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Unexpected Anesthetic Circuit Leak Attributed to Improper Use of a Tube Holder: A Case Report
Naotaka KishimotoDDS, PhD,
Akiko OtsukaDDS, PhD,
Tatsuru TsurumakiDDS, PhD, and
Kenji SeoDDS, PhD
Article Category: Case Report
Volume/Issue: Volume 68: Issue 3
Online Publication Date: Oct 04, 2021
DOI: 10.2344/anpr-68-02-02
Page Range: 154 – 157

Leaks in the anesthesia circuit can be caused by disconnection of or damage to the circuit tubing and can cause patient harm by inducing hypoxia, hypoventilation, and inadequate delivery of inhaled anesthetic agents and gases. Additionally, anesthetic circuit leaks can also lead to contamination of the operating room environment due to the escaping volatile anesthetics. 1 , 2 One potential cause of circuit disconnection is excessive strain placed on the endotracheal tube and its connection with the circuit resulting from the weight of the

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Figure 2.; The Damaged ETT Cuff. Air bubbles (black arrow) leaking from the small hole on the damaged ETT cuff were observed when air was injected into the cuff via the pilot balloon valve. ETT, endotracheal tube.
Yuzo Imai,
Naotaka Kishimoto,
Shigenobu Kurata,
Yutaka Tanaka,
Tatsuru Tsurumaki,
Hiroko Kanemaru,
Toru Yamamoto, and
Kenji Seo
Figure 2.
Figure 2.

The Damaged ETT Cuff.

Air bubbles (black arrow) leaking from the small hole on the damaged ETT cuff were observed when air was injected into the cuff via the pilot balloon valve. ETT, endotracheal tube.

Figure 1.; Tube holder and damaged anesthesia circuit tubing. (A) The tube holder used in this case. (B) The corrugated tubing used in this case with a red circle indicating the damaged area. (C) Enlarged view of the corrugated tubing with a red arrow indicating the tear.
Naotaka Kishimoto,
Akiko Otsuka,
Tatsuru Tsurumaki, and
Kenji Seo
Figure 1.
Figure 1.

Tube holder and damaged anesthesia circuit tubing. (A) The tube holder used in this case. (B) The corrugated tubing used in this case with a red circle indicating the damaged area. (C) Enlarged view of the corrugated tubing with a red arrow indicating the tear.

Figure 2.; Tube holder and tubing measurements. (A) Enlarged view of the tube holder showing the inner diameter of the tube holder groove measuring 18 mm at the entrance and 20 mm at the central portion. (B) Enlarged view of the corrugated tubing showing the outer diameter measuring 27 mm at the widest/convex and 19 mm at the narrowest/concave portions.
Naotaka Kishimoto,
Akiko Otsuka,
Tatsuru Tsurumaki, and
Kenji Seo
Figure 2.
Figure 2.

Tube holder and tubing measurements. (A) Enlarged view of the tube holder showing the inner diameter of the tube holder groove measuring 18 mm at the entrance and 20 mm at the central portion. (B) Enlarged view of the corrugated tubing showing the outer diameter measuring 27 mm at the widest/convex and 19 mm at the narrowest/concave portions.

Figure 3.; Experimental attempts to reproduce the damaged tubing. (A) Corrugated tubing inserted straight into the tube holder groove. The red dotted line shows the proper angle between the groove and the corrugated tubing. (B) Corrugated tubing positioned at a misaligned angle relative to the tube holder groove. (C) Corrugated tubing torn when excessive force used during insertion into the tube holder groove from the position shown in (B). The red arrow indicates the tear in the corrugated tubing likely caused by the edge of the groove.
Naotaka Kishimoto,
Akiko Otsuka,
Tatsuru Tsurumaki, and
Kenji Seo
Figure 3.
Figure 3.

Experimental attempts to reproduce the damaged tubing. (A) Corrugated tubing inserted straight into the tube holder groove. The red dotted line shows the proper angle between the groove and the corrugated tubing. (B) Corrugated tubing positioned at a misaligned angle relative to the tube holder groove. (C) Corrugated tubing torn when excessive force used during insertion into the tube holder groove from the position shown in (B). The red arrow indicates the tear in the corrugated tubing likely caused by the edge of the groove.

