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Anesthesia breathing systems deliver oxygen, remove carbon dioxide, and regulate anesthetic depth through controlled gas exchange. This course reviews these systems, classified as open, semi-open, semi-closed, or closed, which vary by the degree of rebreathing and the presence of components such as reservoir bags, valves, and carbon dioxide absorbers. Open systems, including insufflation and open-drop anesthesia, lack rebreathing capacity, while semi-open and semi-closed systems, such as Mapleson circuits and circle systems, enable variable gas control and efficiency. Closed systems allow total rebreathing with carbon dioxide neutralization. Participants will gain an understanding of each system’s design, gas flow dynamics, and clinical application, which is essential to optimizing anesthetic safety, conserving agents, and reducing environmental impact. This activity outlines anesthesia breathing system classification, function, and clinical relevance as well as system components, optimizing gas delivery and scavenging, minimizing rebreathing and anesthetic waste, and applying low-flow techniques safely. This activity for healthcare professionals is designed to enhance the learner's competence in selecting and managing appropriate breathing systems across diverse clinical scenarios, promoting patient safety, supporting environmental sustainability, and implementing an appropriate interprofessional approach to deliver efficient anesthetic care. Objectives: Identify the classifications of anesthesia breathing systems. Differentiate between open, semi-open, semi-closed, and closed anesthesia breathing systems. Evaluate various breathing systems to select the most appropriate option for specific patient populations. Apply interprofessional team strategies to improve care coordination and patient outcomes when utilizing anesthesia breathing systems. Access free multiple choice questions on this topic.

Anesthesia breathing systems are essential for delivering oxygen, eliminating carbon dioxide, and providing an appropriate depth of anesthesia with inhaled agents. Various designs of breathing systems have been created to serve this function. Anesthesia breathing systems can be classified based on the presence of a reservoir bag and the degree of rebreathing into open, semi-open, semi-closed, and closed.[1]

Anesthesia breathing systems form the foundation of safe anesthetic delivery by enabling oxygen administration, carbon dioxide elimination, and regulation of anesthetic depth. These systems—classified as open, semi-open, semi-closed, and closed—differ in their degree of rebreathing and structural components such as reservoir bags, valves, and carbon dioxide absorbers. Mastery of their function, performance, and limitations ensures safe and efficient anesthesia management across surgical and critical care settings. Effective team-based anesthesia care depends on every clinician’s understanding of these systems. Attending anesthesiologists, residents, certified registered nurse anesthetists, certified anesthesiologist assistants, and anesthesia technologists share responsibility for maintaining system integrity, troubleshooting malfunctions, and applying appropriate techniques. Interprofessional communication among physicians, advanced practitioners, nurses, and pharmacists fosters coordination in gas delivery management, medication administration, and monitoring. Collaboration and accountability within the anesthesia team enhance patient safety, optimize perioperative outcomes, and strengthen patient-centered care by ensuring continuous, well-coordinated vigilance during every phase of anesthesia delivery.