| ||||||||||||||
|
|
|||||||||||||
Anesthesia & Analgesia, Vol 80, 1187-1193, Copyright © 1995 by International Anesthesia Research Society
GENERAL ARTICLES |
ZX Fang, EI Eger 2nd, MJ Laster, BS Chortkoff, L Kandel and P Ionescu
Department of Anesthesia, University of California, San Francisco 94143- 0464, USA.
Anecdotal reports suggest that soda lime and Baralyme brand absorbent can degrade inhaled anesthetics to carbon monoxide (CO). We examined the factors that govern CO production and found that these include: 1) The anesthetic used: for a given minimum alveolar anesthetic concentration (MAC)-multiple, the magnitude of CO production (greatest to least) is desflurane > or = enflurane > isoflurane >> halothane = sevoflurane. 2) The absorbent dryness: completely dry soda lime produces much more CO than absorbent with just 1.4% water content, and soda lime containing 4.8% or more water (standard soda lime contains 15% water) generates no CO. In contrast, both completely dry Baralyme and Baralyme with 1.6% water produce high concentrations of CO, and Baralyme containing 4.7% water produces concentrations equaling those produced by soda lime containing 1.4% water. Baralyme containing 9.7% or more water and standard Baralyme (13% water) do not generate CO.3) The type of absorbent: at a given water content, Baralyme produces more CO than does soda lime. 4) The temperature: an increased temperature increases CO production. 5) The anesthetic concentration: more CO is produced from higher anesthetic concentrations. These results suggest that CO generation can be avoided for all anesthetics by using soda lime with 4.8% (or more) water or Baralyme with 9.7% (or more) water, and by using inflow rates of less than 2-3 L/min. Such inflow rates are low enough to ensure that the absorbent does not dry out.
This article has been cited by other articles:
![]() |
G. Nunn Low-flow anaesthesia CEACCP, February 1, 2008; 8(1): 1 - 4. [Full Text] [PDF] |
||||
![]() |
C. D. Barth, M. B. Dunning III, L. Bretscher, and H. J. Woehlck Barium Hydroxide Lime Turns Yellow After Desiccation Anesth. Analg., September 1, 2005; 101(3): 748 - 752. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Laster, P. Roth, and E. I Eger II Fires from the Interaction of Anesthetics with Desiccated Absorbent Anesth. Analg., September 1, 2004; 99(3): 769 - 774. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Hayashi, T. Takahashi, H. Morimatsu, H. Fujii, N. Taga, S. Mizobuchi, M. Matsumi, H. Katayama, M. Yokoyama, M. Taniguchi, et al. Increased Carbon Monoxide Concentration in Exhaled Air After Surgery and Anesthesia Anesth. Analg., August 1, 2004; 99(2): 444 - 448. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. Eisenkraft Hazards of anesthesia gas delivery systems Can J Anesth, June 1, 2004; 51(suppl_1): R7 - R7. [Full Text] [PDF] |
||||
![]() |
E. G. Lawes Hidden hazards and dangers associated with the use of HME/filters in breathing circuits. Their effect on toxic metabolite production, pulse oximetry and airway resistance Br. J. Anaesth., August 1, 2003; 91(2): 249 - 264. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. Tempia, M. C. Olivei, E. Calza, H. Lambert, L. Scotti, E. Orlando, S. Livigni, and E. Guglielmotti The Anesthetic Conserving Device Compared with Conventional Circle System Used Under Different Flow Conditions for Inhaled Anesthesia Anesth. Analg., April 1, 2003; 96(4): 1056 - 1061. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. J. Holak, D. A. Mei, M. B. Dunning III, R. Gundamraj, R. Noseir, L. Zhang, and H. J. Woehlck Carbon Monoxide Production from Sevoflurane Breakdown: Modeling of Exposures Under Clinical Conditions Anesth. Analg., March 1, 2003; 96(3): 757 - 764. