[Downloaded free from http://www.ijaweb.org on Wednesday, September 28, 2016, IP: 31.151.68.

90]

Review Article

Anaesthesia Gas Supply: Gas Cylinders

Address for correspondence: Uma Srivastava

Dr. Uma Srivastav, Department of Anaesthesia and Critical Care, S N Medical College, Agra, Uttar Pradesh, India
Department of Anaesthesia
and Critical Care, S N Medical
College, Agra - 282 002, ABSTRACT
Uttar Pradesh, India.
E‑mail: drumasrivastava@
Invention of oxygen cylinder was one of the most important developments in the field of medical
rediffmail.com
practice. Oxygen and other gases were compressed and stored at high pressure in seamless
containers constructed from hand‑forged steel in1880. Materials technology has continued to
evolve and now medical gas cylinders are generally made of steel alloys or aluminum. The filling
pressure as well as capacity has increased considerably while at the same time the weight of
cylinders has reduced. Today oxygen cylinder of equivalent size holds a third more oxygen but
weighs about 20 kg less. The cylinders are of varying sizes and are color coded. They are tested
Access this article online at regular intervals by the manufacturer using hydraulic, impact, and tensile tests. The top end of
Website: www.ijaweb.org the cylinder is fitted with a valve with a variety of number and markings stamped on it. Common
valve types include: Pin index valve, bull nose, hand wheel and integral valve. The type of valve
DOI: 10.4103/0019-5049.120147
varies with cylinder size. Small cylinders have a pin index valve while large have a bull nose type.
Quick response code
Safety features in the cylinder are: Color coding, pin index, pressure relief device, Bodok seal,
and label attached etc., Safety rules and guidelines must be followed during storage, installation
and use of cylinders to ensure safety of patients, hospital personnel and the environment.

Key words: Cylinders, installation of cylinders, medical and anaesthetic gases, pin index safety
system, safety devices, testing, valves

INTRODUCTION have the potential to cause injury to patients, doctors

or paramedic staff. Therefore, safety should be the
Gas cylinder is a term that is commonly used to highest priority.
describe a pressurized container used for storage
and transport. The gases used in anaesthesia are CONSTRUCTION OF CYLINDERS
generally supplied under high pressure, either
in cylinders or via pipeline with cylinders on Medical gas cylinders were traditionally constructed
anaesthesia machines for emergency backup. of low carbon steel. Now they are constructed of light
Oxygen, nitrous oxide, and medical air are usually weight chrome molybdenum steel, aluminum or a
supplied from pipeline. Entonox in some hospitals is composite (such as aluminum wrapped in carbon
also supplied via pipeline though it is more common fiber). Special cylinders made from aluminum are
to be supplied by portable cylinders. Bulk supply of useful in magnetic resonance imaging (MRI) room.
oxygen in the hospitals is by cryogenic liquid system, Typical wall thickness of steel cylinders is 3 mm and
liquid cylinder installation or from the oxygen that of an aluminum alloy cylinder is 6 mm2. Composite
concentrator.[1,2] Air is supplied either as pressurized cylinders are manufactured from either light weight
cylinders or from compressors. Bulk production of steel or aluminum liners[1] and are encased within a
oxygen is usually by fractional distillation of liquid high density polyethylene jacket or wrapped by carbon
air. In every country there are a series of regulations fiber, Kevlar, Twaron or glass fiber. These cylinders
and standards for manufacture and the use of medical are ultra‑light in weight, extremely durable and can
cylinders. While regulatory measures are designed to be filled with high pressure of upto 4000 kPa.[1] They
ensure safety in the manufacture and distribution of can hold 30% more gas than an aluminum cylinder of
medical gases, sporadic accidents do occur[3] which comparable size and 70% lighter in weight than steel

How to cite this article: Srivastava U. Anaesthesia gas supply: Gas cylinders. Indian J Anaesth 2013;57:500-6.

