Richard Ginsburg

Ketorolac versus dezocine versus fentanyl: what is the true equianalgesic potency ratio?

through the endotracheal tube. The anesthetic circuit had been tested before the anesthetic and was found to have no leaks. After intubation and initially connecting the circuit to the endotracheal tube, no leaks were discovered and mechanical ventilation was begun. The surgical procedure required repositioning of the patient twice. During each repositioning we disconnected the Y-connector to the endotracheal tube and then reconnected it. After the second reconnect, the lowpressure alarm of the ventilator was activated indicating a leak in the system which was confirmed during manual ventilation. Initial scrutiny of the system did not reveal the site of the leak. To test the integrity of the circuit, the Y-piece was disconnected from the endotracheal tube. It was then that we discovered the broken inner sleeve of the connector (Figure 1). However, the broken fragment was not recovered immediately. It was discovered, much later, lying on the floor in two pieces. We share this incident with readers because it caused a circuit leak and had the potential for an even more serious complication of aspiration of the plastic piece into the endotracheal tube. We believe that there might have been a crack in the inner sleeve which caused this piece to break off during the disconnects and reconnects for repositioning. Since then we have examined several Y-piece connectors and found one more such piece with a crack in the inner sleeve. Vinod Malhotra, MD Eleanor Bradley, CRNA Department of Anesthesiology The New York Hospital/Cornell Medical Center New York, New York

Onset time of analgesic agents revisited

Clinical Pharmacology & Therapeutics (1995) 57, 366–366; doi: