title: The three-way stopcock may be a weak component of total intravenous anaesthesia.
abstract: BACKGROUND
  An intravenous line is needed to administer anaesthesia, particularly when total intravenous anaesthesia (TIVA) is performed. A disadvantage of TIVA is that the intravenous concentration of anaesthetics cannot be easily measured compared with volatile anaesthetics. If a three-way stopcock is accidentally unscrewed, TIVA drugs cannot reach the patient's veins, thus resulting in inadequate anaesthesia levels, possibly resulting in awareness. We therefore measured the required torque to open five different brands of three-way stopcocks in an attempt to make an intravenous-line including all elements safer.
  
  
  METHODS
  The torque required to open one, two or three three-way stopcocks being connected in a perpendicular manner was measured with a biaxial servo hydraulic material testing machine.
  
  
  RESULTS
  The force required to open three-way stopcocks connected with an intravenous catheter ranged in five different stopcock models from 5.03+/-0.75 to 2.21+/-0.51 N respectively; with two three-way stopcocks from 2.68+/-0.42 to 1.31+/-0.59 N, respectively, and with three three-way stopcocks from 1.29+/-0.27 to 0.82+/-0.05 N, respectively.
  
  
  CONCLUSIONS
  Turning a three-way stopcock to become loose with possibly leaking drugs requires minimal amounts of force and decreases significantly if not connected in-line.
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria. angelika.zecha@i-med.ac.at
authors.forename: A
authors.initials: A
authors.lastname: Zecha-Stallinger
authors.forename: W
authors.initials: W
authors.lastname: Schmölz
authors.forename: V
authors.initials: V
authors.lastname: Wenzel
mesh_terms: D000771:Anesthesia, Intravenous / Q000009:adverse effects / Q000295:instrumentation*; D002404:Catheterization; D002406:Catheterization, Peripheral