Morris J. Nicholson

Fire and Explosion Hazards in the Operating Room

The cause of the anesthetic explosion described in this Case History human error-is h o r n to be a common denominator in a wide variety of serious accidents which occur in modem hospitals. All to frequently such errors lead to hemolytic transfusion reactions, the wrong operation on the patient, or serious reaction and even death from mistakes in the selection, measurement, or administration of potent medications.

Tracheotomy tube adapter.

ITH THE broadening indications for W tracheotomy and respiratory assistance, the necessity for an assured supply of sterile cuffed tracheotomy tubes has increased. Current medical literature contains many discussions of the proper size for these tubes and the proper method of applying the appropriate inflatable cuff. Nylon, plastic, and rubber tracheotomy tubes with cuffs attached are now available. Our comments pertain to the rubber tracheotomy tube, which we prefer, since we do not think an inner cannula or an obturator is necessary. The maintenance of constant adequate humidity keeps the tracheobronchial secretions liquid, and they can be readily expelled by the patient’s cough or removed by the use of a sterile suction catheter introduced and used according to a prescribed sterile technic, as is occasionally necessary. The demand for the time-honored use of the removable inner cannula is a pitfall and a delusion, for the presence of this instrument materially decreases the available airway, and constant removal and reinsertion of this cannula almost assures the introduction of pathogenic organisms from the operator’s