Use of a fiberoptic bronchoscope adapter during jet ventilation.

Dr. Krensavage and Mr. Richards describe “sudden development of anesthesia circuit obstruction by an end-tidal CO, cap in the gas sampling elbow” in their letter in the July issue of Anesthesia & Analgesza (1). They recommend dismantling the elbow from the circuit tubing and performing a visual inspection of the tubing. This may not be necessary. A technique that I have used and taught for years 1s this: after performing the high-pressure leak test of the anesthesia circuit and opening the adjustable pressure limiting (“pop-off”) valve, place the end of the elbow in your mouth (while masked, of course) and inhale and exhale while observing the function of the unidirectional (i.e., inspiratory and expiratory) flow valves. This procedure takes but seconds and confirms the patency of the circuit, appropriate valve function, and system decompression via the adjustable pressure-limiting valve. If we are able to breathe through the anesthetic circuit, so may our patients.