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LETTER TO EDITOR
Year : 2010  |  Volume : 54  |  Issue : 2  |  Page : 172 Table of Contents     

"Feel of the reservoir bag" … A dying skill in midst of sophisticated equipment!


Department of Anaesthesia, ESI Hospital, Rohini, New Delhi, India

Date of Web Publication24-May-2010

Correspondence Address:
Rajeev Sharma
C-5/108, 2nd Floor, Rohini Sector-11, Delhi-110 085
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.63627

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How to cite this article:
Sharma R. "Feel of the reservoir bag" … A dying skill in midst of sophisticated equipment!. Indian J Anaesth 2010;54:172

How to cite this URL:
Sharma R. "Feel of the reservoir bag" … A dying skill in midst of sophisticated equipment!. Indian J Anaesth [serial online] 2010 [cited 2020 Nov 25];54:172. Available from: https://www.ijaweb.org/text.asp?2010/54/2/172/63627

Sir,

I read with interest the article on Severe intraoperative brain bulge due to endotracheal tube obstruction by a thick mucous plug by Singhal et al.[1] I congratulate the authors for averting a near-fatal situation using timely change of the blocked endotracheal tube. There was a rise in EtCO 2 levels and gradually increasing airway pressures in the child being ventilated with the help of a ventilator.

I think the problem could have been detected earlier had they been ventilating the lungs manually. The hands of an experienced anaesthetist are trained to instantaneously detect a change in the compliance of the reservoir bag provided the "initial feel" of the bag is used as a base line. Significant time must have elapsed before the EtCO 2 rose to 60 mm Hg. Unfortunately, with the advent of sophisticated equipment and monitors; much less emphasis is placed nowadays on the 'feel' of the bag.

The steps of management of the presented case could have been better sequenced. When the airway pressures and the EtCO 2 levels were rising, a quick check by manual ventilation and feel of compliance followed by ruling out endotracheal tube obstruction (by suctioning) or circuit obstruction and bronchospasm before giving supplemental doses of opioids and muscle relaxants and performing an arterial blood gas analysis, could have avoided the severe intraoperative brain bulge that was seen in the presented case.

 
   References Top

1.Singhal V, Pandia MP, Dash H. Severe intraoperative brain bulge due to endotracheal tube obstruction by a thick mucous plug. Indian J Anesth 2009;53:382-3.  Back to cited text no. 1      




 

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