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• W4238009464 abstract "With reference to the editorial by Cartwright and Freeman (Anaesthesia 1999; 54: 519–20), leakage of anaesthetic agent seems to be one of the commonest problems associated with vaporisers. Typically, an average hospital has a large number of anaesthetic machines and even larger variety of vaporisers in use. Financial constraints prevent achievement of uniformity of the anaesthetic equipment at various locations of the hospital. The process of mounting and demounting of the vaporisers on the backbar of the anaesthetic machine during an anaesthetic procedure is potentially risky. Transporting the vaporiser from the anaesthetic room to the operating theatre during the course of the transfer of the anaesthetised patient is a further source of complications. I wish to report a problem that occurred as a result of transfer of the vaporiser during one of the anaesthetic procedures. Routine check of the anaesthetic machines in the anaesthetic room and the operating theatre was performed at the start of the list. Both these machines had enflurane vaporisers ‘Enfluratec’ (Tec 3) in place. The first half of the list went uneventfully. A patient listed halfway through the list had a history of epilepsy; therefore, isoflurane was selected as the agent of choice for the anaesthetic. However, there was only one isoflurane vaporiser available for the anaesthetic room and the operating theatre. The vaporiser (Ohmeda, Isotec 5) had been tested and found to be compatible with the backbar of the machine in the anaesthetic room as well as that in the operating theatre. The anaesthetic was commenced in the anaesthetic room using an intravenous induction and a laryngeal mask was inserted. Anaesthesia was maintained with a mixture of oxygen, nitrous oxide and isoflurane. The patient was transferred to the operating room and simultaneously the isoflurane vaporiser was dismounted from the machine in the anaesthetic room and remounted on the backbar of the anaesthetic machine (Datex Flexima) in the operating theatre by the theatre assistant. On reconnection of the breathing circuit to the patient, inability to achieve a satisfactory pressure in the circuit was noticed despite high flow of the gases. The patient's lungs were being ventilated manually at this stage. A systematic inspection of the assembly revealed a steady drip of the contents (isoflurane) from the Isotec 5 vaporiser. On closer inspection, the locking lever of the key filler port on the left side of the vaporiser (a) was noted to be displaced downwards; additionally, the valve tap at the base of the vaporiser (b) was found to be partially open, resulting in the drip ( Fig. 3). The situation was rapidly rectified by repositioning the levers in the correct place and the gas-tight seal was restored. The vaporiser was topped up and there was no problem in maintaining the depth of anaesthesia. The close up of the Isotec 5 vaporiser showing downwards displacement of the locking lever of the key filler port (a) and the partially open draining valve tap (b). It appeared that the valve tap had probably been accidentally knocked open as the vaporiser was being remounted on the backbar of the anaesthetic machine in the operating theatre. As seen in Fig. 4, there was a very snug fit between the frame of the anaesthetic machine and the base of the Isotec 5 vaporiser. Additionally, the space between the left-hand side of the Isotec 5 vaporiser bearing the lever for the key filler and the filling port of the adjacent Enfluratec vaporiser was very tight. This left no room for fingers to support the bulky Tec 5 vaporiser at its base or on the left side. The only available space was towards the lower outer right-hand corner of the Tec 5. It is easy to see how the draining valve tap near the base could have been accidentally flicked open during a rushed procedure. Fortunately, due to timely intervention, the drop in the end-tidal concentration of the vapour was prevented. Figure 5 shows a much larger space available between the two adjacent vaporisers when the relative positions of the two were reversed; however, the tight vertical fit with the Tec 5 remained unchanged. The double vaporiser assembly showing the tight fit between the two vaporisers and the frame of the anaesthetic machine in relation to the base of the Tec 5. The double vaporiser assembly with the positions reversed. This case illustrates the fact that the problems can occur despite adequate checking of the equipment. The draining valve tap of the Tec 5 vaporiser is rather easily opened unlike others, where emptying of the vaporiser would involve a series of deliberate manoeuvres. The valve tap is not secured by any locking device. Additionally, it might be difficult to spot a partially open valve when viewed from the front. The accidental opening of the valve is thus a potential problem. These vaporisers have been around for nearly 10 years. Personal communication with the quality control manager at the Datex-Ohmeda UK revealed a couple of other reports of accidental draining of the Tec 5 vaporiser. In the first one the valve was entangled with the monitoring leads and another occurred during a cleaning process of the equipment. As it would be a monumental task to alter the design of the vaporiser, it is suggested that the valve tap be secured with some tape during use as well as for transfers. The spillage of the anaesthetic agent not only results in environmental pollution, it is also likely to damage the surface of the machine underneath. In an ideal world, every anaesthetic machine would have a dedicated vaporiser for the relevant anaesthetic agent, thus obviating the need for transportation of vaporiser from one location to another mid-anaesthetic. Despite the best of efforts, it might not be possible to equip all the machines in such a way. One solution would be to anaesthetise the patient in the operating theatre. This would abolish the need for duplication of the equipment in the anaesthetic room and the operating theatre. Furthermore, the hazards associated with the transfer of the equipment and the anaesthetised patient from the anaesthetic room to the operating theatre would be eliminated." @default.
• W4238009464 created "2022-05-12" @default.
• W4238009464 creator A5037639852 @default.
• W4238009464 date "2000-06-15" @default.
• W4238009464 modified "2023-10-16" @default.
• W4238009464 title "Leaking vaporiser" @default.
• W4238009464 doi "https://doi.org/10.1046/j.1365-2044.2000.01479-27.x" @default.
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