soda-lime and fluoromethyl-2-2-difluoro-1-(trifluoromethyl)vinyl-ether

To determine compound A, formaldehyde and methanol concentrations in low-flow anaesthesia using different carbon dioxide absorbers.. Fifteen patients scheduled for general or urological surgery were exposed to low-flow (500 ml/min) anaesthesia with sevoflurane. The patients were randomly allocated to three groups: soda lime, DrägerSorb Free or Amsorb Plus. The concentrations of compound A, formaldehyde and methanol were sampled and analysed from the limbs of the anaesthesia circuit at T30 (30 min after the start of low-flow sevoflurane anaesthesia), T90 (90 min) and T150 (150 min). The temperatures of the absorbers were measured at the same time.. Statistically significant differences (P < 0.05) were found in the production of compound A from soda lime (with the highest values), DrägerSorb Free and Amsorb Plus at each measurement time. Only traces of methanol (ranging from < 0.131 to 3.799 mg/m(3)) were measured, higher with Amsorb Plus (statistically significant differences were found only at T90). The formaldehyde values (ranging from < 0.1227 to 17.79 mcg/m(3) p.p.b.) were higher with soda lime, and the difference was statistically significant at T150 and, in the inspiratory limb only, at T90. The temperatures of the absorbers were higher for soda lime and lower for Amsorb Plus; the difference was statistically significant at T0 in the upper canister and at T30 in both canisters.. The concentrations of harmful products in the circuit were negligible and were lower using the new-generation absorbers. Using Amsorb Plus, the temperatures in the canisters were lower than with the other two absorbers.

Topics: Adsorption; Aged; Anesthesia, Inhalation; Anesthetics, Inhalation; Calcium Chloride; Calcium Compounds; Calcium Hydroxide; Carbon Dioxide; Equipment Safety; Ethers; Formaldehyde; Humans; Hydrocarbons, Fluorinated; Methanol; Methyl Ethers; Middle Aged; Oxides; Sevoflurane; Sodium Hydroxide; Time Factors

The alkali hydroxide content in soda lime induces Compound A formation from Sevoflurane (Sevo). This study was designed to answer the question if the use of potassium hydroxide-free Soda Lime (SL) would lead to lower Compound A levels as compared to Sodasorb (SO). A total of 30 patients scheduled for elective laparoscopic cholecystectomy received Sevo anaesthesia under low-flow conditions (0.8 l/min fresh gas flow). Each absorbent was used in 15 patients, but 3 patients of the SO group were excluded due to technical problems with Compound A analysis. Hemodynamic parameters, parameters of ventilation and gas concentrations were documented. Compound A concentrations were measured by gas chromatography from gas samples before Sevo application and 20, 40, 60, 90 and 120 min after low-flow start. Mean endtidal Sevo concentrations were 1.94 +/- 0.17 (SO) and 1.97 +/- 0.15 (SL) vol %, the total anaesthetic exposition was 1.52 +/- 0.36 (SO) and 1.64 +/- 0.47 (SL) MAC-h (n.s). The maximum Compound A concentration was significantly higher in SL group (19.6 +/- 2.8 vs. 11.7 +/- 4.1 ppm, p < 0.001). Therefore, elimination of potassium hydroxide from carbon dioxide absorbents alone did not lead to a reduction of Compound A formation during low-flow anaesthesia.

Topics: Anesthesia, Inhalation; Anesthetics, Inhalation; Calcium Compounds; Carbon Dioxide; Cholecystectomy, Laparoscopic; Chromatography, Gas; Ethers; Hemodynamics; Humans; Hydrocarbons, Fluorinated; Hydroxides; Methyl Ethers; Oxides; Sevoflurane; Sodium Hydroxide

The purpose was to compare the concentrations of compound A in inspired gas breathed by patients produced by different types of anesthetic machines under prolonged sevoflurane low-flow anesthesia.. The anesthetic machines tested were Excel 210 SE (Datex-Ohmeda, Louisville, CO), Cicero (Dräger, Lübeck, Germany), and AS/3 ADU (Datex-Ohmeda, Louisville, CO). Anesthesia expected to last more than four hours was maintained with 2.0% sevoflurane and nitrous oxide (0.5 L x min(-1))/oxygen (0.5 L x min(-1)). The concentrations of compound A, obtained from the inspiratory limb of the circle system, were measured using a gas chromatograph.. When Excel and Cicero were used, concentrations of compound A increased steadily from the baseline values to 28 and 29 (mean) ppm, respectively, at two hours after exposure to sevoflurane and became constant. There was no significant difference between the concentrations of compound A produced by these anesthetic machines. In contrast, the new anesthetic machine AS/3 was associated with lower concentrations of compound A (6 ppm at one hour, P <0.05 compared with Excel and Cicero), and the concentration did not change significantly thereafter.. In spite of the use of a conventional carbon dioxide (CO2) absorbent with strong bases, the anesthetic machine AS/3 with a small volume of canister/soda lime (900 ml/700 ml) produced lower concentrations of compound A than those produced by the other machines.

