevoflurane
3,00
CGA Reaction Time
2,00
1,00
0,00 Transportation time
0,00 2,00 4,00 6,00 8,00 10,00 12,00
Flow[l/min]

Figure 9.13: The reaction time of the DGS system contra the CGA´s reaction time and the transportation time

As one can see from the graph in Figure 9.13, the reaction time of the DGS system is not fast
enough to replace the CGA for gas flows under 7-8 l/min. One can also see in the graph that
the reaction time of the DGS system is not fast enough to ensure that the safety valve is
opened in due time. Since this reaction time is not fast enough to replace the CGA or to
ensure a fast safety valve is opened in due time, there is a need to improve the DGS systems
reaction time. The sections below give some suggestions on how to improve the reaction
time of the DGS system.

9.6. Optimizing the volume

Since the transportation time (described in the previous section) is dependent on the
volume (see Figure 9.14) between the second sensor and the safety valve, this volume can
be modified and optimized in order to achieve a longer transportation time thus augmenting
the required reaction time that is needed to open the safety valve.

53
 Sensor 1 Sensor 2

Vaporizer

Safety valve

V
Anesthesia

Figure 9.14: A schematic figure of the volume between the second BGA sensor in the DGS system and the safety valve

By plotting the reaction time of the DGS system and the transportation time for different
volumes the following graph in Figure 9.15 is achieved.

Reaction time of the DGS system for different

10,00
volumes
9,00
8,00
7,00 34ml
tr[sec]

6,00
5,00
4,00
3,00 200ml
2,00
1,00
0,00
0,00 2,00 4,00 6,00 8,00 10,00 12,00
Flow[l/min]

Figure 9.15: The volume required to increase the transportation time

As a result from this graph one can see that the volume between the BGA second sensor in
the DGS system and the safety valve has to be increased to approximately 200ml in order to
be fast enough.

9.7. Flow restrictor

The reaction time for the DGS system is not fast enough for low gas flows. This disadvantage
is due to the sensors design, since it does not sample the main stream gas flow. In order to
improve the reaction time a thin film of plastic was placed on the sensors lip in order to
redirect the gas flow in to the sensors measurement chamber during low gas flow operations.
This plastic film should be stiff enough to restrict the gas flow when using a low gas flow but
also flexible enough to bend during high gas flow operations so that the film does not cause
any unnecessary gas flow resistance. This gas flow restriction concept is illustrated in Figure
9.16 and Figure 9.17.

54
 Measurement chamber Measurement chamber
Measurement distance Measurement distance

Transmitter Receiver Transmitter Receiver

Main flow Main flow

channel channel

Figure 9.16: Shows the BGA with a thin film attached to the Figure 9.17: Shows the BGA with the thin film attached during
sensors lip in order to restrict low gas flows inside the high flow operations, causing the thin film to bend thus
measurement chamber. reducing the flow resistivity.

This concept was tested by taping a plastic film (taken from a plastic overhead paper) on the
sensors lip, this film was cut in a way so that it fitted inside the modified pipe. The rise time
and response time was measured in the same way as the previous rise and response time
measurement using the same lab setup. The response and rise time were added in order to
get the reaction time when using the flow restrictor. The results of these measurements are
presented in the graph below.

Reaction time of the DGS system using a flow

60ml
restrictor
10,00
9,00 O2 to the same O2
8,00 with 2,5% Sevoflurane
7,00
tr[sec]

with thin film

6,00 Air to the sameAir
5,00 with 2,5% Sevoflurane
4,00 with thin film
3,00 N2O to the same N2O
2,00 with 2,5% Sevoflurane
1,00 with thin film
0,00 CGA´s reaction time
0,00 2,00 4,00 6,00 8,00 10,00 12,00
Flow[l/min]

Figure 9.18: Shows the graph of the DGS systems reaction time using a flow restrictor

As a result one can see that the reaction time is reduced drastically. One can also see that
the DGS systems reaction time reaches the CGA´s for gas flows of approximately 3-4
l/minute instead of 7-8 l/minute when using the gas flow restrictor. The graph also shows
that the volume between the sensor and the safety valve does not need to be increased to
more than 80ml when using the gas flow restrictor instead of 200ml without the gas flow
restrictor in order to operate the safety valve properly.

