Anaesthesia Journal of the Association of Anaesthetists of Great Britain and Ireland Volume 46 Number 2 February 1991 The Association of Anaesthetists of Great Britain and Ireland Patron: HRH The Princess Margaret, Countess of Snowdon Published for the Association by Academic Press Grune & Stratton London — San Diego New York Boston Sydney Tokyo Toronto ss 0003-2409)tudible “hiss” could be heard in the region of the back bur. The Boyle's machine and ventilator were taken out of use ind the service personnel contacted. The source of the leak turned out to be from an old Boyle cther vaporizer on the >ack bar of the machine. The grease around the drum and tas inlet pipe had dried and the drum was worn, When dack pressure in the back bar inereased during controlled ‘entilaion using the Manley Pulmovent, fresh gus was able ‘escape betwcen the drum and the gas inlet pipe, exiting © the atmosphere through the slot for the drum-actuating ver. It did not matter whether the actuating lever was in he on or off position. This vaporizer had not been in use ‘or many years and was consequently not serviced. 183 allowing the grease around the drum 10 dry out and 3 Significant leak to develop. There are numerous other places in a vaporizer like this where potential leaks ean ‘occur, including the bottle sealing washer, the cork stopper fF the locking and adjusting rings. In view of our experience we recommend that this type of ‘vaporizer be removed from the buck bar of anaesthetic machines unless i is in regular use and receiving frequent servicing, K.W, Parminson PK. Kean University College Hospital, Gatway Ireland Fixation of tracheal tubes Fixation ofthe tracheal tube i problem encountsred by ry neonatologist and anaesthetist. Firm fixation is vital. but the present method using gauze Strapping or sticky tape om the patient’ face is ineffective, unhygienie, and results in otemuial serious problems, Confused patients and children aay pull out the tubo and restraining the hands of the patients using tubegauze mittens is traumatic to them and their attendants, Adhesive tape may damage skin. sspecially of burns. patients and. premature babies. Furthermore, tubs firmly fixed with sticky tape. cord igature, silk suture or cord clamp is difficult (0 readjust. Firm fixation is necessary, and should prevent the tube pulling against the external nares to equse pressure necrosis dr kinking, slipping and piston-like movement transmitted From ventilator to patient "To counter these problems, | have devised a simple and celiable appliance which permits quick fixation and repositioning of the tube (Figs 1-3). This method is aygienic since the device is made of plastic, secretions are sasy 10 clear and conscious patients are ai ease, Various zombinations of tubes can be fixed using a single device, thus making itcasier for the patients to be handled. The nasoiracheal tube fixer has a soft. polypropylene. aose-shaped dome ith the tube holder attached (0 its ‘ie Tae, Fr tie anterior border at a slight angle, thereby directing. the tracheal tbe away from the fragile nasal septum, preventing erosion and pressure on the nares. The lateral edges of the dome have extensions to which slrapping is attached, stabilising the holder. These arch around the ‘maxilla and do not apply pressure on the skin of the face As the material used is very soft, pressure necrosis of the rhares and manilla are avoided, “The oral tracheal tube Fixer i a fat plastic sheet with the holder attached at its edge on one side. The holder is a C-shaped soft plastic tube with a longitudinal shit on its anterior aspect. The internal diameter of the tube holder is qual to the outer diameter ofthe tracheal tube. The lock is Gm plastic tube with a graduated bore which when pushed down on to the tube holder causes the longitudinal Si to collapse on the tracheal tube. thus preventing it from, slipping. The lock has a small ring internally which fits on to the slit on the outer surface of tube holder. The (ube fixer is placed on the upper lip/chin or nose, depending on whether the patient i 10 be intubated orally or nasally and. the strapping adjusted, ‘When the oralnasal cavity, visible from anterior aspect is imubated, the part of the tracheal tube outside the ‘mouthinose is pushed through the longitudinal sit in the rrr We ee 4 Fig. 1. Diagram of nasal and orot “ie Nase eter meaae erie rater Oe te fxators134 Fig. 2 Photograph of ral nator st on dur ead tube holder, Onse the tube is in place the rin pushed down on the holier and twisted into the proses, firmly holding the tube, This device would be useful to intensive care personnel. raconatologiss, dental surgeons and plastic surgeons since the fixation is reliable and gives better access 10 the oral sand masa city. Depariment of Paediatrics, K.M. Seivarsa Prince Charles Hospital, Merthyr Tdt Monitoring of tidal carbon dioxide in spontancousty ‘To the majority of patients anaesthesia is synonymous with painsfoe sleep and associated with amnesia. Thus regional anaesthesia frequently requires augmentation — with sedatives, Maintenance of patent airway in a sedated patient sof prime importance and monitoring tidal carbon Gioxide will pve some measure of adequacy of ventilation patency of airway and wil act as an apnoea slarm, Relsble fhethods of monitoring Feo, using siestream analysing monitors have boon described for sedated patients!” and for patients receiving infusions of epidural opioids." In hospitals and operating theatee. suites equipped with ‘instream analysing monitors this method of monitoring Seiated patients is not possible, but L would like to deseribe 4 simple method of monitoring tidal earbon dioxide in Sedated patients using a mainstream analysing, monitor A'standard medical suction unit, Ohmeda International was used to aspirate exhaled gases through the analysing ell where the CO, was measured. The suction control unit a ator som mn Bead References 1 Liovw Twosts AR. Paciatric trauma primary survey and fesuseation fe Brak Maca forma 190. Mle 334-6 2. Hue B- Acsideal rma of endotracheal whe. Bish Maia Jowral 197% W135 3. Bncaan PK, Hows BAN fndoteaheal take Huaion. im 4. Scorn Pl, Lies Hy Move LA, Groans 3, Lacon J) Prediatic ICU Cia Care Meshene IONS: 1328 32 breathing patients using a mainstream analysing mon was connected through a filer, a | 6sitre container and a 2m long tube (ID 7 mm) 10 Portex 1S-mm female mount ‘This was attached to the airway adaptor of a Hewlet Packard M3608 CO, transducer, mounted onto a 60-mm tracheal tube connexion which was connected to an FG Suction catheter with terminal and lateral eyes (Fig. 1) ‘ subatmospherie pressure of 10 kPa is maintained with the suction control at the lowest setting and the unit turned ‘one this sufficient to generate a constant low of 28 ire minute. A sitisactory trices obtained on the eapnograph tsth the eatheter inserted em into the nostril and the Transducer placed onto the airway adaptor (Fig. 2). The analysing cel although a Hite bulky. can be strapped 10 the patients ehst or simply Jaid on the pillow. This adaptation can also be attached to nasal prongs. 35 Sygested Goldman! by using an [gauge cannula attached to a 3.Smm tracheal tube connector mounted fonto the airway adaptor. The Mowe generated with his