Low-Flow Anesthesia and Reduced Animal Size Increase Carboxyhemoglobin Levels in Swine During Desflurane and Isoflurane Breakdown in Dried Soda Lime

Bonome, C; Alvarez-Refojo, F.; Soro, Marina; Fernández-Goti, Concepcion; Cortés, Alberto

doi:10.1097/00000539-199910000-00017

Cited by 10 publications

(8 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The different responses to LFA with regard to COHb in younger vs older children were likely due to patient size, 12 14 since CO exposure results in a greater increase in COHb in smaller subjects. 12 The observation that COHb did not decrease after HFA is probably explained by the lack of offgassing. 3 15 Off-gassing, the displacement of CO from haemoglobin by oxygen might have been minimized by using air as the fresh gas in the breathing circuit.…”

Section: Discussionmentioning

confidence: 99%

Carbon monoxide re-breathing during low-flow anaesthesia in infants and children

Nasr

Emmanuel

Deutsch

et al. 2010

British Journal of Anaesthesia

View full text Add to dashboard Cite

LFA increased exhaled and inspired CO and increased COHb% in children <2 yr of age. Thus, LFA resulted in re-breathing of exhaled CO and exposure, especially in the youngest children. Re-breathing exhaled gas during LFA could pose a risk for an acute CO exposure in patients who have elevated COHb and high baseline levels of exhaled CO. If practitioners match or exceed minute ventilation with FGF to avoid LFA, CO re-breathing can be limited.

show abstract

Section: Discussionmentioning

confidence: 99%

Carbon monoxide re-breathing during low-flow anaesthesia in infants and children

Nasr

Emmanuel

Deutsch

et al. 2010

British Journal of Anaesthesia

View full text Add to dashboard Cite

show abstract

“…Halothane and sevoflurane did not produce detectable amounts of carbon monoxide, and carboxyhemoglobin levels did not increase above baseline values (93). The effects of animal size, anesthetic concentration, and fresh gas flow rate on inspired carbon monoxide and carboxyhemoglobin production were studied (26). Compared with isoflurane, carbon monoxide and carboxyhemoglobin concentrations were significantly greater with desflurane, particularly in smaller pigs.…”

Section: Carbon Monoxidementioning

confidence: 99%

“…2. This moiety may degrade to carbon monoxide under conditions of high anesthetic, dry carbon dioxide absorbent, increasing temperature, and low gas flow rates (26,74,203,204). Since sevoflurane and halothane lack the difluoro-methyl moiety, no degradation to carbon monoxide can occur.…”

Section: Carbon Monoxidementioning

confidence: 99%

Sevoflurane: Approaching the Ideal Inhalational Anesthetic A Pharmacologic, Pharmacoeconomic, and Clinical Review

2001

View full text Add to dashboard Cite

Sevoflurane is a safe and versatile inhalational anesthetic compared with currently available agents. Sevoflurane is useful in adults and children for both induction and maintenance of anesthesia in inpatient and outpatient surgery. Of all currently used anesthetics, the physical, pharmacodynamic, and pharmacokinetic properties of sevoflurane come closest to that of the ideal anesthetic (200). These characteristics include inherent stability, low flammability, non-pungent odor, lack of irritation to airway passages, low blood:gas solubility allowing rapid induction of and emergence from anesthesia, minimal cardiovascular and respiratory side effects, minimal end-organ effects, minimal effect on cerebral blood flow, low reactivity with other drugs, and a vapor pressure and boiling point that enables delivery using standard vaporization techniques. As a result, sevoflurane has become one of the most widely used agents in its class.

show abstract

“…Even though the conventional CO 2 absorbent Wakolime™ A contains the strong bases NaOH and KOH, it did not increase the concentrations of CO, which leads to an increase in COHb. Bonome et al 7 reported that fresh gas flow had a diluting effect on CO concentrations in the circuit. Tang et al 12 also reported results of analysis using a regression model that predicted decreases of approximately 7.7 ppm and 5.9 ppm in peak and mean CO concentrations for an increase in gas flow rate by 1.0 l.min -1 .…”

Section: Discussionmentioning

confidence: 99%

“…Smokers have a high incidence of postoperative respiratory complications such as pneumonia 2,3 , and smoking can also increase the concentration of carboxyhemoglobin (COHb) up to 5% to 10% 4 , a concentration that inhibits the preferred binding of haemoglobin (Hb) with oxygen, leading to cardiac events during anaesthesia 5 . On the other hand, carbon monoxide (CO) can be produced from degradation of isoflurane by soda lime 6 , especially with dry soda lime 6,7 , or by the use of a low-flow anaesthetic technique 7,8 . An unfavourable increase in COHb in smoking patients is therefore anticipated under these conditions.…”

mentioning

confidence: 99%

The Type of Carbon Dioxide Absorbent has no Relation to the Concentration of Carbon Monoxide in the Breathing Circuit during Low-flow Isoflurane Anaesthesia in Smoking and Non-smoking Subjects

Yamakage

Iwasaki

et al. 2004

Anaesth Intensive Care

View full text Add to dashboard Cite

The present study was designed to investigate the concentrations of carbon monoxide (CO) in the anaesthetic circuit and of arterial carboxyhaemoglobin (COHb) during low-flow isoflurane anaesthesia in smoking and non-smoking subjects using three kinds of cardon dioxide (CO 2 ) absorbent. Thirty smoking and 30 non-smoking subjects were selected for this study, and these two groups were each divided into three groups according to the type of CO 2 absorbent used (Wakolime™ A, Drägersorb™ Free, and Amsorb™). Anaesthesia was maintained with 1.0% isoflurane and nitrous oxide (1.0l min -1 )/oxygen (1.0l min -1 ). Concentrations of CO in the inspired breathing circuit and concentrations of arterial COHb were measured at 0, 1, 2, 3, and 4 hours after exposure to isoflurane. In the smoking groups there were no significant differences in CO concentrations in the circuit between the groups and the CO concentrations did not change significantly during the study period. There were also no significant differences in the arterial COHb values between the groups and the COHb concentrations remained constant. There was a significant linear correlation between the concentrations of CO and COHb (r=0.86, n=30, P<0.001). In the nonsmoking groups all of the parameters remained constant at low levels that were independent of the type of CO 2 absorbents tested. The major source for increased intraoperative CO exposure is related to the patient's smoking status, and the type of CO 2 absorbent used has no relation to an increase in CO concentration in the breathing circuit.

show abstract

Low-Flow Anesthesia and Reduced Animal Size Increase Carboxyhemoglobin Levels in Swine During Desflurane and Isoflurane Breakdown in Dried Soda Lime

Abstract: The present study shows that the use of desflurane with desiccated carbon dioxide absorbents in pediatric anesthesia can produce a dangerous carbon dioxide intoxication, especially with low-flow anesthesia.

Cited by 10 publications

References 3 publications

Carbon monoxide re-breathing during low-flow anaesthesia in infants and children

Carbon monoxide re-breathing during low-flow anaesthesia in infants and children

Sevoflurane: Approaching the Ideal Inhalational Anesthetic A Pharmacologic, Pharmacoeconomic, and Clinical Review

The Type of Carbon Dioxide Absorbent has no Relation to the Concentration of Carbon Monoxide in the Breathing Circuit during Low-flow Isoflurane Anaesthesia in Smoking and Non-smoking Subjects

Contact Info

Product

Resources

About