55
 9.8.Position of the sensor
The reaction time of the sensor is the time that it takes to exchange the gas in the
measurement chamber with a new gas. When using low flows in the system, the rise time
varies by positioning the sensor upside down or sideways to its normal position.

Since different gases have different molecular weights, it takes a longer time to replace a gas
in the chamber with higher molecule weight when the ingoing gas has a lower molecular
weight at low flows.

The measurements were conducted by positioning the sensor upside-down and sideways of
the main stream flow see Figure 9.19, using low flows in the gas with added anesthesia, the
rise time and the response time were measured using the same principle as described in the
sections above.

These tests were conducted in order to verify the position dependency and to find the
optimal positioning of the sensor in the monitoring system. Using the same lab setup as the
response and rise time measurement different measurements series were made. The sensor
was first flushed with a fresh gas mixture using a high gas flow, afterwards the gas was
altered to fresh gas mixture with added anesthesia agent for flows of 0,3 to 0,5 minutes.
The graph and the table of the measurement series are presented below. These
measurements were repeated three times in order to calculate an average of the response
and rise time.

Figure 9.19: A picture of the different positioning of the sensor

56
 Air, 2.5% Sevoflurane, Reaction time
Flow [l/min] Reaction time [s] Positioning
0.32 293,75 Normal
0.52 123,68
0.32 79,34 Side ways
0.52 34,25
0.32 18,13 Upside-down
0.52 11,53

Table 9.3: The table show the result of the position measurements

The tables above shows the result of the rise and response time measurements for the
different positions.

As one can see form the table above, the rise time is in some cases more than 10 times
faster by positioning the sensor upside down and three to five times faster by positioning
the sensor sideways. These results have to be taken into consideration when choosing the
final position of the binary gas analyzer sensor in the DGS system.

9.9.Effect of pressure variations on the DGS system

Since fast pressure changes affects the temperature in a gas, there is a need to examine the
effect of the pressure variations on the anesthetic concentration measured in Flow-i. The
sole purpose of this measurement isn’t the temperature, but rather the impact of the
sudden pressure change resulting in a fast temperature change.

A test was made by setting Flow-i to pressure control mode, the PEEP level was set to 1
mbar. The respiration rate was set to 20b/min, the pressure above PEEP level (PC) was set to
100 PC and the fresh gas flow rate to 15l/min. The fresh gas was set to 79% N 2O and the
anesthetic agent that was chosen for this test was Sevoflurane. The set anesthetic
concentration in Flow-i was 2%.

The observed result of this measurement was that the anesthetic agent concentration
fluctuated in between 1.8% - 2.8% for these settings. The result is presented in the table
below.

57
Flow Set N2O concentration in Set Sevoflurane Measured Sevoflurane
Flow-i concentration in concentration with DGS
Flow-i system.
Continuous 79% 2% 1.8%
Pulsating (100 79% 2% 2.8%
mbar)
Table 9.1: The table above show the result of the pressure measurement test

From the results one can draw the conclusion that the instant changes in pressure cause
temperature changes that affects the anesthetic agent concentration.

9.10.Effects of high concentrations in the DGS system

A measurement was made in order to compare the DGSS and the patient gas analyzer (PGA)
system’s ability to detect high anesthetic agent concentrations. This measurement is also
crucial in order to find out if the DGS system is able to measure high concentration levels of
anesthetic agent.

FLOW-i
Sensor 2

Vaporizer

In
sp
.f
lo
Sensor 1

w
Fresh gas Patient
output lo
w
Waste gas
p.f
Ex

Figure 9.20: An overview of the lab environment for high anesthesia test

This measurement was made by using a specially modified vaporizer that is connected to a
docking station. This docking station is connected to a PC where one can manually control
the vaporizers anesthetic agent delivery. This vaporizer and docking station was stationed
under a fume hood so that the hazardous high concentration fume doesn’t pollute the
environment air (see Figure 9.20 ). The fresh gas inlet to the vaporizer was connected to the
fresh gas output in Flow-i and the vaporizers outlet back into the Flow-i. The first BGA sensor
is connected in between the fresh gas output and the vaporizers inlet and the second BGA
sensor in between the vaporizers outlet and the Flow-i machines PGA gas input. This
connection had to be made in order to compare the values of the PGA unit and the DGSS.
The connecting hoses between the vaporizer and Flow-i have a volume of approximately 1
liter. Two tests were conducted, the first with 100% air as the fresh gas and the second test
with 79% N2O. The flow rate of the fresh gases was set in Flow-i to 3 l/minute for both the
cases. Desflurane was chosen in both cases as the anesthetic agent, this is due to that
Desflurane has the lowest boiling point of all the different anesthetic agents and is therefore

