Global Journal of Anesthesia &

Pain Medicine

Review Article

Physics of Anaesthesia Made Easy

Bhavna Gupta1* and Lalit Gupta2

1
Department of Anaesthesia and Critical Care, AIIMS, India
2
Department of Anaesthesia and Critical Care, Maulana Azad Medical College, India

*Corresponding author: Bhavna Gupta, Department of Anaesthesia and Critical Care, AIIMS, Rishikesh, India

Received: February 06, 2019 Published: February 28, 2019

Abstract
Physics is an attempt to describe the fundamental laws of world around us. As anesthesiologists we deal with liquids and gases
under pressure at varying temperature and volume. These inter relationships are simple, measurable and their understanding
ensures a safe outcome for the patient. For the safe and efficient use of anesthesia apparatus, a basic knowledge of fundamental
physics is must for a clear concept of their working principle. We have tried to simplify the basic physics related to anesthesia in a
simplified way through the review article.

Introduction e) 1 calorie = 4.18J

Basic Concepts
f) 1-kilogram weight = 9.8N
Units of Measurements
g) Pounds / inch2(PSI) -Atmospheric Pressure (1
(Table 1)
PATM=14.7PSI)
Table 1: Units of measurements.
h) 1 Bar = 100kPa = Atmospheric pressure at sea level [1].
Basic SI Units Derived Units Units not in SI system
Pressure
temp (degrees
length (meter) pressure (mmHg)
Celsius) a) Force = mass x acceleration = kgms-2 = Newton
mass (kilogram) force (newton) pressure (cmH2O)
b) Pressure = Force/Area
pressure (standard
time (second) pressure (pascal/ bar)
atmosphere)
c) 1 Pascal = I Newton acting over 1m2
current (ampere) energy (electron volt) energy (calorie)
force (kilogram
Gauge pressure is defined as pressure which is measured when
temp (kelvin) power (watt)
weight) unknown pressure is measured relative to atmospheric pressure
luminous intensity [2]. This pressure is used in measuring:
frequency (hertz)
(candela)
a) Blood pressure
amount of substance
Volume (lliter)
(mole)
b) Airway measurements
Simple Mechanics In order for fluid to pass out of the barrel of the syringe the
a) kilopascal = 7.5mmHg. same pressure must be developed in the syringe.

b) 1 Bar = 750mmHg a) For a 20ml syringe (diameter 2cm) – pressure generated

is 100kPa; even this is 6 times more than SBP of 16kPa (120 mmHg).
c) 1 kilopascal = 10.2cmH2O
So, during Biers block, pressure in the vein during rapid injection
d) 1 std atmosphere = 101.325kPa
can exceed systolic pressure, particularly if a vein adjacent to the

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cuff is present. b) Intravenous fluids: Intravenous fluids flow via laminar

flow, and flow is determined by Hagen Poiseuille Equation. This
Bed Sores: for a 20kg of patient mass supported on an area of
means that flow is greater through a shorter and wider cannula
contact of 100cm2 (10x10)
as compared to cannula which are long and small when the same
a) Force = 196N (20kg x 9.81); Pressure = 19.6kPa pressure is applied to it. That’s why shorter and wider cannula such
as 16 or 18 G cannulas are preferred during resuscitation.
b) Normal SBP = 16kPa, so there is always a risk of Ischemia

Similar concepts are applied for pressure relief valves and Turbulent Flow
expiratory valves of anaesthetic breathing systems. Pressure in Turbulent flow denotes a situation in which the fluid flows in
the circuit exerts a force on the diaphragm and when this force is an unpredictable manner with multiple eddy currents which are
greater that the force exerted by the valve, air escapes through the not parallel to the sides of the tube through which they are flowing.
expiratory valve. They are typically low-pressure valves (50Pa). Flow is facilitated by irregularities, sharp angulation, corners and
Fluid Mechanics are predicted by density of gas. Reynold number is always greater
than 2000.
Flow is defined as amount of fluid or gas passing in unit time.
Flow becomes laminar to turbulent after Reynold number (defined Clinical Relevance
below) reaches above a value of 2000. a) Kinked ETT or ETT connectors often result in turbulent flow.
Reynold’s number (Re): - is a dimensionless number and has no b) Heliox (a mixture of 21% helium and 79% oxygen) is used
units and is defined as: to reduce density and thereby improve the flow and is used in
Velocity x pressure x density / viscosity respiratory tract obstruction. Helium is much less dense than
nitrogen, which constitutes 79% concentration of air. In patients
R = vpd / µ
with upper airway obstruction, flow is through an orifice and hence
When more likely to be turbulent and dependent on the density of the gas
passing through it. Therefore for a given pressure gradient (patient
Re < 2000 – flow is laminar
effort), there will be a greater flow of a low density gas (heliox) than
Re > 2000 – flow is turbulent a higher density gas (air).

