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Use of tracheal tube as a splint to prevent intraoperative kinking of gas sampling line.

To JNA Readers: Capnography is an essential monitor during neurosurgery, and kinking of the gas sample line is not unknown, particularly with the side stream analyzer.1 We present a solution that prevents the problem of kinking. A 25-year-old male patient was scheduled to undergo frontal craniotomy and excision of meningioma under general anesthesia. After about 30 minutes from start of surgery, a loss of capnogram was traced to kinking of the gas sampling line at the point connected to the adapter, probably due to the weight of the drapes. To overcome this problem, we took a small length of a nonsiliconised tracheal tube with an ID of 3.0mm. A cut was made in this piece along its long axis, was spread apart, and gently slipped over the sample line near the adapter (Fig.1). This worked as reinforcement over the sample line and prevented kinking at the point of attachment of the line to the adapter. The course of anesthesia was uneventful thereafter. During anesthesia, the gas sampling line is kept vertical to prevent moisture entering the line which also exposes it to the possibility of kinking in certain situations. Mostly kinking occurs near the point where the sampling line is connected to the adapter in the breathing system because of compression by drapes, suction tubing, drill, or the assistant’s hand.2 This can happen more often during prolonged surgeries or when a forced air warming device is being used. Our solution to this problem is simple and quick to perform with the help of easily available resource. Kinking is thus prevented because now the pressure is exerted more proximally on the sample line itself rather than at the junction of the sample line and the adapter. The sample line being high-pressure tubing can withstand this moderate pressure without kinking. Our method can be used to prevent kinking anywhere in the sample line including the end that is attached to the water trap. Care should be taken that the direction of the possible kink in the sample line should not lie against the split side of the reinforcement tube. Or else, a paper tape can be wrapped around the reinforcement tube. One method described to prevent this problem is to loop the sample line; however, this does not prevent lateral kinking.1 Another technique suggests adding a 3-way stop cock to the sampling line near the breathing circuit.2 However, there are concerns of leak, and increase in resistance and efficacy to remove secretions by purging the sample line or increasing the flow rate with this technique. The various manufacturers of the side stream capnograph use different systems at the adapter end. Some have a detachable sample line, and in others, the sample line is fixed to the adapter (Fig.1). Appropriate size of tracheal tube should be selected to ensure a snug fitting over the adapter end of the sample line. Prakash K. Dubey, MD Neeraj Kumar, MD Department of Anesthesiology and Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, India