A 45-yr-old patient, American Society of Anesthesiologists physical status 2, is to undergo a removal of a cerebral tumor under general anesthesia. An anesthesia machine (Drager Fabius GS, Telford, PA) and breathing system check are performed before the patient’s arrival. The Drager Vapor 2000 (Drager Medical AG, Lubeck, Germany) sevoflurane vaporizer is seen to be full. Noninvasive monitors are placed, and after preoxygenation the patient is anesthetized in a routine manner. Invasive monitors are placed and the operating table is turned 180 degrees from the anesthesia machine. The operation proceeds uneventfully until about 2h into the case, when you suddenly smell anesthesia vapor around the anesthesia machine. You think you can smell more vapor around the vaporizer, but you are not sure. All vital signs are within normal limits. There are no warnings to indicate low minute volumes, apnea, or nonventilation of the patient. The rotameters show adequate flow and the pipeline pressure is 50 psi. The expired tidal volume is 600 ml, peak pressure is 25 cm and the respiratory rate is 8. Endtidal CO2 and sevofiurane are within normal limits. (Datex Capnomac Ultima, Helsinki, Finland). What will you do? Will you ignore this finding or get another machine? Is there any way of identifying more precisely where the leak originates?
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