500 Indian Journal of Anaesthesia | Vol. 57 | Issue 5 | Sep-Oct 2013

[Downloaded free from http://www.ijaweb.org on Wednesday, September 28, 2016, IP: 31.151.68.90]

Srivastava: Medical gas cylinders

cylinder. Composite cylinders are used by firefighters, of three types: Burst disk, fusible plug, and combination
paramedics, and emergency first responders. of two. Burst disk is most commonly used. It is a small
metal gasket which bursts at a pre‑determined pressure.
COMPONENTS OF CYLINDER
Pressure relief valve is a spring‑loaded device designed
Body to re‑close and prevent gas in cylinder from being
The cylinder has a body, shoulder, and a neck. The curved discharged after a set pressure has been restored.[2]
upper part of the body is called as shoulder which tapers
in a neck. The neck ends in a tapered screw thread into Conical depression
which the valve is fitted. When the valve is screwed to On small cylinder valves a conical depression is
cylinder neck, a fusible material (Wood’s Metal) is used present that receives the retaining screw of the yoke.
to seal leaks between the valve and the cylinder which
melts if the cylinder is exposed to intense heat. This Non‑interchangeable safety system was introduced to
allows gas to release and lessens the risk of explosion.[1] prevent coupling of anaesthetic gas cylinders to wrong
manifold or inlet of anaesthesia machine by Dr Philip
Valve Woodbridge.
The valve is made of bronze or brass and is most
fragile part of cylinder, therefore provided with a metal Pin index safety system
protection cap to protect [Figure 1]. It allows the cylinder It has a unique configuration of holes and pins which
to be turned on and off and provides a means by which match precisely to eliminate connection of the wrong
the cylinders are filled and connected to yoke assembly cylinder to equipment, thus prevents delivery of
on anaesthesia machine or to regulator. The gas exits wrong gas to patients.[1,2,6] This system is also used
through the port. The valve contains a stem or shaft, by supplier to fill correct gas in the cylinder.[7] It
which is rotated for opening or closing of cylinder. When incorporates two holes in specific positions on the
the valve is opened the stem moves upward and gas cylinder valve below the outlet port [Figure 3]. The
flows to the port. During closure, the stem seals against cylinder can only be connected to a yoke or pressure
the seat [Figure 2]. Two types of valves are in use. In the regulator with a matching pair of pins. The holes in
packed valve, the stem is sealed by resilient packing such the cylinder valve accept pins 4 mm diameter by 6 mm
as Teflon. In Diaphragm valve, a diaphragm separates long.[2] Unless pins and holes are aligned, the port
upper and lower stem. Lower stem shuts or allows gas will not seal and gas will not pass to the anesthesia
flow through the valve. The latter can be opened by only machine. Each gas or combination of gases has a
½ or ¾ turns and is less likely to leak.[4] specific pin arrangement [Table 1]. Pin index valves
are fitted in small cylinders which are commonly
Pressure relief device is fitted on cylinders with the connected directly to the anesthesia machine. Side
aim to vent the cylinder contents to atmosphere if the spindle pin index valves are fitted in large cylinders
pressure in the cylinder increases to a dangerous level of medical O2, air and Entonox for pipeline manifold
as a result of high temperature or overfilling.[5] They are and to F size Entonox cylinders.[1] Pin index cylinders

Figure 1: Medical‑oxygen‑cylinder with protective cap Figure 2: Cylinder valve

Indian Journal of Anaesthesia | Vol. 57 | Issue 5 | Sep-Oct 2013 501

[Downloaded free from http://www.ijaweb.org on Wednesday, September 28, 2016, IP: 31.151.68.90]

Srivastava: Medical gas cylinders

require a seal between cylinder valve outlet and yoke. Integral valve
The seal is called as Bodok washer. It is a gasket with The easily portable cylinders with inbuilt integral
metal rim manufactured from a non‑combustible pressure regulators, flow meters, as well as handles is
material [Figure 4]. available for use[2] [Figure 6]. Regulator maintenance of
hospital is not required for these valves.[9]
Valve outlet connection for large cylinders
The valves of large cylinders (F and G size) of medical Cylinder size
gases have threaded outlet often called as bull nose Size of cylinder is defined by their capacity to hold water
valve [Figure 5]. The valve is spindle type and has a and range between 1.2 and 6550 L. The cylinders are
5/8 inch female outlet where a regulator is fitted. The produced in various sizes designated by a capital letter
nut causes the nipple to seal against the valve outlet code with A being the smallest. Tables 2 and 3 give details
and allows gas to pass.[1] A non‑interchangeable screw of commonly used oxygen and nitrous cylinders.[1,2,5]
thread system with a different number of threads per On anaesthesia machine, work stations and for patient
inch for each medical gas prevents wrong connection.[5] transportation and resuscitation, size E cylinder is most
MPR (minimum pressure retention) device is fitted in commonly used. On anaesthesia machine cylinders of
all bull nose valves to ensure that a positive pressure 4.5 inch in diameter and 26 inches in length, 5.4 kg tare
of approximately 2 bars is retained in the cylinder to weight and smaller can be directly attached.
prevent ingress of moisture.[1]
PRESSURE AND FILLING
Hand Wheel valve [Figure 5] is used for N2O (for use
on manifold) and CO2 cylinders (size F and G). The The majority of the gases are stored in cylinders as
valve may be surrounded by a protective guard. The compressed gases (oxygen, air, nitrogen, helium,
valve has a gas specific side outlet and male thread. heliox). These gases do not liquefy at ordinary ambient
Bull nose and pin index cylinders require a wrench temperature regardless of pressure applied.[4] as their
to open the valve while hand wheel cylinders do not critical temperature is low. These cylinders are filled up
require any additional equipment.[5,8] to service pressure (defined as the maximum pressure