The Effects of Mouth Opening and Throat Pack Placement on Uncuffed Nasal Endotracheal Tube Leakage and Delivered Tidal Volumes in Mechanically Ventilated Pediatric Patients Undergoing Dental Procedures
Katie E. BradfordDDS,
Louis I. SiegelmanDDS, and
Walter J. PsoterDDS, PhD
Article Category: Research Article
Volume/Issue: Volume 65: Issue 4
Online Publication Date: Jan 01, 2018
DOI: 10.2344/anpr-65-03-13
Page Range: 237 – 243

pediatric nasal intubations with uncuffed tubes, both mouth opening and throat pack placement may minimize leakage and the need to exchange ETTs by compressing the soft tissue of the upper airway around the ETT. We have been unable to identify reports in the literature that specifically evaluate the effects of mouth opening and/or neck extension on uncuffed ETT leakages. Sanuki et al have conducted 3 oral surgery studies evaluating the effects of mouth opening and neck extension on leaks around, and the cuff pressures of, laryngeal mask airways. 5 – 7 They report that

Upside-Down Mask Ventilation Technique for a Patient With a Long and Narrow Mandible
Takuro SanukiDDS, PhD,
Toshihiro WatanabeDDS,
Yu OzakiDDS,
Mizuki TachiDDS, PhD,
Kensuke KiriishiDDS,
Gaku MishimaDDS,
Mari KawaiDDS, PhD,
Ichiro OkayasuDDS, PhD,
Shinji KurataDDS, PhD, and
Takao AyuseDDS, PhD
Article Category: Other
Volume/Issue: Volume 61: Issue 4
Online Publication Date: Jan 01, 2014
DOI: 10.2344/0003-3006-61.4.169
Page Range: 169 – 170

Mask ventilation, along with tracheal intubation, is one of the most basic skills for managing an airway during anesthesia. Facial anomalies are a common cause of difficult mask ventilation, although numerous other factors have been reported. 1 , 2 The long and narrow mandible is a commonly encountered mandibular anomaly. In patients with a long and narrow mandible, the gaps between the corners of the mouth and the lower corners of the mask are likely to prevent an adequate seal, and a gas leak may occur. When we administer general

A Case of Successful Tracheal Tube Exchange With McGrath MAC for Tube Damage During Oral Surgery
Yuko Koyanagi,
Eiko Yokota,
Marina Iwata,
Ritsuko Shimazaki,
Toru Misaki, and
Yoshiyuki Oi
Article Category: Brief Report
Volume/Issue: Volume 67: Issue 3
Online Publication Date: Sep 29, 2020
DOI: 10.2344/anpr-67-02-01
Page Range: 174 – 176

been damaged, as the cuff pressure gauge failed to maintain the correct pressure despite reinflation. Damage to the ETT itself was not assessed at this time, as a wet gauze pack placed in the patient's inferior oropharynx to minimize any air leak effectively stopped the audible sound of leaking air and improved the V TE to 300 mL. However, 30 minutes after the first hypoventilation occurrence, the V TE decreased again to 80–150 mL during the maxillary osteotomy. At this time there was a sound of air leaking from the nasal cavity, and the capnography pattern notedly

Complicated Airway Due to Unexpected Lingual Tonsil Hypertrophy
Aarti Bhavesh PatelBS,
Edward DavidianDDS, MS, and
Uday ReebyeDMD, MD
Article Category: Research Article
Volume/Issue: Volume 59: Issue 2
Online Publication Date: Jan 01, 2012
DOI: 10.2344/11-06.1
Page Range: 82 – 84

an end-tidal CO 2 monitor and good breath sounds through the pretracheal stethoscope. A size 5 LMA ProSeal (LMA North America) laryngeal mask airway was inserted with little resistance and inflated with 35 mL air. Breath sounds and end-tidal CO 2 confirmed placement with a small leak at 20 cm of H 2 O pressure. Anesthesia was maintained with 1 L/min O 2 , 1 L/min N 2 O, and 2% sevoflurane. Twenty minutes into the procedure, the dentist anesthesiologist noticed a leak in the LMA with some gurgling sounds through the pretracheal stethoscope. It was suspected that

Comparison of Insertion of the Modified i-gel Airway for Oral Surgery With the LMA Flexible: A Manikin Study
Takuro SanukiDDS, PhD,
Shingo SugiokaDDS, PhD,
Nobuyasu KomasawaMD,
Ryusuke UekiMD, PhD,
Yoshiroh KaminohMD, PhD, and
Junichiro KotaniDDS, PhD
Article Category: Other
Volume/Issue: Volume 61: Issue 4
Online Publication Date: Jan 01, 2014
DOI: 10.2344/0003-3006-61.4.145
Page Range: 145 – 149

. LMA Flexible (top) and modified i-gel airway (bottom). Figure 1. LMA Flexible (top) and modified i-gel airway (bottom). The i-gel airway (Intersurgical Ltd, Wokingham, UK) is a disposable supraglottic device that was developed by Dr Nasir. It consists of an airway tube with a noninflatable gel-like cuff designed to fit perfectly over the larynx and also has a gastric tube orifice. The i-gel airway features a high-pressure seal (pharyngeal leak pressure), 4 potentially preventing leakage of blood and water into the