A reply

Draeger Medical is grateful for the opportunity to comment on this reported incident. We note the authors point regarding increased safety by the reintroduction of the pipeline disconnection test and would be delighted to be involved in this dialogue with the Association of Anaesthetists of Great Britain and Ireland or other appropriate bodies. We cannot comment in detail on this actual incident as at no time were the Medical Devices Agency (MDA) or Draeger Medical requested to investigate nor were the valves returned to us for examination. Similarly, the possible failure mentioned in 1999 was not reported to the MDA or ourselves. The Julian anaesthetic machine is representative of many devices that are in common use today. The pre-use checks ask that care be taken to note the correct pipeline pressure and that cylinder checks are also made. In the event of pipeline failure, with no secondary check vales in line, the cylinder once opened would supply the patient with oxygen as well as feeding backwards into the failed pipeline. In the worst case situation (with a total failure of the check valve) a full cylinder would supply oxygen for at least 15 min. After this time, and with total oxygen failure, the Julian would alarm to alert the user and automatically switch to 100% air from the medical air supply, continuing to ventilate the patient and supply gas in a safe way and without interruption.