2.4. Points to Remember c) There is laminar flow during quiet breathing which becomes
turbulent during coughing and speaking thereby resulting in
a) Viscosity is an important parameter to determine laminar
breathlessness or dyspnea.
flow
d) According to, Hagen – Poiseuille’s Law. flow is laminar at low
b) Density is an important parameter to determine turbulent
flows in the flow meter, while at higher flows, the law applicable to
flow
turbulent flow is applicable [3].
c) Reynold’s number of 2000 delineates laminar from turbulent
flow. Critical Flow
Critical flow for a typical anesthetic gas has approximately the
Laminar Flow
same numerical value as the diameter of the airway concerned.
Flow moves in a steady state with no turbulence or eddies. Flow
a) 9mm ETT has a critical flow of 9L/min: Above 9L/min =
is greatest in the mid center and zero in peripheral wall. Hagen
turbulent flow
Poiseuille Equation is used to determine laminar flow, defined as:
Q π ( P1 − P 2)r 4 / 8η l
= b) Air has a lower density than Nitrous Oxide – laminar flow
prevails
Where P1 – P2 = Pressure difference across the tube
c) Air flow through the smaller airways is slower – laminar
r4 = Radius to the power of four flow predominates
= Viscosity The Gas Laws
L = Length and 8 = constant a) Boyles Law
Clinical Relevance b) Charles Law
a) The endotracheal tube with size 7 has almost twice resistance c) Third Perfect Gas Law
as compared to sized 8.0 ETT
d) Dalton’s Law of Partial Pressures

Citation: Bhavna Gupta, Lalit Gupta. Physics of Anaesthesia Made Easy. Glob J Anes & Pain Med 1 (2)-2019. [Link].000107. 31
Glob J Anes & Pain Med Volume 1 - Issue 2 Copyrights @ Bhavna Gupta, et al.

e) Universal Gas Constant of gases, the pressure exerted by each gas is the same as that which
it would exert if it alone occupied the container
Boyles law: Boyle’s law is a gas law, stating that the pressure
and volume of a gas have an inverse relationship, when temperature Universal Gas Constant: Ideal Gas law is deduced by combining
is held constant. all 3 perfect gas laws and combining with the avogadro’s hypothesis
the concept of mole gives us the Universal Gas Constant = R.
PV = k
PV/ T= Constant
(P = pressure, V = volume, and k = constant)
For one mole of any gas (molecular weight expressed in grams)
Cylinder capacity of oxygen cylinder at atmospheric pressure
= 10 L PV = n RT