Figure 3: Pin index of oxygen cylinder Figure 4: Bodok seal

Table 1: Color coding, pin index and physical state in cylinder of medical gases
Oxygen Nitrous oxide Air Carbon‑dioxide Entonox Nitrogen Helium
Physical state in cylinder Gas Gas+Liquid (below 980 F) Gas Gas+Liquid (below 880 F) Gas Gas Gas
Color (India)
Body Black Blue Black Gray Blue Black Brown
Shoulder White Blue White/Black Gray White/Blue Black Brown
International
Color White Blue Black/White Gray Blue/White Black Brown
Formula O2 N 2O ‑ CO2 ‑ N2 He
Pin index 2‑5 3‑5 1‑5 1‑6 7 1‑4 No pin

502 Indian Journal of Anaesthesia | Vol. 57 | Issue 5 | Sep-Oct 2013

[Downloaded free from http://www.ijaweb.org on Wednesday, September 28, 2016, IP: 31.151.68.90]

Srivastava: Medical gas cylinders

Figure 5: Bullnose and handwheel valve Figure 6: Integral valve

Table 2: Size and specification of commonly used gas in a cylinder/weight of water that cylinder can hold
oxygen cylinders at 60° F).[3] The filling ratio of oxygen and nitrous oxide
Size Capacity (L) Pressure (psi) Tare Wt. (kg) Valve type is 0.75, but 0.67 in the tropics. The contents of these
B 200 1900 2.27 Pin index
cylinders can be accurately measured by weighing
D 400 1900 3.4 Pin index
the cylinders (1.87 g/L of gas) rather than by pressure
E 660 1900 5.4 Pin index
F 1360 1900 14.5 Bull nose gauge.[13] The pressure depends on the vapor pressure
G 3400 1900 34.5 Bull nose of liquid and so does not indicate the amount of gas
H 6900 2200 53.2 Bull nose remaining in the cylinder as long as the contents are
M 3450 2200 29.0 Bull nose partly in the liquid phase. The pressure will remain
same till all the liquid is converted to gas, after which the
Table 3: Relative size and specification of nitrous pressure falls until the cylinder is exhausted. Cylinder
oxide cylinders pressure varies only if temperature changes due to rapid
Size Capacity (L) Pressure (psi) Tare Wt. (kg) Valve type
emptying of cylinder causing cooling of contents due
C 450 745 2 Pin index
D 940 745 3.4 Pin index
to absorption of latent heat of vaporization. Under this
E 1800 745 5.4 Pin index condition, cylinder pressure will decrease with cooling
F 3600 745 14.5 Hand wheel but will be restored as the cylinder warms up again.[7]
G 9000 745 34.5 Hand wheel
J 18000 745 68.9 Hand wheel COLOR OF CYLINDERS

to which the cylinder may be filled at 70° F) but they An international color code to aid in identification of
should be able to withstand 1.66 times the service gas cylinders was adopted by medical gas industry
pressure. The service pressure is usually 2000‑2015 in 1949. Unfortunately, this has not been adopted by
psi.[10] The quantity of gas in these cylinders can be many countries, US uses green and Germany uses blue
estimated by using a pressure gauge, as the quantity color for oxygen cylinders. International color code
is directly proportional to gauge pressure.[1,2,5] The of various cylinders and that used in India are given
amount of time that an anaesthesia machine can in Table 1. Due to variation in color tones, chemical
operate from E type cylinders is important. During changes in paint pigments, color should not be used
use, an equation can help to estimate the remaining as a primary means for identification of cylinders.[2,7]
time proposed by Arlas.[11] Approximate remaining in
hours = O2 cylinder pressure in psi/200 × O2 flow rate Cylinder identification
per minute. But this gives only a rough estimate.[12] Each cylinder should have a label [Figure 7] which has
all the informations about the cylinder for the users.
Nitrous oxide and carbon‑dioxide liquefy at pressures to The label has the following information:
which cylinders are filled (at ambient temperature) and • Name and chemical symbol of gas.
are therefore stored as liquids. These cylinders are not • Product specification.
filled completely, but only up to a filling ratio (weight of • Hazard warning diamond shaped figure

