title: Inspiratory valve malfunction in a circle system: pitfalls in capnography.
abstract: Capnography is a useful technique in monitoring the integrity of anaesthetic equipment such as the malfunctioning of unidirectional valves in circle system. However, the lack of a precise mechanism in existing capnographs to identify the start of inspiration and the beginning of expiration in the capnograms, makes the analysis of the carbon dioxide waveforms during inspiration difficult and thus results in inaccurate assessment of rebreathing. We report a case where, during the malfunction of the inspiratory unidirectional valve in the circle system, the capnograph failed to detect the presence of substantial rebreathing. Critical analysis of the capnogram recorded during the malfunction revealed that there was substantial rebreathing which was underestimated by the capnograph as it reports only the lowest CO2 concentration rebreathed during inspiration in such abnormal situations.
authors.affiliation: Department of Anaesthesia, Queen Elizabeth Hospital, University of West Indies, Faculty of Medical Sciences, Barbados.
authors.forename: A Y
authors.initials: AY
authors.lastname: Kumar
authors.forename: K
authors.initials: K
authors.lastname: Bhavani-Shankar
authors.forename: H S
authors.initials: HS
authors.lastname: Moseley
authors.forename: Y
authors.initials: Y
authors.lastname: Delph
mesh_terms: D000764:Anesthesia, Closed-Circuit / Q000009:adverse effects* / Q000295:instrumentation*; D002245:Carbon Dioxide / Q000032:analysis*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D001239:Inhalation; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D011312:Pressure; D012123:Pulmonary Ventilation / Q000502:physiology; D012121:Respiration, Artificial; D013990:Tidal Volume
chemical_list: D002245:Carbon Dioxide