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Move the anesthesia workstation cautiously!

Dubey PK - J Anaesthesiol Clin Pharmacol (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology & Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.

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Sir, Inadvertent damage to lines and cords during repositioning of anesthesia workstation after a patient is anesthetized can occur due to carelessness... However, damage to the blood pressure tubing or the sample line tubing of capnograph can affect the anesthesia monitoring significantly... During this process, the anesthesia workstation had to be moved to make room for the OR personnel... Routine auscultation of the chest was done to rule out any displacement of the tube after repositioning and was found satisfactory... The capnogram now displayed a normal waveform... Mechanics of change in capnogram with a “tail-up” due to damage to the sample line has been investigated by Tripathi and Pandey... During movement of the workstation, the sample line dangling on the floor was crushed inadvertently as the capnogram was normal before this... These changes were reproducible by changing the new sample line with the damaged one... Patient repositioning during general anesthesia is known to potentially cause injury... Repositioning of workstation may also jeopardize patient safety, as illustrated by this case... Alarms are often caused by manipulations performed by the medical staff working with the anesthesia workstation and may be annotated as “not relevant,” changing the significance of the alarm... Also, awareness of this possible cause may help the clinician in narrowing down the reason of sudden decrease in EtCO2 value due to such a mishap... Extreme precaution during movement of the work station is needed to avoid such occurrences as a sudden decrease in EtCO2 value can lead to confusion especially during procedures like neurosurgery or where carbondioxide is used as insufflation gas.

No MeSH data available.


Dual waveform capnogram showing an EtCO2 level of 20 mm of Hg
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Figure 1: Dual waveform capnogram showing an EtCO2 level of 20 mm of Hg

Mentions: Suddenly it was noticed that the capnogram had changed into a dual waveform [Figure 1]. The EtCO2 level had also dropped from 34 mmHg to 20 mmHg, the inspiratory and end tidal values of isoflurane changed from 0.5% and 0.4% respectively to 0.3% and 0.3% and that of nitrous oxide from 54% and 53% to 28% and 35% respectively. There was, however, no change in oxygen saturation or hemodynamic parameters. Chest auscultation was again performed to ensure bilateral equal air entry. Integrity of the sample line right from the sidestream connector was checked that revealed a damaged sample line. The sample line was immediately replaced with a fresh one and the EtCO2 value returned to the baseline. The capnogram now displayed a normal waveform. Surgery and anesthesia continued and terminated uneventfully.


Move the anesthesia workstation cautiously!

Dubey PK - J Anaesthesiol Clin Pharmacol (2014)

Dual waveform capnogram showing an EtCO2 level of 20 mm of Hg
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927281&req=5

Figure 1: Dual waveform capnogram showing an EtCO2 level of 20 mm of Hg
Mentions: Suddenly it was noticed that the capnogram had changed into a dual waveform [Figure 1]. The EtCO2 level had also dropped from 34 mmHg to 20 mmHg, the inspiratory and end tidal values of isoflurane changed from 0.5% and 0.4% respectively to 0.3% and 0.3% and that of nitrous oxide from 54% and 53% to 28% and 35% respectively. There was, however, no change in oxygen saturation or hemodynamic parameters. Chest auscultation was again performed to ensure bilateral equal air entry. Integrity of the sample line right from the sidestream connector was checked that revealed a damaged sample line. The sample line was immediately replaced with a fresh one and the EtCO2 value returned to the baseline. The capnogram now displayed a normal waveform. Surgery and anesthesia continued and terminated uneventfully.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology & Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, Inadvertent damage to lines and cords during repositioning of anesthesia workstation after a patient is anesthetized can occur due to carelessness... However, damage to the blood pressure tubing or the sample line tubing of capnograph can affect the anesthesia monitoring significantly... During this process, the anesthesia workstation had to be moved to make room for the OR personnel... Routine auscultation of the chest was done to rule out any displacement of the tube after repositioning and was found satisfactory... The capnogram now displayed a normal waveform... Mechanics of change in capnogram with a “tail-up” due to damage to the sample line has been investigated by Tripathi and Pandey... During movement of the workstation, the sample line dangling on the floor was crushed inadvertently as the capnogram was normal before this... These changes were reproducible by changing the new sample line with the damaged one... Patient repositioning during general anesthesia is known to potentially cause injury... Repositioning of workstation may also jeopardize patient safety, as illustrated by this case... Alarms are often caused by manipulations performed by the medical staff working with the anesthesia workstation and may be annotated as “not relevant,” changing the significance of the alarm... Also, awareness of this possible cause may help the clinician in narrowing down the reason of sudden decrease in EtCO2 value due to such a mishap... Extreme precaution during movement of the work station is needed to avoid such occurrences as a sudden decrease in EtCO2 value can lead to confusion especially during procedures like neurosurgery or where carbondioxide is used as insufflation gas.

No MeSH data available.