Indian Journal of Anaesthesia | Vol. 57 | Issue 5 | Sep-Oct 2013 503

[Downloaded free from http://www.ijaweb.org on Wednesday, September 28, 2016, IP: 31.151.68.90]

Srivastava: Medical gas cylinders

denoting hazard class contained gas. Flattening test

• Name and address of cylinder manufacturer. The cylinder is kept between two compression blocks
• Cylinder contents in liters. and pressure is applied from both sides until the
• Tare weight (weight when empty). distance between blocks remains 6 times the thickness
• Maximum cylinder pressure. of the wall of cylinder. The walls should not crack.
• Cylinder size code.
Impact test
• Directions for use.
Three of each, longitudinal and transverse stripes
are taken from a finished cylinder and struck by
The cylinders have a tag attached which has three
mechanical hammer. Mean energy to produce the crack
sections labeled, FULL, IN USE and EMPTY.
should not be less than 5 and 10 lb/ft for transverse
Periodic testing and longitudinal strips, respectively.
Before releasing for distribution, a random cylinder
Bend test
from each batch is examined and tested by the
A ring of 25 mm width is cut from the cylinder and
manufacturer to verify that appropriate design and
divided into strips. Each strip is bent inward until
standard was followed. Each cylinder is visually
inner edges are a part, not greater than the diameter
checked before filling. The cylinder should be inspected of strip.
endoscopically for cracks and defects on their inner
side[14] and can also be tested ultrasonically.[7] The Entonox
cylinders undergo various tests to ensure safety. The This is 50.50 mixtures of nitrous oxide and
test is carried out every 10 years for steel cylinders and oxygen [Figure 8]. The premixed contents remain in
every 5 years for composite cylinders. A specific shape gaseous phase at pressures and temperature at which
and color coded plastic ring around the cylinder neck N2O by itself would normally be a liquid (poynting
indicates the time of next testing. effect).[1,15] Entonox is compressed in cylinders at a
pressure of 13,700 kPa. Cylinders are colored blue
Hydraulic test with white quadrants on the shoulder. For filling,
Is a measure of cylinder’s elasticity.[8] The cylinder is the cylinders are first filled with the correct weight
connected by a thread to testing unit, filled with water of nitrous oxide. The cylinder is then inverted and
and the water level is measured by gauge. The gauge is oxygen is bubbled through. As oxygen dissolves in
isolated and cylinder pressurized to 240 atmospheres. nitrous oxide, the latter vaporizes until all the liquid
The pressure is released and gauge opened. The is vaporized. The mixture remains in gaseous state
cylinder should stretch less than 0.02%. unless the temperature falls to −7°.[7]

Tensile test The gas mixture is delivered to patients using a two

Done in one out of 100 cylinders. The yield point stage pressure regulator consisting of the BOC Entonox
should not be less than 15 tons per square inch. valve, the second incorporating a demand valve. This

Figure 7: Oxygen cylinder label Figure 8: Entonox with delivery system

504 Indian Journal of Anaesthesia | Vol. 57 | Issue 5 | Sep-Oct 2013

[Downloaded free from http://www.ijaweb.org on Wednesday, September 28, 2016, IP: 31.151.68.90]

Srivastava: Medical gas cylinders

valve is now replaced by pneupac entonox valve. This

also consists of a first stage pressure regulator connected
by a narrow bore delivery tube to demand valve which
has a 22 mm male connector that is attached to the
mouthpiece or face mask. The tubing can be very
long so Entonox cylinder can be stored remotely from
demand valve in a warm area.[1] The delivery apparatus
can deliver a peak inspiratory flow rate in excess of
275 L/minute. As the patient inspires through the mask
or mouthpiece, the gas flows and ceases at the end of
inspiration. Demand valve ensures that gas does not
flow unless negative pressure is achieved. Airtight seal
between mask and face are essential.

