Fatal respiratory thermal injury following accidental administration of carbon dioxide using the circle system for a cesarean delivery

M. M. Aghdashi; R. Abbasivash; E. Hassani; H. Pirnejad

doi:10.1016/j.ijoa.2009.02.020

Fatal respiratory thermal injury following accidental administration of carbon dioxide using the circle system for a cesarean delivery

M. M. Aghdashi^*, R. Abbasivash, E. Hassani, H. Pirnejad

^*Corresponding author for this work

Health Care Governance (HCG)

Research output: Contribution to journal › Article › Academic › peer-review

1 Citation (Scopus)

Abstract

A 37-year-old parturient underwent emergency cesarean delivery because of severe preeclampsia. After induction of general anesthesia, the oxygen saturation decreased. Volatile anesthetics were discontinued and examination of the anesthetic circuit and machine revealed a soda lime canister that was extremely hot. The patient was detached from the anesthetic machine and hand-ventilated with an external oxygen cylinder. The surgery was cancelled and the patient was extubated. Analysis of the cylinder connected to the anesthesia machine displayed 100% carbon dioxide. The patient developed progressive respiratory failure. Bronchoscopic examination revealed burn scars from the carina to the main bronchi. The patient died within four months of the incident.

Original language	English
Pages (from-to)	400-402
Number of pages	3
Journal	International Journal of Obstetric Anesthesia
Volume	18
Issue number	4
DOIs	https://doi.org/10.1016/j.ijoa.2009.02.020
Publication status	Published - Oct 2009

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10.1016/j.ijoa.2009.02.020

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abstract = "A 37-year-old parturient underwent emergency cesarean delivery because of severe preeclampsia. After induction of general anesthesia, the oxygen saturation decreased. Volatile anesthetics were discontinued and examination of the anesthetic circuit and machine revealed a soda lime canister that was extremely hot. The patient was detached from the anesthetic machine and hand-ventilated with an external oxygen cylinder. The surgery was cancelled and the patient was extubated. Analysis of the cylinder connected to the anesthesia machine displayed 100% carbon dioxide. The patient developed progressive respiratory failure. Bronchoscopic examination revealed burn scars from the carina to the main bronchi. The patient died within four months of the incident.",

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Fatal respiratory thermal injury following accidental administration of carbon dioxide using the circle system for a cesarean delivery

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