Capnometer has been widely used as a respiratory monitor. Stable carbon dioxide (CO(2)) monitoring of non-intubated patient is especially problematic due to the frequent occurrence of tube obstruction and it could be even more difficult when oxygen is being administered. Oxygen is often administered by an oxygen mask or oxygen nasal cannula; however there are some problems with these methods. For oxygen masks, it is necessary to provide high-flow oxygen to prevent rebreathing of exhaled CO(2), and as for oxygen nasal cannula, it is incapable of increasing the oxygen concentration and patient may feel uncomfortable during oxygen administration because it could dry nasal mucous. To solve these problems, we developed a novel mainstream capnometer system, which provides stable monitoring of exhaled CO(2) while administering oxygen. This capnometer system has a mask with an opening large enough to facilitate the observation of patient's nose and mouth and the procedures such as daily oral care. Furthermore, the outer rim of the mask is designed to effectively retain oxygen flow without causing rebreathing.

A sharp rise in intracranial pressure (ICP) was noted in a 6-year-old girl with Fontan circulation after surgical removal of a hematoma associated with intracranial hemorrhage. Inhalation of nitric oxide resulted in reduction of central venous pressure (CVP) and precipitous fall in ICP, which was otherwise resistant to conventional therapy. Specifically, the rate of fall of ICP (9 mm Hg) exceeded that of the CVP (3 mm Hg), indicating disproportionate CVP-ICP coupling. The present case provides not only a novel insight into cardio-cerebral interaction in Fontan physiology but also useful information regarding the treatment of Fontan patients in the setting of increased ICP.