Anaes Cases · The anaesthetic machine
Oxygen supply failure during surgery
The classic anaesthetic-machine hot case — the pipeline oxygen failure (or the empty cylinder) during surgery. The discriminating management is: do NOT diagnose first; ventilate the patient by hand on 100 per cent oxygen from the reserve cylinder (open the cylinder valve, switch to the reservoir bag), call for help, switch to the self-inflating bag if the machine cannot deliver O2, and only then investigate the supply. The pre-use check that confirmed the reserve O2 cylinder was full and the fail-safe alarms worked is the single measure that prevents this becoming a hypoxic arrest.
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You are giving a general anaesthetic for an elective laparoscopic cholecystectomy in a healthy 45-year-old. The patient is paralysed and ventilated on a circle system with sevoflurane in oxygen and air. Suddenly the oxygen pipeline pressure alarm fires on the workstation, the inspired oxygen reading begins to fall, the Bosun whistle sounds from the machine, the ventilator bellows begins to collapse, and the oxygen saturation is 94 per cent and falling. The end-tidal CO2 trace is preserved. The pipeline pressure gauge on the machine reads zero. Manage.
References4ShowHide
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- [11]Li J, Zhang Y, Gu W, et al. Diagnosis, management, and prevention of malfunctions in anesthesia machines. Technology and Health Care, 2023.PMID 37302057