Abstract
When Equipment Misbehaves: Severe Respiratory Acidosis Resulting from a Compromised Coaxial Circuit
Highlights
The circle breathing circuit is the most widely used breathing circuit in the United States
We describe a clinical case in which a disconnection in the inner inspiratory limb of a King (King Circuits, Noblesville, IN) coaxial breathing circuit resulted in severe respiratory acidosis 4 hours after induction during a craniotomy for tumor resection
Anesthetic providers who are aware that coaxial circuit failures associated with the inspiratory limb can occur at any time during surgery will be in a position to identify the problem early, thereby limiting the degree of respiratory acidosis that develops and reducing the risk of associated complications
Summary
The circle breathing circuit is the most widely used breathing circuit in the United States. A coaxial system (King Circuits, Noblesville, IN) is a circle breathing circuit that encloses the inspiratory limb within the expiratory limb This design decreases the circuit’s bulkiness and better conserves the heat and humidity of the inspired gases. When there is kinking or disconnection of the central inspiratory limb of the breathing circuit, the patient may rebreathe expiratory gases, leading to a significant increase in dead space and concomitant respiratory acidosis. This respiratory acidosis often becomes severe because neither an increase in minute ventilation nor fresh gas flow will correct it.
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