Expiratory limb ventilation during unique failure of the anesthesia machine breathing circuit.

751 March 2013 T anesthesia machine is the most integral piece of equipment used by anesthesia providers. When semiclosed circle systems are used, unidirectional valves become integral components that direct carbon dioxide containing gas across the absorbent and along the inspiratory limb, mixing with fresh gas as it flows into the patient. Unfortunately, human error is known to be the most common source of machine malfunction, particularly of the breathing circuit.1,2 Such malfunctions should be detected during the application of the American Society of Anesthesiologists’ 2008 Recommendations for Pre-Anesthesia Checkout. In that situation, the self-inflating manual ventilation device (SIMVD) is suggested for first-line backup ventilation.‡ Responses to such critical incidents are taught in simulation courses, which are required by the American Board of Anesthesiology as a component of its Maintenance of Certification in Anesthesiology program.2,3 We present a unique human-induced failure of the breathing circuit in a patient who was turned 180° away from the machine during major ear, nose, and throat surgery. Sequential responses to ventilate the patient were successfully applied by the resident and attending anesthesiologist based upon their experiences in simulation workshops. We describe the functional aspects of these effective methods for ventilating the patient during this machine failure.