Absolute cylinder pressure= 138 bar Where R = Universal Gas Constant

Therefore, since, n = Number of moles

P1V1 = P2V2 Avogadro’s Hypothesis: States that equal volumes of gases at

the same temp and pressure contain equal number of molecules.
138x10 = 1xV2
One mole of any gas occupies 22.4L at STP (standard temperature
So, V2 = 1380 L and pressure). Avogadro’s number is defined as the number of
elementary particles (molecules, atoms, compounds, etc.) per mole
Charles Law (Gay Lussacs Law):
of a substance. It is equal to 6.022×1023 mol-1 and is expressed as
a) Charles Law States that at Constant Pressure the symbol NA.
V a Temp (i.e. Gases expand when heated) Clinical Relevance
Clinical relevance- respiratory gas measurements are done at Nitrous oxide cylinder contains 3.4kg N20
ambient temperature while exchange of gases rakes place at room
Mol wt. of N2O = 44 (1mole)
temperature i.e. 37 ºC
1 mole occupies 22.4 L at standard temp and pressure
b) Third Perfect Gas Law
Therefore 3400 g occupies 22.4 x 3400/44 = 1730L
At constant volume, absolute pressure of a mass of gas varies
directly with temperature. Solubility Mechanics
P a Temp Solubility Saturated vapor pressure is defined as the partial
pressure exerted by vapour in the equilibrium state is achieved
Clinical Relevance
at the surface between vapor of the liquid and liquid itself when a
a) Medical gases are stored in cylinders having a constant liquid is placed in a closed container. SVP is associated with Henry’s
volume and high pressures (138 Barr in a full oxygen/air cylinder). law [4].
If these are stored at high temperatures, pressures will raise
Henry’s Law states that at a temp, the amount of a given gas
causing explosions.
dissolved in a given liquid is directly proportional to the partial
b) Adiabatic changes: it is a change which doesn’t involve pressure of the gas in equilibrium with the liquid.
transfer of heat (Q) or matter into and out of a system, so that Q = 0,
a) Bubbles may be seen when a liquid is warmed and less gas
and such a system is said to be adiabatically isolated.
dissolves in it.
Clinical Relevance: When a valve of an oxygen cylinder is
b) The effect of high pressure is particularly relevant to deep
opened suddenly, oxygen will rush into high pressure hose or stem
sea divers as the solubility of nitrogen if breathed under pressure
of oxygen regulator and on reaching the end of hose, adiabatic
passes into solution in the tissues. If a return to atmospheric
process might occur. That suggests that local pressure is much
pressure is made too rapidly, the nitrogen comes out of solution as
higher than that of filling pressure of the cylinder (about 150 bar)
small bubbles in the joints and tissues causing pain and bends.
for a very brief time. The process is adiabetic because compression
occurs without any heat from outside and the effect can lead to Ostwald Solubility Coefficient is the volume of gas which
sudden explosion if there is dust or grease at regulator preventing dissolves in one-unit volume of the liquid at the temp concerned
further gaseous expansion. (Independent of pressure) Ostwald solubility coefficient of ether is
highest, and the value is 12. Halothane has solubility coefficient of
Dalton’s Law of Partial Pressures: It states that in a mixture
2.3 and that of nitrous oxide is 0.47. So, ether used to be carried

Citation: Bhavna Gupta, Lalit Gupta. Physics of Anaesthesia Made Easy. Glob J Anes & Pain Med 1 (2)-2019. [Link].000107. 32
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away very slowly and its concentration to build up in alveoli was Concentration Effect and Second Gas Effect: At the time
very slow thereby leading to slower induction of anesthesia. of inspiration, Nitrous oxide is absorbed into blood stream at a
faster rate than oxygen or nitrogen gas. At the peak of inspiration,
Blood: Gas Solubility Coefficient: the ratio of the amount of
when pressure in the alveoli equalizes with the ambient pressure,
substance in equal volume phases of blood and gas in a closed
there is net surpulous supply of oxygen and nitrogen molecules.
system at equilibrium and at standard temperature and pressure.
This results in effects known as the “concentration effect” and the
Oil: Gas Solubility Coefficient: the ratio of the amount of second gas effect. When a constant concentration of an anesthetic
substance present in equal volume phases of oil and gas in a closed such as sevoflurane is inspired with nitrous oxide, the alveolar
system at equilibrium and at standard temperature and pressure. concentration of sevoflurane is accelerated due to nitrous oxide,
because alveolar uptake of the latter creates a potential sub
Clinical Relevance: Agents with the highest oil solubility have
atmospheric intrapulmonary pressure that leads to increased
the greatest potency and lower MAC value and forms the basics of
tracheal inflow.
Meyer Overton theory of anesthesia Table 2.
Diffusion Hypoxia: Nitrous oxide diffuses faster from the
Table 2:
alveoli at the end of anesthetic exposure, as N20 diffuses faster
N2O 1.4
into the alveoli thereby diluting the gases leading to fall in oxygen
Ether 65
saturation, also known as diffusion hypoxia, therefore 100% oxygen
224 is required at the end of surgery to avoid diffusion hypoxia.
Halothane (very potent and needs lesser
concentration in alveoli and brain) Osmolarity