58
the agent who can reach the highest concentrations in normal room pressure. The vaporizer
in the docking station was manually controlled by setting the temperature inside the
vaporization chamber to 45◦C. For these tests, the vaporizer doubles the amount of
anesthetic, starting at a concentration of 1% Desflurane and ending up at approximately 56%.

High Desflurane test with Air/O2 mixture (Set O2 = 21%)

Flow [l/min] Estimated conc. [%] Des conc. With CGA [%] Des conc. With DGSS [%]
3.13 0 0 0
3.13 1 0.8 0.49
3.13 2 1.7 1.3
3.13 4 3.5 3.03
3.13 8 7.1 6.6
3.13 15.8 14 13.7
3.13 24.2 21.3 21.2
3.13 39 29.4 35.7
3.13 56 29 58

Table 9.2: High Desflurane measurements in air/O2 fresh gas mixture

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 High Desflurane test with Air/O2 mixture (21% O2)
60
55
50
45
40
Measured concentration [%]

35
30 Des conc.
With PGA
25
Des conc.
20
With DGSS
15
10
5
0
0 5 10 15 20 25 30 35 40 45 50 55 60
Estimated delivered concentration [%]
Figure 9.21 : The graph shows that the PDA system is limited to approximately 29% Desflurane concentration when
measuring Desflurane in air/O2 fresh gas mixture

High Desflurane test with O2/N2O mixture (Set O2 = 21%)

Flow [l/min] Estimated conc. [%] Des conc. With CGA [%] Des conc. With DGSS [%]
3.13 0 0 0
3.13 4 3,6 3.3
3.13 15.8 14.1 13.4
3.13 39 29.9 35
3.13 50 29 47
Table 9.3 High Desflurane measurements in N2O/O2 fresh gas mixture.

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 High Desflurane test with O2/N2O mixture (Set N2O = 79%,
60
measured N2O = 83%)
55
50
45
40
Measured concentration [%]

35
30 Des conc.
25 With PGA

20 Des conc.
15 With DGSS

10
5
0
0 5 10 15 20 25 30 35 40 45 50 55 60
Estimated delivered concentration [%]

Figure 9.22: The graph shows that the PGA system is limited to approximately 30% concentration when measuring
Desflurane in a O2/N2O fresh gas mixture

As showed in the graphs, the DGS system does not have any problems when measuring high
anesthetic concentrations. The PGA module has a limitation of measuring high
concentrations and was only able to measure a Desflurane concentration of approximately
30%. The highest detected Desflurane concentration measured and detected by the DGS
system was approximately 58% using an air/O2 fresh gas mixture. The sound speed
measured at 58% Desflurane was about 152 m/s in 25◦C, this temperature of the gas in the
BGA´s measurement chamber. This sound speed is equivalent with 52% Isoflurane and 47%
Sevoflurane and one can therefore draw the conclusion that the DGS system should be able
to measure high concentrations even in Isoflurane and Sevoflurane.

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10.Suggestions for Improvement
Since the sensor is designed to sample side stream, it affects the reaction time of the sensor
making it slow to react at low flows. This can be solved by using a flow restrictor that forces
all the gas in the measurement chamber during low flows and therefore improving the
reaction time of the sensor. It is important to design the flow restrictor in such a matter that
it does not cause any flow resistance during high flows operation. This suggestion was tested
by attaching a plastic film on the sensors lip in order to force all the gas up in the
measurement chamber during low flows.