If Entonox cylinder is stored at cold temperature (−7°C), Figure 9: Heliox

some N2O separates as liquid and may lead to delivery
of uneven mixtures, too much O2 at the beginning and chain or any other restraining device
too much N2O later as the cylinder empties. Danger • The suitable trolley/cart should be used to
of separation can be avoided by storing the cylinders transport and support the cylinders.
above 0°C, immersing the cylinder in water at 52°C,
inverting it thrice or keeping it above a temperature of Handling and installation
10°C for 2 hours before use.[7,15] • Before using, the contents of the cylinder must
be identified by reading the label[7] and also
Heliox seeing the color of the cylinder
Heliox is a mixture of oxygen and helium. The latter • Full cylinders are fitted with tamper evident
is 86% less dense (0.179 g/L) than air (1.293 g/L).[5] A seal, usually a shrink wrapped around the
mixture of 21% oxygen and 79% of helium named valve, should be removed immediately before
as Heliox 21 is used to improve gaseous exchange in use[2]
acute exacerbation of asthma and COPD [Figure 9]. • Before connecting to yoke, the cylinder valve
be cracked (i.e.,  Opened only slightly) to blow
Storage of cylinders away any dust or flammable silting on the valve.
• The storage area should be cool, dry, ventilated, • The person opening the cylinder should be
clean area constructed of fire resistant positioned so that the valve outlet and/or the
material[16] face of pressure gauge points away from self,
• Have good access for deliveries and a reasonable patient and machine
level floor surface • Care should be taken to see that sealing
• Should have segregation of ‘‘Full’’ and “Empty washer (Bodok Seal) is present on the yoke and
cylinders” is in good condition to prevent leakage.[6,7] More
• Cylinders with an oldest fill date should be than one washer should never be used as it can
used first default PISS
• Cylinders should not be stored in direct • The valve should be opened slowly to release the
sunlight[10] pressure gradually. Sudden opening can produce
• Easily visible sign such as no smoking, no open a shock wave in the pressure gauge and regulator
flames or sparks, no oil or grease etc., should be and can damage parts. Also, if gas passes quickly
displayed in the space between the valve and yoke or
• Cylinders should not be exposed to dampness, regulator, it can generate a large amount of heat.
corrosive chemicals, fumes as they may damage As there is almost no time to dissipate, this
cylinders and/or cause valve protection caps constitutes an adiabatic process[1] (no heat is lost
stick or gained from surrounding). The heat generated
• The temperature should not go below 10°C can ignite grease or any dust particle present,
where Entonox cylinders are stored causing flash fire or explosion
• Cylinders should always be kept in place with • The cylinders should never stand upright

Indian Journal of Anaesthesia | Vol. 57 | Issue 5 | Sep-Oct 2013 505

[Downloaded free from http://www.ijaweb.org on Wednesday, September 28, 2016, IP: 31.151.68.90]

Srivastava: Medical gas cylinders

without support Wilkins; 2008.