Diffusion: Diffusion is a process in which the molecules of a It is defined as the sum total of the molarities of the solutes in
substance (such as gas) transfer through a layer such as the surface a solution.
of a solution to another one.
a) Ringer Lactate has an osmolarity of 278mosm/l
Grahams Law states that the rate of diffusion of a gas is inversely
Constituents of RL
proportional to the square root of its molecular weight.
Na 131mosm/l
Clinical Relevance
K 5mosm/l
a) Thus, heavier gas will diffuse more slowly. Also, if the MW
(molecular weight) of a gas is four times of another, it would diffuse Cl 111mosm/l
at half the rate of the other. Ca 2mosm/l
b) Local anesthetics injection for nerve block should be done as Lactate 29mosm/l
proximity to the nerve as diffusion only allows limited penetration
of the LA into the tissues. Plasma has an osmolarity of 275–295 mosm/kg >99% due to
Na, Cl, HCO3.
c) Heliox mixture of helium and oxygen, is a lighter gas, hence is
used in airway obstruction to improve diffusion and gas exchange. Energy Mechanics

Fick’s Law of Diffusion: Heat Capacity: Heat Capacity is defined as the amount of heat
required to raise the temperature of a given object by 1 kelvin.
The rate of diffusion of a gas across a membrane is directly
proportional to the membrane area (A) and the concentration Specific Heat Capacity
gradient (C1-C2) across the membrane and inversely proportional Specific Heat Capacity defined as the amount of heat required
to its thickness (D). to raise the temperature of 1kg of a substance by 1 kelvin. (J /kg/
Rate of diffusion a A (C1-C2) / D. Kelvin)

Clinical Relevance Clinical Relevance

a) Anesthetic vapors diffuse into breathing circuits and later Normal body temperature is 36 degrees Celsius and basal heat
acting as Vaporizers at the time of discontinuation of anesthetic production is 80 W(J/Sec)
gases. Shivering increases heat production by 4fold (ie 320W, with
b) N2O gas diffuses into cuff of endotracheal tube. extra 240W= 14.4kJ/min) 245kJ needed to increase temp by 1
degree (total heat capacity = 3.5x70kg), so patient has to shiver for
c) Diffusion of N2O into air filled cavities as in pneumoecephalous, approximately 245/14.4=17min to produce this extra heat.
pneoumoperitoneum etc.

Citation: Bhavna Gupta, Lalit Gupta. Physics of Anaesthesia Made Easy. Glob J Anes & Pain Med 1 (2)-2019. [Link].000107. 33
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Bernoulli’s Principle Absorbance of Oxy-Hb at wavelengths of 660 nm (red light) is less

and that of DeOxy-Hb is less in 940nm (blue light).
It is defined by the law of conservation of energy. Flowing liquid
possess 2 types of enrgy- potential and kinetic energy. If there is b) Two diodes, one emitting red light 660 nm and the other
a constriction in tube, there is increase in kinetic energy, there is a blue light (940nm) are positioned so that they are opposite
subsequent fall in potential energy, to conserve the total energy [4]. their respective detectors through 5-10 mm of tissue. The output
processed electronically on the other side of the finger gives the
The Venturi Effect
oxygen saturation depending on the relative amount of each type of
Venturi effect was named after famous Italian physicist, Hb present in the pulsating arterial blood.
Giovanni Battista Venturi (1746–1822). It is the effect by which
c) More the Hb per unit area more is the light is absorbed. This
the introduction of a constriction to fluid flow within a tube causes
property is described in a law in physics called “Beer’s Law”. While,
the velocity of the fluid to increase, therefore, the pressure of the
longer the path the light has to travel, more is the light absorbed.
fluid to fall. By measuring the change in pressure, the flow rate can
This property is described in a law in physics called “Lambert’s Law.
be determined, as in various flow measurement devices such as
venturi masks, venturi nozzles and orifice plates. Capnography and Anesthetic Analyzers

a) The Venturi effect may be observed or used in the following: a) Both mainstream and side stream capnometers rely on
absorption spectroscopy and, accordingly, on Beer-Lambert law.
b) The capillaries of the human circulatory system, where it
indicates aortic regurgitation. b) In side stream type infrared absorption spectroscopy,
respiratory gas analyzers are usually integrated in the anesthesia
c) Injectors used to add chlorine gas to water treatment
machine. These devices use different wavelengths appropriately
chlorination systems.
chosen to measure, in addition to pCO2, the concentration of other
d) Ventilators. respiratory gases such as nitrous oxide, and different volatile
anesthetics (anesthetic analyzers) [5].
Conada effect

