Case 49: A Leaking Anesthesia Machine
You are scheduled to anesthetize a 45-year-old male (150 kg, 5 ft 10 in.) for cervical laminectomy. His medical history is significant for hypertension and noninsulin-dependent diabetes. On examination he complains about a stiff and painful neck when he moves it. You place an IV and sedate him with midazolam and take him to the operating room. In the operating room you place routine monitors and induce anesthesia. He is an easy mask and because of his neck problem you use a trachlight (Laerdal Medical, Stavanger, Norway) with an endotracheal tube (ETT) attached. The ETT is placed in the trachea without any problems. End-tidal CO2 is seen and bilateral air entry is heard. An esophageal stethoscope is placed and the patient is turned prone. After he is positioned prone, you notice that the end-tidal CO2 is decreased from 38 to 30 mmHg. The Apollo machine (Drager Medical, 233542 Lubeck, Germany) is now indicating that you have a leak in the machine and/or the breathing system. You confirm bilateral air entry and normal breath sounds. You commence manual ventilation but the leak is still there.