Journal of Clinical Monitoring and Computing

, Volume 33, Issue 2, pp 349–351 | Cite as

A novel cause of rebreathing carbon dioxide related to removed CLIC-seal on the Dräger Apollo© anesthesia machine

  • B. NiknamEmail author
  • Z. Bebic
  • A. Roseman
Letter to the Editor


We present a case report involving two sequential, surgically uneventful, laparoscopic cholecystectomies using the same anesthesia machine (Drager Apollo©) for which the level of inspired carbon dioxide was noted to be elevated following various diagnostic interventions including replacing the sodalime, increasing fresh gas flows, and a full inspection of equipment for malfunction. Eventually it was discovered that a rubber ring seal connecting the Dragersorb CLIC system© to the sodalime canister was inadvertently removed during the initial canister exchange resulting in an apparent bypassing of the absorbent and thus an inability of the exhaled gas to contact the sodalime. To our knowledge this is the first such description of this potential cause of elevated inspired carbon dioxide and should warrant consideration when other conventional interventions have failed.


Dragersorb CLIC Sodalime Inspired carbon dioxide Rebreathing 


Author contributions

BN: This author formulated this case report and was the primary resident involved in the care of patients. ZB: This author helped edit this case report and was a senior resident that assisted in the care of the patients. AR: This author was the attending anesthesiologist during the two procedures. He aided in supervision and guidance of this publication.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


  1. 1.
    Vasudevan A, et al. Carbon dioxide rebreathing caused by deformed silicon leaflet in the expiratory unidirectional valve. J Anaesthesiol Clin Pharmacol. 2013;29(1):108–10.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology at Long Island Jewish Medical CenterHofstra-Northwell School of MedicineNew Hyde Park, Long IslandUSA

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