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TECHNOLOGY, COMPUTING, AND SIMULATION

Increased Carbon Monoxide Concentration in Exhaled Air After Surgery and Anesthesia

Masao Hayashi, MD^*, Toru Takahashi, MD, Hiroshi Morimatsu, MD, Hiromi Fujii, MD, Naoyuki Taga, MD, Satoshi Mizobuchi, MD, Masaki Matsumi, MD, Hiroshi Katayama, MD, Masataka Yokoyama, MD, Masahiro Taniguchi, MD^*, and Kiyoshi Morita, MD

*Department of Anesthesiology, National Okayama Medical Center, Tamasu, Okayama, Japan; and Department of Anesthesiology and Resuscitology, Okayama University Medical School, Okayama, Japan

Address correspondence and reprint requests to Toru Takahashi, MD, Department of Anesthesiology and Resuscitology, Okayama University Medical School, 700-8558, Japan. Address e-mail to takatoru{at}cc.okayama-u.ac.jp

Heme oxygenase-1 (HO-1) is induced by oxidative stress and is thought to confer protection against oxidative tissue injuries. HO-1 catalyzes the conversion of the heme moiety of hemeproteins, such as hemoglobin, myoglobin, and cytochrome P450, to biliverdin, liberating carbon monoxide (CO) in the process. CO reacts with hemoglobin to form carboxyhemoglobin. In this study, to examine the effect of anesthesia and/or surgery on endogenous CO production, we measured the amount of exhaled CO and the arterial carboxyhemoglobin concentration of patients who underwent surgery under general or spinal anesthesia. Both CO and carboxyhemoglobin concentrations were significantly larger on the day after surgery than during the preoperative period (P < 0.05) and in the recovery room (P < 0.05), regardless of anesthesia. However, neither index differed between general and spinal anesthesia. These results suggest that oxidative stress caused by anesthesia and/or surgery may induce HO-1, which catalyzes heme to produce CO, leading to increased exhaled CO concentration.

IMPLICATIONS: We measured exhaled carbon monoxide (CO) concentrations and arterial carboxyhemoglobin concentrations in patients who underwent surgery under general or spinal anesthesia. Both indices were significantly larger than the preoperative value on the day after surgery and in the recovery room, regardless of anesthesia, suggesting that endogenous CO production is increased by generalized oxidative stress.

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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