3. Schumacher SD, Brockwell RC, Andrews JJ, Ogles D. Bulk
• Handling should only be by trained staff. liquid oxygen supply failure. Anesthesiology 2004;100:186‑9.
4. Compressed Gas Association. Handbook of compressed gases.
Problems and hazards of medical gases and 3rd ed. Boston: Kluver Academic Publisher; 1999.
5. Sandberg W, Urman R, Ehrenfeld J. The MGH Textbook of
cylinders Anesthetic Equipment. 1st ed, Elsevier Saunders London,
1. Wrong cylinder despite pin index safety system 2010.
has been attached to yoke or regulator due to 6. Sinclair CM, Thadsad MK, Barker I. Modern anaesthetic
machines. Contin Educ Anaesth Crit Care Pain 2006;6:75‑8.
altered or broken pins or the use of more than 7. Lin ES. Anaesthetic equipment. In: Pinhock CA, Lin T, Smith T,
one washer[17‑21] editors. Fundamentals of Anaesthesia 1st ed. Cambridge,
2. Problems due to improper maintenance or England: Cambridge University Press; 2003. p. 878‑9
8. Davey A, Ince CS, Editors. Fundamentals of Operating
checking[13,22] Department Practice. 1st ed, Cambridge, England: Cambridge
3. Problems of filling of wrong gas[17,23] and over or University Press; 1999.
under filling of cylinder. 9. Giruad C. Oxygen cylinder with an integrated pressure
regulator and cylinder valve. Ann Fr Anesth Reanim
4. Wrong color coding – cylinder painted with 2003;22:301‑11.
other than standard color[24] 10. Wyka KA, Mathews PJ, Rutkowski JA, Editors. Foundations of
Respiratory Care. 2nd ed, Stamford, Connecticut, U.S: Cengage
5. Wrong or ambiguous label[25]
Learning; 2011.
6. Faulty delivery of oxygen[26] 11. Arlas G. A method to quickly estimate remaining time for an
7. Damaged valve[27] oxygen E‑cylinder. Anesth Analg 2004;98:1190.
12. Brockwill SC, Andrews JJ. Inhaled anesthetic delivery system.
8. Chemical contamination or moisture in gas[28] In: Miller RD, editors. Millers Anesthesia. 7th ed, Philadelphia:
9. Hazard due to fire and explosion Churchill Livingstone; 2010. p. 667‑718.
10. Physical injury to hospital personnel or patient 13. Rousseau GF, Carr AS. Reserve nitrous oxide cylinder on
anaesthetic machines: A survey of attitudes and equipment at
if unrestricted cylinder falls. a large DGH. Anaesthesia 2000;55:883‑5.
14. Vallis CJ, Hutton P, Clutton‑Brock TH, Stedman R. The
SUMMARY Anesthetic Machine and Breathing systems. In: Healy TE,
Knight PR, editors. Wylie and Churchill‑Davidsons’s A Practice
of Anesthesia, 7th ed. Arnold London; 2003. p. 465‑86.
Medical gas cylinders are usually made of molybdenum 15. Davies NJ, Cashman JN, editors. Lee’s Synopsis of Anaesthesia.
steel or aluminum and contain pressurized or liquefied 13th ed, United Kingdom: Butterworth‑Heinemann; 2006.
16. Guidance for the storage of gas cylinders in the workplace;
gases. They are of various sizes, color coded, undergo GN2 (Revision 4). British Compressed Gas Association; 2011.
testing at periodic interval and have several safety 17. Petty WC. Medical gases: Hospital pipelines and medical gas
cylinders: How safe are they? AANA J 1995;63:307‑12.
features. Nitrous oxide and carbon‑dioxide are stored
18. Mead P. Hazard with cylinder yoke. Anaesth Intensive Care
as liquefied gases employing filling ratio whereas 1981;9:79‑80.
other gases stored as pressurized gases at 13700 kPa. 19. Thomas AN, Hurst W, Saha B. Interchangeable oxygen and air
connectors. Anaesthesia 2001;56:1295‑6.
Each cylinder has a label attached to identify contents 20. Saha B, Thomas AN, Tuichi A. Interchangeable oxygen and
of the cylinder. The main hazard arises from a large carbon dioxide cylinders. Anaesthesia 2005;60:827‑8.
amount of stored energy the cylinders contain due 21. Chamley D, Trethowen L. Pin index failure. Anaesth Intensive
Care 1993;21:128‑9.
to high pressure of gases, wrong contents, improper 22. Serlin S. Check for tanks (letter). Anesth Analg 2004;98:870.
maintenance or human error. The hazards have 23. Menon MR, Lett Z. Incorrectly filled cylinders. Anaesthesia
the potential to harm the patients and health care 1990;46:155‑6.
24. Taylor NJ, Davison M. Inaccurate colour coding of medical gas
providers. Therefore, proper precaution should be cylinders. Anaesthesia 2009;64:690.
taken and backup plans must be instituted to minimize 25. Crombie N. Confusing and ambiguous labelling of an oxygen
impact of any hazard.[5] cylinder. Anaesthesia 2009;64:99.
26. Mcvey FK, Streets CA. Oxygen delivery failure from
faulty portable cylinder. Correspondence. Anaesthesia
REFERENCES 2009;64:1150‑1
27. Millkers RA. Correspondence. Anesth Analg 1971;50:775.
1. Bland H. The Supply of anesthetic and other medical gases 28. Coveler LA, Lester RC. Contaminated oxygen cylinder. Anesth
in Davey AJ, Diba A editors. Ward’s Anesthetic Equipment. Analg 1989;69;674‑6.
5th ed, Elsevier Saunders London; 2005. p. 23‑49.
2. Dorsch JA, Dorsch SE, editors. Understanding Anesthesia
Source of Support: Nil, Conflict of Interest: None declared
Equipment. 5th ed, Philadelphia US: Lippincott Williams and

506 Indian Journal of Anaesthesia | Vol. 57 | Issue 5 | Sep-Oct 2013