Circuit obstruction

J. Choi1 and G. M. Cooper1

1 Birmingham, UK

Editor—Further to the recent reports of obstructions in airway circuits,13 we write to warn of another cause of circuit obstruction. A 3-year-old child required a second anaesthetic after a perforated eye injury. At gaseous induction, he sucked his dummy. Once asleep, the facemask was applied more tightly and it was clinically obvious that the airway had obstructed. On checking the tubing system, the base of the dummy had jammed in the opening of the facemask (Fig. 1). It was detached uneventfully before any arterial desaturation occurred.



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Fig 1 (A) The dummy lying alongside the paediatric facemask used. (B) The position of the dummy in the child’s mouth beneath the facemask before it went to sleep. (C) The view from underneath the facemask with the dummy fitting tightly into it.

 
Allowing a child to suck their comforting dummy is normally beneficial, reducing crying and also dead space. However, one needs to be aware of the potential danger of such a perfect fit into the facemask, and remove the dummy as soon as the child is asleep.

J. Choi

G. M. Cooper

Birmingham, UK

References

1 Hall C. Staff error, not sabotage, to blame for boy’s death. Daily Telegraph, July 23, 2002

2 Meikle J. Third patient at risk from ‘oxygen block’. Guardian, August 10, 2002

3 Ward MM, Collins SJ. Another case of obstruction to an anaesthetic circuit. Br J Anaesth 2003; 90: 110–11[Free Full Text]





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