Topics: Anesthesia, Inhalation; Anesthesiology; Anesthetics, Inhalation; Calcium Compounds; Ethers; Female; Gases; Humans; Hydrocarbons, Fluorinated; Male; Methyl Ethers; Middle Aged; Oxides; Sevoflurane; Sex Characteristics; Sodium Hydroxide

Potent inhaled anesthetics degrade in the presence of the strong bases (sodium hydroxide or potassium hydroxide) in carbon dioxide (CO2) absorbents. A new absorbent, Amsorb (Armstrong Medical Ltd., Coleraine, Northern Ireland), does not employ these strong bases. This study compared the scavenging efficacy and compound A production of two commercially available absorbents (soda lime and barium hydroxide lime) with Amsorb in humans undergoing general anesthesia.. Four healthy volunteers were anesthetized on different days with desflurane, sevoflurane, enflurane, and isoflurane. End-tidal carbon dioxide (ETCO2) and anesthetic concentrations were measured with infrared spectroscopy; blood pressure and arterial blood gases were obtained from a radial artery catheter. Each anesthetic exposure lasted 3 h, during which the three fresh (normally hydrated) CO2 absorbents were used for a period of 1 h each. Anesthesia was administered with a fresh gas flow rate of 2 l/min of air:oxygen (50:50). Tidal volume was 10 ml/kg; respiratory rate was 8 breaths/min. Arterial blood gases were obtained at baseline and after each hour. Inspired concentrations of compound A were measured after 15, 30, and 60 min of anesthetic administration for each CO2 absorbent.. Arterial blood gases and ETCO2 were not different among three CO2 absorbents. During sevoflurane, compound A formed with barium hydroxide lime and soda lime, but not with Amsorb.. This new CO2 absorbent effectively scavenged CO2 and was not associated with compound A production.

Topics: Absorption; Adult; Anesthesia, Inhalation; Anesthetics, Inhalation; Barium Compounds; Blood Gas Analysis; Calcium Chloride; Calcium Compounds; Calcium Hydroxide; Ethers; Female; Humans; Hydrocarbons, Fluorinated; Male; Methyl Ethers; Oxides; Sevoflurane; Sodium Hydroxide

Sevoflurane anaesthesia was conducted using a totally closed circuit PhysioFlex anaesthesia machine (PhysioFlex group) or with a standard Modulus CD anaesthesia machine (Modulus group) (n = 8 in each group). The PhysioFlex was used under closed system conditions and the Modulus was used under low-flow system conditions (flow rate 1 litre min-1). Concentrations of sevoflurane degradation products and the temperature of soda lime were compared. Degradation products in the circuit were measured hourly, and the temperature of soda lime was monitored. The only degradation product detected was CF2 = C(CF3)-O-CH2F (compound A). Maximum concentrations of compound A were significantly lower (median 8.5 (range 5.4-15.9) ppm) in the PhysioFlex than in the Modulus group (21.2 (16.5-27.4) ppm) (P < 0.05). The maximum temperature of soda lime was also significantly lower in the PhysioFlex group (35.3 (32.1-36.3) degrees C vs 44.6 (43.0-47.1) degrees C, respectively) (P < 0.05). Hourly compound A concentrations were lower in the PhysioFlex group than in the Modulus group. End-tidal sevoflurane concentrations during measurement of degradation products were not different between groups. Therefore, use of the totally closed PhysioFlex system may significantly reduce compound A concentrations compared with low-flow anaesthesia using a standard anaesthesia machine.

Topics: Adult; Aged; Anesthesia, Closed-Circuit; Anesthesia, Inhalation; Anesthetics, Inhalation; Calcium Compounds; Ethers; Humans; Hydrocarbons, Fluorinated; Methyl Ethers; Middle Aged; Oxides; Sevoflurane; Sodium Hydroxide; Temperature

Sevoflurane expenditure, inspired gas humidity, temperature, soda lime temperature, and compounds A and B were measured during high and low fresh gas flow anaesthesia in paediatric patients.. Sixty ASA 1 or 2 paediatric patients were randomly allocated to two groups: low-flow circle anaesthesia (LFA) patient group (n = 30) and high-flow circle anaesthesia (HFA) patient group (n = 30). Initial fresh gas flow (FGF) was 4l.min-1 of nitrous oxide and 2l.min-1 of oxygen in both groups. This FGF of 6l.min-1 was maintained in the HFA group. After 10 min of HFA, the FGF was reduced to 600 ml.min-1 (nitrous oxide and oxygen 300 ml.min-1 each) in the LFA group.. Sevoflurane expenditure during LFA was about 1/7 of that during HFA (3.3 +/- 0.2 ml.h-1.vol.%-1 compared to 22.8 +/- 0.6 ml.h-1.vol.%-1, mean +/- SEM, respectively). Absolute humidity in the LFA patients was 4 times higher than that in the HFA patients (22.8 +/- 2.4 g.m-3 and 5.6 +/- 3.4 g.m-3 respectively). There was no significant difference in the inspiratory gas temperature between the LFA (28.5 +/- 0.6 degrees C) and HFA (26.9 +/- 1.3 degrees C) groups. There was significant difference in the mean highest soda lime temperature between the LFA (35.5 +/- 1.2 degrees C) and HFA (28.7 +/- 1.2 degrees C) groups. The mean highest concentration of compound A was 12.2 +/- 3.8 ppm in the LFA group. The mean highest concentration of compound B was less than 1 ppm. Compounds A and B were below detectable level in the HFA group.. In conclusion, sevoflurane used for paediatric patients in a circle system with a fresh gas flow of 0.6l.min-1 resulted in a significantly reduced sevoflurane expenditure, higher inspired absolute humidity, but not temperature, compared to a fresh gas flow of 6l.min-1. Low levels of compounds A and B were detected.