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. Knolle, G. Heinze, and H. Gilly Small Carbon Monoxide Formation in Absorbents Does Not Correlate with Small Carbon Dioxide Absorption Anesth. Analg., September 1, 2002; 95(3): 650 - 655. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. Knolle, G. Heinze, and H. Gilly Carbon Monoxide Formation in Dry Soda Lime is Prolonged at Low Gas Flow Anesth. Analg., August 1, 2001; 93(2): 488 - 493. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. R. Wohlfeil, H. J. Woehlck, J. L. Gottschall, and W. Poole Increased Carboxyhemoglobin from Hemolysis Mistaken as Intraoperative Desflurane Breakdown Anesth. Analg., June 1, 2001; 92(6): 1609 - 1610. [Full Text] [PDF] |
||||
![]() |
C.-S. Tang, S.-Z. Fan, and C.-C. Chan Smoking Status and Body Size Increase Carbon Monoxide Concentrations in the Breathing Circuit During Low-Flow Anesthesia Anesth. Analg., February 1, 2001; 92(2): 542 - 547. [Abstract] [Full Text] [PDF] |
||||
![]() |
C. F. Kong, S. T. H. Chew, and P. C. Ip-Yam Intravenous opioids reduce airway irritation during induction of anaesthesia with desflurane in adults{dagger} Br. J. Anaesth., September 1, 2000; 85(3): 364 - 367. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. Schindler, M. Vorweg, T. W. L. Scheeren, and M. Doehn Water vapour in a closed anaesthesia circuit reduces degradation/adsorption of halothane by dried soda lime Br. J. Anaesth., August 1, 2000; 85(2): 308 - 310. [Abstract] [Full Text] [PDF] |
||||
![]() |
H. Higuchi, Y. Adachi, S. Arimura, M. Kanno, and T. Satoh Compound A Concentrations During Low-Flow Sevoflurane Anesthesia Correlate Directly with the Concentration of Monovalent Bases in Carbon Dioxide Absorbents Anesth. Analg., August 1, 2000; 91(2): 434 - 439. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. Knolle and H. Gilly Absorption of Carbon Dioxide by Dry Soda Lime Decreases Carbon Monoxide Formation from Isoflurane Degradation Anesth. Analg., August 1, 2000; 91(2): 446 - 451. [Abstract] [Full Text] [PDF] |
||||
![]() |
C. R. Stabernack, R. Brown, M. J. Laster, R. Dudziak, and E. I Eger II Absorbents Differ Enormously in Their Capacity to Produce Compound A and Carbon Monoxide Anesth. Analg., June 1, 2000; 90(6): 1428 - 1435. [Abstract] [Full Text] [PDF] |
||||
![]() |
H. J. Woehlck, L. A. Connolly, M. P. Cinquegrani, M. B. Dunning III, and R. G. Hoffmann Acute Smoking Increases ST Depression in Humans During General Anesthesia Anesth. Analg., October 1, 1999; 89(4): 856 - 856. [Abstract] [Full Text] [PDF] |
||||
![]() |
C. Bonome, J. Belda, F. Alvarez-Refojo, M. Soro, C. Fernandez-Goti, and A. Cortes Low-Flow Anesthesia and Reduced Animal Size Increase Carboxyhemoglobin Levels in Swine During Desflurane and Isoflurane Breakdown in Dried Soda Lime Anesth. Analg., October 1, 1999; 89(4): 909 - 909. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. A. Neumann, M. J. Laster, R. B. Weiskopf, D. H. Gong, R. Dudziak, H. Forster, and E. I Eger II The Elimination of Sodium and Potassium Hydroxides from Desiccated Soda Lime Diminishes Degradation of Desflurane to Carbon Monoxide and Sevoflurane to Compound A but Does Not Compromise Carbon Dioxide Absorption Anesth. Analg., September 1, 1999; 89(3): 768 - 768. [Abstract] [Full Text] [PDF] |
||||
![]() |
L. K. Weaver, R. O. Hopkins, G. Elliott, J. B. Leikin, J. C. Clifton, P. K. Hanashiro, H. J. Woehlck, H. M. Kauffman, D. P. Ryan, A. M. Cosentino, et al. Carbon Monoxide Poisoning N. Engl. J. Med., April 22, 1999; 340(16): 1290 - 1292. [Full Text] |
||||
|