case_images: PMC4279360_01
case_images: (a) Ventilator screen snap shot showing peak airway pressure of 58 cm H2O, with a tidal volume of 440 mL. Also note the plateau pressure of 37 cm H2O. (b) Coiled inspiratory limb of the breathing circuit near its attachment to soda lime canister with a broken ring of the tube. (c) Inside part of the removed breathing circuit after manually twisting showing partial obstruction
case_images: SJA-9-94-g001.jpg
case_images: PMC4279360_01_SJA-9-94-g001.jpg
case_images: F1
case_images: After positioning of the patient for craniotomy, we observed that the peak airway pressure rose to 58 cm H2O, with delivered tidal volume of 440 mL, with a plateau pressure of 37 cm H2O [Figure 1a]. On careful examination of the breathing circuit, we noted that there was crowding of rings of breathing circuit near its attachment with soda lime absorber, and the inner tubing was twisted and rotated on itself causing obstruction [Figure 1b]. On examination of the circuit closely, we observed that even with mild rotational force there was a significant reduction in diameter of the circuit leading to partial obstruction [Figure 1c].