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GENERAL ARTICLES

Compound A Concentrations During Low-Flow Sevoflurane Anesthesia Correlate Directly with the Concentration of Monovalent Bases in Carbon Dioxide Absorbents

Hideyuki Higuchi, MD^*, Yushi Adachi, MD, Shinya Arimura, MD^*, Masuyuki Kanno, MD^*, and Tetsuo Satoh, MD

*Department of Anesthesia, Self Defense Force Central Hospital, Tokyo; and Department of Anesthesiology, National Defense Medical College, Saitama, Japan

Address correspondence and reprint requests to Hideyuki Higuchi, MD, Department of Anesthesia, Self Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya, Tokyo 154-8532, Japan. Address e-mail to higu-chi{at}ka2.so-net.ne.jp

Sevoflurane degrades to Compound A, which is nephrotoxic in rats. Potassium hydroxide (KOH) and sodium hydroxide (NaOH) are primary determinants of this degradation reaction. To address this, new carbon dioxide absorbents, such as Amsorb^® (A; Armstrong Medical, Coleraine, Northern Ireland), which contains neither KOH nor NaOH, Drägersorb 800 Plus^® (D; Dräger, Luebeck, Germany), and Medisorb^® (M; Datex-Ohmeda, Bromma, Sweden), which contain some NaOH (1% to 2%) and only trace amounts of KOH (0.003%), were recently developed. We compared Compound A concentrations using these three CO₂ absorbents during low-flow (1 L/min) sevoflurane anesthesia in surgical patients, with those using a conventional CO₂ absorbent, Drägersorb 800 (C). The mean Compound A concentrations ± SD using C, A, D, and M were 18.7 ± 2.5, 1.8 ± 0.7, 13.3 ± 3.5, and 11.2 ± 2.6 ppm, respectively, with significant differences (P < 0.001; A versus C, A versus D, A versus M, C versus D, C versus M). Amsorb prevented the degradation of sevoflurane to Compound A, whereas Drägersorb 800 Plus and Medisorb decreased the degradation to Compound A.

Implications: Sevoflurane degradation to Compound A is decreased by lowering the concentration of monovalent bases in the carbon dioxide absorbent (Drägersorb 800 Plus^® [Dräger, Luebeck, Germany] and Medisorb^® [Datex-Ohmeda, Bromma, Sweden]) and is virtually eliminated in the absence of these bases (Amsorb^® [Armstrong Medical, Coleraine, Northern Ireland]).

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