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GENERAL ARTICLES

Smoking Status and Body Size Increase Carbon Monoxide Concentrations in the Breathing Circuit During Low-Flow Anesthesia

Chin-Sheng Tang, MS*, Shou-Zen Fan, MD, PhD, and Chang-Chuan Chan, ScD

*Department of Environmental Engineering and Health, Yuanpei Technical College, National Taiwan University Hospital, College of Medicine, National Taiwan University, and Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan

Address correspondence and reprint requests to Chang-Chuan Chan, ScD, Rm. 1447, 14F, No.1, Sec. 1, Jen-ai Rd., Taipei 100, Taiwan. Address e-mail to ccchan{at}ha.mc.ntu.edu.tw

The major sources for intraoperative carbon monoxide (CO) in the breathing circuit are related to patient’s hemoglobin catabolism, smoking and the degradation between absorbent and anesthetics. We performed this study to evaluate their combined effects on CO production during low-flow anesthesia. We used a direct-measurement instrument to measure real-time CO concentrations in the breathing circuit during different anesthetic conditions for patients who received desflurane or isoflurane. By applying multiple linear regression models, we determined the significant factors related to CO concentrations in the circuit. We identified patients’ smoking status, preoperative smoking and body weight as well as gas flow rates as important factors for affecting peak and time-weighted CO levels. These four factors predicted approximately 44.1% and 42.7% of peak and mean inspiratory CO concentrations respectively. We found that chronic and preoperative smokers and patients with larger body weights are associated with increased CO concentrations, whereas increase in gas flow rates could decrease CO concentrations. After controlling these four important factors, we found that inspiratory CO concentrations were not significantly associated with the choice of anesthetic and its concentration during low-flow anesthesia.

Implications: We found that smoking status, preoperative smoking, body weight and gas flow rates were major factors of affecting peak and mean carbon monoxide concentrations in low-flow anesthesia. Our direct measurement system is useful for monitoring real time exposures to CO during continuous clinical anesthesia.

This article has been cited by other articles:

				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]

				H. J. Woehlck and C.-C. Chan Carbon Monoxide Rebreathing during Low Flow Anesthesia Anesth. Analg., August 1, 2001; 93(2): 516 - 517. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999