Inadvertent Anesthetic Overdose Obscured by Scavenging

Abstract

Virtues of scavenging waste anesthetic gases have been extolled and failure to scaventge condemned, although benefits of scavenging remain to be proven. It is generally assumed that elimination of waste gases is a sufficienctly benign practice that no justifiable reaspm exosts fpr fao;iretp scavenge. This may be true,but it should be pointed out that the process of scavenging may expose patients to certain hazards. some, such as pulmonary barotrauma, can probably be avoided by lusing properly designed and well maintained equipment; others may be unavoidable. We report here a death owing to anethetic overdose when liquid halothane splashed into the anesthetic circuit. The problem was obscured by the absence of a strong odor of halothane, an unavoidable consequence of scavenging.