In Reply

Abstract

We thank Dr. Eisenkraft for taking the time to write regarding our recent article1 and describe to us a detailed alternative scheme by which expiratory limb ventilation can be provided. The suggestion is valid and not the one that we thought of in this emergency. We were unaware of the Kummar et al. description, which does not explain how the Bain circuit was pressurized on his Aisys machine (GE Healthcare, Madison, WI). Dr. Eisenkraft’s alternative demands mental preparation for such emergencies, just as we taught our option in previous simulations, and would require that the clinician recall the alternate common gas outlet circuitry immediately within a crisis situation. Although we admire his technically accurate methods of scavenging the volatile agent, we believe that such connections would not be available or clinically necessary in a brief emergency situation. From a technical perspective, we would like to raise three issues with his alternative.In summary, we applaud this alternative suggestion as long as the clinician uses high fresh gas flow and desires the continuity of volatile anesthetic, but in the emergency situation we describe, we feel more secure in delivering higher oxygen concentrations from our SIMVD reservoir connected to auxiliary oxygen and do not see the need for scavenging arrangements. Our technique can be used on ANY anesthesia machine (without the alternate common gas outlet) and may require less technological understanding.