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A breathing circuit disconnection detected by anesthetic agent monitoring

[Une déconnexion du circuit respiratoire détectée par le monitorage de l'anesthésique]

From the Department of Anesthesia, Christchurch Hospital, Christchurch, New Zealand.

Address correspondence to: Dr. R.A. French, Department of Anesthesia, Christchurch Hospital, Riccarton Avenue, Christchurch, New Zealand. Phone: 03 364 0288; Fax: 03 364 0289; E-mail: anaesthesia{at}chmeds.ac.nz

Purpose: To describe a case involving a spontaneously breathing patient where a circuit disconnection was detected by a change in monitored anesthetic agent parameters.

Clinical features: A patient undergoing shoulder surgery was breathing spontaneously from a circle type anesthesia circuit via a laryngeal mask. A disconnection occurred between the heat and moisture exchanger (HME) and the circle system's Y-piece. As the gas sampling port was integrated into the HME a near normal pattern of CO₂ continued to be displayed. The disconnection was noted because of a change in the graphical display of the volatile agent concentration.

Conclusions: Anesthetic circuit disconnection can be difficult to detect, especially in the spontaneously breathing patient. Capnometry may not detect a disconnection on the machine side of the gas sampling port. Changes in oxygen and volatile agent concentrations may provide an early indication of these types of disconnection.

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