- 期刊
Hypercarbia Induced by Detachment of Inner Fresh Gas Delivery Tube of the Bain Circuit - A Case Report
Bain circuit內管脫落所導致高二氧化碳症之病例報告
摘要
Semi-open system such as Bain circuit is occasionally used in general anesthesia. The system has many advantages such as use of a single, light weight tube which is adaptable to both adult and pediatric patients and bypass of the carbon dioxide absorber. It is especially useful in procedures on the head, face and neck. The main disadvantage of Bain circuit is the difficulty in testing the inner tube. We encountered a case of hypercarbia due to detachment of the inner fresh gas delivery tube of the Bain circuit. The whole outer tube became a dead space and as a consequence, hypercapnia was unavoidable due to the ＂to and fro＂ mechanism of rebreathing. Adequate gas now and manual hyperventilation would not correct the situation. After changing the tube CO_2 tension gradually returned to normal. Many methods for testing of the Bain circuit have been published. Pethick technique, Foëx and Crampton Smith test and test adaptor are useful. Hypercarbia is difficult to detect under general anesthesia. It is often misdiagnosed due to its similarity to other stress responses. Therefore, it is necessary to check ABG's in patients with unexplained tachycardia and/or in those who fight the ventilator even with sufficient amount of muscle relaxant. For quality assurance, use of capnography is recommended for routine use in anesthesia.
並列摘要
於日常執行全身麻醉中，偶而會使用到半開放系統，如Bain circuit。Bain circuit之管路有重量輕、可運用於成人及小孩並不必使用二氧化碳吸收器等之優點，其運用於頭、臉、頸等部位之手術尤為合適，但其亦有難於測試內管之缺點。吾人曾遭逢因Bain circuit內管脫落而導致血中二氧化碳偏高之病例。於麻醉中雖給予足夠通氣，但因內管脫落後，整個外管變成死腔，有嚴重rebreathing現象，引起血中二氧化碳升高。幸好我們即刻檢查發現內管之脫落，而予以更換，短暫時間後後，病人之動脈血氣值即恢復到工常範園。事後吾人檢閱相關文獻，發現Bain circuit於使用前，可有如下之檢查方法：Pethick technique、Foëx and Crampton Smith test、test adaptor，值得大家研究使用。於全身麻醉中，血中高二氧化碳值之癥兆常易與其它刺激反應混淆，故有懷疑時，應作動脈血氣分析來證實。為了確保麻醉品質，二氧化碳分析儀應例行使用於全身麻醉中。
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