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LETTER TO EDITOR
Year : 2013  |  Volume : 57  |  Issue : 6  |  Page : 631-632  

An indigenous method to prevent intraoperative kinking of gas sampling line


Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Web Publication20-Dec-2013

Correspondence Address:
Lenin Babu Elakkumanan
Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.123351

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How to cite this article:
Elakkumanan LB, Baskaran S, Muthapillai S. An indigenous method to prevent intraoperative kinking of gas sampling line. Indian J Anaesth 2013;57:631-2

How to cite this URL:
Elakkumanan LB, Baskaran S, Muthapillai S. An indigenous method to prevent intraoperative kinking of gas sampling line. Indian J Anaesth [serial online] 2013 [cited 2019 Dec 11];57:631-2. Available from: http://www.ijaweb.org/text.asp?2013/57/6/631/123351

Sir,

Capnography monitoring is essential, especially in neurosurgical patients. Intraoperative kinking of gas sampling line needs immediate intervention which is difficult under the drapes. Even though many techniques have been described, none is failproof. [1] Here we report an indigenous method to prevent kinking of gas sampling line for sidestream capnography in head and neck surgery, especially in neurosurgery.

A 45-year-old female patient, case of tuberculum sellae meningioma, underwent bifrontal craniotomy and decompression under general anaesthesia. The breathing circuit of circle system was connected to the patient without heat moisture exchanger. The gas sampling line was connected via a three-way stop cock to the adapter in the breathing circuit [Figure 1]. The gas sampling line was parallel to the breathing circuit without any angulation. This was successfully used for 10 hrs of surgical procedure without any problem of kinking or obstruction.
Figure 1: Gas sampling line of sidestream capnography connected via three way stop cock (A) to the straight connector (C) which is between the breathing circuit (B) and endotracheal tube (D)

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The position of the gas sampling line is crucial as the vertical position can cause kinking and obstruction. This could be due to the compression either by the weight of the drapes and surgical equipment such as suction tubings, drill, cautery, or pressure from the assistant's hands. The incidence of this complication might increase with the prolonged surgical procedure. Young et al. suggested a simple technique by changing the angle by making a loop of gas sampling line. [2] But again, it could not prevent the sideways lateral kinking of the gas sampling line. If the gas sampling line is in dependent position, then the condensed water droplets or patients secretions could enter the gas sampling line by gravity resulting in obstruction to gas flow. [3] Most of the anesthesiologist would prefer to keep the gas sampling line facing laterally to avoid both these complications. While this prevents kinking, there is risk of entrainment of water droplets because of the horizontal position. This necessitated for an alternate technique that lead us to develop this Indigenous idea by adding a three-way stop cock to the gas sampling line near the breathing circuit. Even though this technique might increase the chance of leak (as one more connection is added), this has been used in ten consecutive neurosurgical patients in supine position with no complication. The possible increase in the resistance because of acute angulation and the efficacy to remove the secretions by increasing the flow rate or purging the sampling line needs randomized controlled trails. As we are absolutely convinced with the effectiveness of this technique, we suggest connecting the three-way stop cock with gas sampling line to the adapter in breathing circuit especially in supine neurosurgical patients.

 
   References Top

1.Chhabra S, Taxak S. An easy solution to obstructed sampling line: Auxillary oxygen flowmeter. Saudi J Anaesth 2012;6:312-3.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Young M, Umesh G, Kadam N, Jasvinder K. Solutions to kinking of the side stream carbon dioxide sampling line. J Clin Monit Comput 2010;24:221-2.  Back to cited text no. 2
[PUBMED]    
3.Skeehan TM, Biebuyck JF. Erroneous mass spectrometer data caused by a faulty patient sampling tube: Case report and laboratory study. J Clin Monit 1991;7:313-9.  Back to cited text no. 3
[PUBMED]    


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2 Use of Tracheal Tube as a Splint to Prevent Intraoperative Kinking of Gas Sampling Line
Prakash K. Dubey,Neeraj Kumar
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