Anesth Analg 2006;102:1290-1291
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000199209.42223.CC
LETTER TO THE EDITOR
Should Soda Lime Be Abolished?
Lewis S. Coleman, MD, DABA
Harbor General/UCLA Medical Center Torrance, CA, lewiscoleman{at}bak.rr.com
To the Editor:
As noted in the September 2005 issue of Anesthesia & Analgesia, the presence of soda lime canisters in anesthesia machines confers the risk of dangerous circuit leaks and reactions with anesthetic agents (1,2). The use of soda lime originated when "closed circuit" techniques were popular, excessive CO2 levels were feared, and there was no means to monitor them. However, closed circuit techniques have long been abandoned, and CO2 monitoring is now ubiquitous. The available evidence suggests that hypercarbia is benign (3,4), supports respiratory drive, complements opioid use, increases oxygen carrying capacity of blood (5), reduces lung injury (6), and increases cardiac output, tissue perfusion (7), and oxygenation (8). In contrast, hypocarbia decreases cardiac output and tissue perfusion (9), risks hypoxemia (10), is incompatible with the use of opioids, and may cause "Hyperventilation-Hypoventilation Syndrome" (11), dysrhythmias (12), and brain and lung damage (13–15). Do the questionable merits of soda lime justify its continued presence in the face of the risks associated with its use?
References
- Laster MJ, Eger EI II. Temperatures in soda lime during degradation of desflurane, isoflurane, and sevoflurane by desiccated soda lime. Anesth Analg 2005;101:753–7.[Abstract/Free Full Text]
- Ianchulev SA, Comunale ME. To do or not to do a preinduction check-up of the anesthesia machine. Anesth Analg 2005;101:774–6.[Abstract/Free Full Text]
- Morisaki H, Serita R, Innami Y, et al. Permissive hypercapnia during thoracic anaesthesia. Acta Anaesthesiol Scand 1999;43:845–9.[ISI][Medline]
- Hino JK, Short BL, Rais-Bahrami K, Seale WR. Cerebral blood flow and metabolism during and after prolonged hypercapnia in newborn lambs. Crit Care Med 2000;28:3505–10.[ISI][Medline]
- Ramirez J, Totapally BR, Hon E, et al. Oxygen-carrying capacity during 10 hours of hypercapnia in ventilated dogs. Crit Care Med 2000;28:1918–23.[Medline]
- Ohmura A, Sha M, Katagiri J. How far can we go with permissive hypercapnia? A case presentation and some biased comments with emphasis on maintaining normal haemoglobin level. Acta Anaesthesiol Scand Suppl 1995;107:209–13.[Medline]
- Arellano R, Jiang MT, O'Brien W, et al. Acute graded hypercapnia increases collateral coronary blood flow in a swine model of chronic coronary artery obstruction. Crit Care Med 1999;27:2729–34.[ISI][Medline]
- Hare GM, Kavanagh BP, Mazer CD, et al. Hypercapnia increases cerebral tissue oxygen tension in anesthetized rats. Can J Anaesth 2003;50:1061–8.[Abstract/Free Full Text]
- Bradley SM, Simsic JM, Mulvihill DM. Hypoventilation improves oxygenation after bidirectional superior cavopulmonary connection. J Thorac Cardiovasc Surg 2003;126:1033–9.[Abstract/Free Full Text]
- Corne S, Webster K, Younes M. Hypoxic respiratory response during acute stable hypocapnia. Am J Respir Crit Care Med 2003;167:1193–9.[Abstract/Free Full Text]
- Miller RD. Anesthesia, 5th ed. San Francisco: Churchill Livingstone, 2000:296.
- Cooper HE, Clutton-Brock TH, Parkes MJ. Contribution of the respiratory rhythm to sinus arrhythmia in normal unanesthetized subjects during positive-pressure mechanical hyperventilation. Am J Physiol Heart Circ Physiol 2004;286:H402–11.[Abstract/Free Full Text]
- Laffey JG, Englelberts D, Duggan M, et al. Carbon dioxide attenuates pulmonary impairment resulting from hyperventilation. Crit Care Med 2003;31:2634–40.[ISI][Medline]
- Lovering AT, Fraigne JJ, Dunin-Barkowski WL, et al. Hypocapnia decreases the amount of rapid eye movement sleep in cats. Sleep 2003;26:961–7.[Medline]
- Shahar E, Postovsky S, Bennett O. Central neurogenic hyperventilation in a conscious child associated with glioblastoma multiforme. Pediatr Neurol 2004;30:287–90.[Medline]
