Tight reservoir bag: the bag itself may be the culprit.

Numerous possibilities exist which may cause obstruction to ventilation under anesthesia resulting in a tight reservoir bag with low compliance. We report an interesting case where a reservoir bag twisted around its own neck and resulted in a tight bag situation. The neck portion of the reservoir bag would be hidden from the view of anesthesiologists in head and neck surgery and hence it is easier to miss early recognition of the twist. We caution all anesthesiologists using the disposable modified Jackson-Rees breathing system to be aware of such an eventuality. We also urge the manufacturer to consider strengthening the neck of the reservoir bag by improving the quality of the material used for its construction.