The automatic pressure liming (APL) valve used on the Fabius GS Anesthesia Machine (Dräger Medical, Inc., Telford, PA) has two functions: (1) to limit the maximum pressure during manual ventilation and (2) to exhaust excess gas into the scavenger system during manual and spontaneous ventilation. Pulling up on the knob quickly releases pressure when in the manual ventilation mode.

A line, cable, or other material caught underneath the APL Valve adjustment knob could, depending on the thickness of the object, interfere with the proper functioning of the valve and may affect manual ventilation. It will not affect spontaneous or automatic ventilation. The Fabius GS will not pass the preuse leak test if an object is caught underneath the APL Valve adjustment knob. The author of this correspondence states that the device had passed the preoperative checkout. This indicates that the temperature-monitoring cable became caught underneath the APL Valve adjustment knob at some point between the preoperative check and induction.

The reported incident emphasizes the challenges surrounding the increased number of cables and hoses associated with patient monitoring in the operating room environment. The Fabius GS Operator's Instruction Manual contains a warning to route all lines and cables away from the APL Valve to prevent interference with the APL Valve adjustment knob. The breathing system mounting arm provides an area underneath the arm for routing lines and cables connecting to the breathing system. Dräger Medical, Inc. also offers a boom arm as an accessory that can assist the user in cable management. Device users should perform the daily and preuse checklist to confirm the proper functioning of the device before use and follow all warnings and cautions outlined in the Operator's Instruction Manual, before and during use.

Dräger Medical, Inc. is committed to providing reliable, quality products and appreciates this matter being brought to our attention. This type of information is valuable when evaluating potential enhancements to our products.

Dräger Medical, Inc., Telford, Pennsylvania.