Another idea for improvement is to replace the current design of the sensor with an design
that measures in the main stream flow. This would lead to no time delays at all due to semi
side stream samples. If one could measure in the main stream flow it would be possible not
only to measure the concentration with the ultrasound technique but also the flow. This
would lead to a major improvement since the flow is used to calculate the delivered volume
of anesthesia to the patient as mentioned in section 8.2. Measuring both the concentration
and flow would mean that the monitoring system would not be dependent on another
sensor to measure the flow in order to monitor the anesthesia concentration; this would
lead to not only a more precise and reliable monitoring system, but also a less costly system
in terms of power distribution efficiency, manufacturing costs etc.

The final suggestion in order to improve the anesthetic monitoring system is to monitor the
anesthetic concentration using only one sensor after the vaporizer. This suggestion is treated
in section 8.6. This system would lead to several advantages. One of the mayor advantages is
the reliability of the system since the monitoring system would only depend on one sensor.
The other mayor advantage with monitoring the anesthetic agent using only one sensor is
the systems accuracy. Monitoring the anesthetic concentration with two sensors means
that the accuracy of the anesthetic concentration depends also on how well the first sensor
is to measure the fresh gas concentration thus affecting the systems accuracy.

These suggestions presented above need to be taken into consideration to obtain the
optimal results in monitoring the anesthetic agent before implementing the DGS system in
Flow-i.

10.1.Conclusion
Designing a system made with two binary gas analyzers to monitor the anesthetic agent
concentration works well during high flow rates but the systems reaction time is not fast
enough during low flow rates. Several suggestions have been planted in this thesis in order
to make the system anesthetic monitoring system more reliable and with a faster reaction
time. How the gas is mixed before measured by the binary gas analyzer should also be taken
into consideration when designing an anesthetic agent monitoring system, this is since the
ultrasound technology is limited by how well the gas is mixed before it is being measured by

62
the sensor. In order to monitor the anesthetic using a binary gas analyzer sensor, the sensor
should be redesigned to measure the gas directly in the main stream flow. This is achieved
by placing a flow restrictor between the inlet and outlet of the sensor that forces al the gas
in to the measurement chamber. This would result in an approximately 10 times faster
reaction time for the system in flow rates up to 1 l/min.

Some advantages with ultrasound technique for anesthetic agent monitoring:

· Ultrasound is simple and rugged, resulting in sensors that are durable and repeatable.
· There are no mechanical moving parts.
· There are no delays to pre heat the sensor before usage.
· Using ultrasound does not require a constant reference point to calibrate the sensor.

63
11.References
1. Yee-Pang, Ultrasound sensor for gas concentration measurement, Examensarbete i
mätteknik, KTH/Maquet, April 2011.

2. “Standards for basic anesthesia monitoring”, American Society of Anesthesiologist, 2010.

3. “Anesthesia Gas Monitoring: Evolution of a de facto Standard of Care”, ProMed

Strategies, LLC under an educational grant from PHASEIN AB, Sweden, 2009.

4. http://en.wikipedia.org/wiki/Ideal_gas_law

5. Halldin, M., & Lindahl, S., Anestesi, Stockholm: Liber, ISBN 91-47-04914-6, 2000

6. Markus Joos, Harald Müller ’ An ultrasonic sensor for the analysis of binary gas mixtures’
Sensor and Actuators B, 15-16, 1993

7. Serway, Jewett, Physics for Scientists and Engineers with Modern Physics, Thomson, ISBN
0-534-40949-0, 6th Edition.

8. A. N. Johnson; J. D. Wrighta; S. Nakaob; C. L. Merklec; M. R. Moldover, 'Effect of

Vibrational Relaxation on Discharge Coeff of Crit Flow Venturis', Flow Measurement and
Instrumentation, Vol. 11, (2000), p. 315.

9. E. Ingelstam; R. Rönngren; S. Sjöberg, TEFYMA: handbok för grundläggande teknisk fysik,

fysik och matematik, Studentlitteratur AB, ISDN 9789144057125, 2009.

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 Appendix
I.Time Vs. concentration of anesthesia/nitrous oxide and oxygen

65
66
II.CGA´s datasheet.

Gas Range [ ] Inaccuracy [ ]

N 2O 20-100
ISO 1-5
SEV 5-8
DES 15-18
O2 0-100

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