The L-Tap - a new two-way tap to prevent inadvertent over transfusion and fluid overload in neonates and infants

Abstract

SIR IR-There are multiple causes of hypercapnia during anesthesia (1,2). We report an unusual cause of hypercapnia during the induction of anesthesia owing to a malfunctioning of the Pediatric Anesthesia Breathing Circuit (PDY 160-6121 PED F2 @ King System Corporation, Noblesville, IN, USA).An eight-month-old (8.4 kg) child was scheduled for proximal hypospadias repair. Induction of anesthesia was uneventful with N 2 O ⁄ O 2 (70% : 30%) and increasing sevoflurane concentrations up to 8%. After an intravenous access was secured, propofol 25 mg and fentanyl 10 mcg were administered, and the sevoflurane concentrations were decreased to 4%. The trachea of the patient was intubated without difficulty. Shortly thereafter, the CO 2 concentrations were elevated and noted to be as high as 70-80 mmHg, and oxygen saturation remained greater than 98%.Our patient was not tachypnic, and his temperature was within normal. Thus, malignant hyperthermia was not considered as a cause of the hypercapnia. The CO 2analyzing line and the CO 2 -analyzing water trap cassette were changed without effect. Check on the unidirectional valves revealed that they worked properly. The CO 2 canisters were checked and had not changed color. Further examination revealed that the inner blue tubing of the Pediatric Anesthesia Breathing Circuit (PDY 160-6121 PED F2 @ King System Corporation) had become disconnected and that the CO 2 was accumulating in the open area (See arrow, Figure 1). Upon changing the anesthesia breathing circuit, the CO 2 decreased to normal levels.Causes of hypercarbia during the induction of anesthesia are numerous. Review of the literature reveals that equipment malfunction and breathing circuit are causes of hypercarbia. We present a case of hypercarbia during the induction of anesthesia, secondary to a malfunctioning pediatric anesthesia breathing circuit. We noticed that the blue tubing inside the Pediatric Anesthesia Breathing Circuit (PDY 160-6121 PED F2 @ King system Corporation) had become dislodged. References1 Sibai AN, Kassas C, Loutfi E et al. Progressive hypoxemia, hypercarbia and hyperthermia associated with prolonged anesthesia-a case report. Middle East