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TECHNOLOGY, COMPUTING, AND SIMULATION

No Compound A Formation with Superia^® During Minimal-Flow Sevoflurane Anesthesia: A Comparison with Sofnolime^®

Marie-Paule L. A. Bouche, Pha^*, Linda F. M. Versichelen, MD, Michel M. R. F. Struys, MD PhD, Jan F. P. Van Bocxlaer, Pha PhD^*, André P. De Leenheer, Pha PhD^*, Eric P. Mortier, MD DSc, and Georges Rolly, MD PhD

*Faculty of Pharmaceutical Sciences, Laboratory of Medical Biochemistry and Clinical Analysis, and University Hospital, Department of Anesthesia, Ghent University, Ghent, Belgium

Address correspondence and reprint requests to Linda Versichelen, MD, Department of Anesthesia, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. Address e-mail to linda.versichelen{at}rug.ac.be

There is concern about the toxicity of Compound (Co) A. Absorbents differ in the production of Co A during minimal-flow sevoflurane anesthesia. Strong alkali-free Amsorb^® does not produce Co A. It was our aim to study Superia^®, another new NaOH- and KOH-free CO₂ absorbent, in minimal-flow anesthesia, compared with KOH-free Sofnolime^®. After Ethics Committee approval, 14 consenting adult patients were included randomly by using Superia or Sofnolime as the CO₂ absorbent in the compact 750-mL canister of an ADU ventilator. After propofol and remifentanil administration, sevoflurane was given in oxygen and air (500 mL/min; fraction of inspired oxygen, 0.4), aiming at an end-tidal concentration of 2.3%–2.5%; ventilation aimed for 33–35 mm Hg PETCO₂. Compound A inspired (Co A_insp) and expired (Co A_exp) samples were taken for analysis, and canister temperatures were measured for 150 min. Statistical analysis was performed with the Friedman test or the Mann-Whitney U-test where appropriate. Correction for multiple testing was used. In the Superia group, no significant amount of Co A was formed, whereas in the Sofnolime group, maximum median (range) inspiratory values of 25 ppm (16 ppm) were found. The intergroup difference was P < 0.05. No difference was noticed between the two groups for the canister CO₂ absorbent temperature.

IMPLICATIONS: During minimal-flow 2.3%–2.5% end-tidal sevoflurane, no compound A (Co A) is formed with the NaOH- and KOH-free CO₂ absorbent Superia. Although Co A values with KOH-free Sofnolime are still within reported safe limits, Superia is definitely an alternative for safe clinical practice.