If a constriction occurs at bifurcation because of increase in Circulation

velocity and reduction in the pressure, fluid (air, blood tends to Hemodynamics can be defined as the physical factors that
stick to one side of the branch causing maldistribution. govern blood flow. These are the same physical factors that govern
the flow of any fluid and are based on a fundamental law of physics.
a) Mucus plug at the branching of tracheo-bronchial tree may
cause maldistribution of respiratory gases. Ohm’s Law

b) Unequal flow may result because of atherosclerotic plaques a) Pressure = Flow x Resistance
in the vascular tree.
b) Voltage = Current x Resistance
c) Fluid logic used in ventilators employs this principle to
c) Resistance = Pressure/Flow
replace valves or mobile parts.
Law of Laplace
Spectrophotometry– Basic Concepts
Tension may be defined as the internal force generated by a
a) Beers Law
structure, La Place Law states that for cylinders,
Beer law states that amount of light absorbed is proportional to
T = Pr
the concentration of the light absorbing substance.
(where T = wall tension, P = pressure of fluid within the cylinder,
b) Lamberts Law
r = radius
Equal thicknesses absorb equal amounts of radiation. Amount
Ohm’s Law: It states that current (I) equals the voltage
of light absorbed is proportional to the length of the path that the
difference (ΔV) divided by resistance (R). In relating Ohm’s Law
light has to travel in the absorbing substance. Both laws say that
to fluid flow, the voltage difference is the pressure difference (ΔP;
the absorption of radiation depends on the amount of a particular
sometimes called driving pressure, perfusion pressure, or pressure
substance. This fact has been utilized in pulse oximetry.
gradient), the resistance is the resistance to flow (R) offered by the
Pulse Oximetry: It involves Spectrophotometry & blood vessel and its interactions with the flowing blood, and the
Plethysmography. current is the blood flow (F). This hemodynamic relationship can
be summarized by:
a) Light absorbed by the blood depends on the quantities of
∆Ρ (Ρ A − ΡV )
Haemoglobin and Deoxy-Hb and the wavelengths of the light. F =
=
R R

Citation: Bhavna Gupta, Lalit Gupta. Physics of Anaesthesia Made Easy. Glob J Anes & Pain Med 1 (2)-2019. [Link].000107. 34
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a) For the flow of blood in a blood vessel, the ΔP is the pressure and air expulsion is favored.
difference between any two points along a given length of the
c) Archimedes’ principle helps cardiac anesthesiologists to
vessel. When describing the flow of blood for an organ, the pressure
prevent (or reduce) cerebral air embolism when air accidentally
difference is generally expressed as the difference between the
enters the circuits during cardiopulmonary bypass (CPB) by
arterial pressure (PA) and venous pressure (PV).
immediately placing the patient in steep Trendelenburg position.
Law of Laplace (Wall Stress):
Calculating the Duration of a N2O Cylinder
Laplace Law states that for cylinders,
Just Now a new N2O cylinder is fitted to the Machine. How
T = Pr or P =T/r (e.g. Arteries) Long Will It Last…? Can a case of 6 hrs duration be taken with this
cylinder?
For sphere,
First step is to calculate the Amount of N2O Gas in Cylinder?
P= 2T/r (e.g. Anesthesia Bag/ Heart)
a) Atomic weight of nitrogen – 14, oxygen – 16,
(Where T = wall tension, P = pressure of fluid within the
cylinder/ sphere, r = radius); Molecular weight of N2O = 14+14+16 = 44

Tension may be defined as the internal force generated by a b) As per AVAGADRO Hypothesis:
structure.
one-gram molecular weight of all gases will contain the same
Clinical Relevance number of molecules and occupy the same volume (22.4 l) at STP.

a) In a failing heart –there is an increase in radius therefore a So,

decrease in pressure, and failing heart is unable to increase T.
32g of O2 = 44 g of N2O = 28g of N2 =22.4Lt.
b) In a normal heart, increase in radius is beacuase of increase
Empty weight of the cylinder = 12.5 Kg, Cylinder weight with
in venous return, also there is increase in Tension according to
N2O = 15 Kg
Frank starling law. Therefore there is no change in pressure.
So,
c) The management of stable angina is to reduce wall stress
thereby decreasing myocardial oxygen demand. Weight of the N2O = 2.5Kg = 2500g; 44g of N2O = 22.4Lt
(Avogadro hypothesis)
d) In a patient with chronic hypertension, there is overall
increase in left ventricular wall thickness to compensate for Therefore 2500g = 22.4/44 x 2500 = 1272Lt.
increased wall stress. So, amount of duration for which a N2O cylinder can be used =
e) Left ventricular pressure increases with symptoms of 1272Lt/ flow of N2O on machine per minute.
increased “afterload” of the heart, including systemic hypertension (Suppose the flow of N2O is 3Lt/m=180Lt/hr, so the cylinder
and aortic valve stenosis. will last for 1272/180= 07hr).
Miscellaneous Physics Unexpected Help from the Reservoir Bag
Archimedes’ Principle The reservoir bag in an anesthesia machine allows manual
Archimedes’ principle is a law of physics fundamental to fluid ventilation as well as a “visual” monitoring of spontaneous
mechanics. It says any object, wholly or partially immersed in a breathing.
stationary fluid, is buoyed up by a force equal to the weight of the a) Thanks to Laplace’s law, it can prevent barotrauma in case
fluid displaced by the object. of malfunction or unintentional closing of the APL (adjustable
a) Air Bubbles: According to Archimedes’ principle, air bubbles pressure limiting) valve. In fact, in the presence of an overflow or a
always tend to go upward in any liquid, including saline, drugs, and flow obstruction in the breathing system, the radius of the reservoir
blood. So, just keep up the cone of the syringe (exit path), bubbles bag increases (Figure 5) and, according to Laplace’s law, the
can be removed by ejecting air by pushing the plunger of syringe. pressure inside it decreases (P=2T/R), thus preventing a dangerous
rise in pressure in the entire breathing system and, consequently,
b) Cardiac Surgery: During cardiac surgery, de-airing is
in lungs.
done before aortic de-clamping in order to prevent air bubbles
from reaching the brain. If de-airing is performed through a b) Accordingly, a reservoir bag which feels stiff should be
ventriculotomy, the anesthesiologist is asked to place the patient in replaced, since its wall tension (which we can define, similarly to
the Trendelenburg position, so that the venting site is located above surface tension γ, as the work required to extend the surface of an

Citation: Bhavna Gupta, Lalit Gupta. Physics of Anaesthesia Made Easy. Glob J Anes & Pain Med 1 (2)-2019. [Link].000107. 35
Glob J Anes & Pain Med Volume 1 - Issue 2 Copyrights @ Bhavna Gupta, et al.

elastic membrane by a unit area will be higher, for the same radius easy to operate. Learning conceptual physics also helps to trouble
(or its radius will increase by a lesser extent for the same value of shoot the problem associated with them.
wall tension), thus providing a lower “pressure relief”.
References
Conclusion 1. Fundamentals of Anesthesia, (2nd edn).

Anesthesia has evolved very fast over last few decades but 2. Understanding Anesthesia equipment by Dorsch and Dorsch, (5th edn).
the basic are still same and applicable in day to day anesthesia 3. Physics, Pharmacology and Physiology for Anesthetists, (2nd edn).
instruments and apparatus. It is necessary to understand the basic 4. Basic physics and measurement in anaesthesia, (4th edn).
physics behind every anesthetic instrument, so that it becomes

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Citation: Bhavna Gupta, Lalit Gupta. Physics of Anaesthesia Made Easy. Glob J Anes & Pain Med 1 (2)-2019. [Link].000107. 36