Topics: Anesthesia, Closed-Circuit; Anesthetics, Inhalation; Calcium Compounds; Carbon Dioxide; Child; Child, Preschool; Chromatography, Gas; Ethers; Female; Humans; Humidity; Hydrocarbons, Fluorinated; Infant; Male; Methyl Ethers; Nitrous Oxide; Oxides; Oxygen; Sevoflurane; Sodium Hydroxide; Temperature; Tidal Volume; Time Factors

We performed low-flow sevoflurane anaesthesia at a flow rate of 1 litre min-1 in three groups (n = 8 each) using 600 g of fresh soda lime (control group), 600 g of soda lime with 60 ml of water added (water group) or 600 g of soda lime saturated with carbon dioxide, that is partly exhausted soda lime (carbon dioxide group). Degradation products in the system were measured hourly. Inspired and end-tidal carbon dioxide and sevoflurane concentrations, carbon dioxide and temperature of the soda lime were monitored. CF2 = C(CF3)-O-CH2F (compound A) was the only sevoflurane degradation product detected. The mean maximum concentration of compound A was significantly higher in the control group (mean 16.0 (SD 5.0) ppm) than in the water (1.4 (1.0) ppm) or carbon dioxide (4.0 (1.8) ppm) group, and the maximum temperature of the soda lime was significantly lower in the carbon dioxide group (30.7 (3.5) degrees C) than in the control (43.4 (1.8) degrees C) or water (40.8 (1.8) degrees C) group (P < 0.05). The use of partly exhausted soda lime or soda lime with water added reduced compound A concentrations in the system during low-flow sevoflurane anaesthesia.

Topics: Adult; Aged; Anesthesia, Closed-Circuit; Anesthetics, Inhalation; Calcium Compounds; Carbon Dioxide; Ethers; Humans; Hydrocarbons, Fluorinated; Methyl Ethers; Middle Aged; Oxides; Sevoflurane; Sodium Hydroxide; Temperature; Time Factors; Water

Sevoflurane is degraded by soda lime to a vinyl ether commonly referred to as compound A. We measured the concentration of compound A in the circle breathing system of 31 patients receiving sevoflurane anaesthesia. Inspiratory and expiratory gas samples were analysed using gas chromatography and flame ionisation detection. The end-tidal sevoflurane concentration and soda lime temperature were recorded. The peak compound A concentration ranged between 10 to 32 ppm in the inspiratory limb and 7 to 26 ppm in the expiratory limb. There was a positive correlation between the peak compound A concentration and the end-tidal sevoflurane concentration (r2 = 0.545, p < 0.0001) and the soda lime temperature (r2 = 0.301, p = 0.0014). We conclude that the end-tidal concentration of sevoflurane and the temperature of the soda lime are important variables in determining concentration of compound A in a circle system.

Topics: Adult; Anesthesia, Closed-Circuit; Anesthetics, Inhalation; Calcium Compounds; Drug Administration Schedule; Ethers; Humans; Hydrocarbons, Fluorinated; Methyl Ethers; Oxides; Sevoflurane; Sodium Hydroxide; Temperature

To evaluate the performance of four kinds of carbon dioxide (CO(2)) absorbents (Medisorb GE Healthcare, Amsorb Plus Armstrong Medical, YabashiLime Yabashi Industries, and Sodasorb LF Grace Performance Chemicals), we measured their dust production, acceptability of colour indicator, and CO(2) absorption capacity in in vitro experimental settings and the concentration of compound A in an inspired anaesthetic circuit during in vivo clinical practice. In vitro, the order of the dust amount was Sodasorb LF > Medisorb > Amsorb Plus = YabashiLime both before and after shaking. The order of the color acceptability was similar: Sodasorb LF > Amsorb Plus = Medisorb > YabashiLime both initially and 16 h after CO(2) exhaustion. During exposure to 200 ml.min(-1) CO(2) in vitro, the period until 1 kg of fresh soda lime allowed inspired CO(2) to increase to 0.7 kPa (as a mark of utilisation of the absorbent) was longer with Medisorb (1978 min) than with the other absorbents (1270-1375 min). In vivo, compound A (1.0% inspired sevoflurane) was detected only when using Medisorb. While Medisorb has the best ability to absorb CO(2), it alone produces compound A.

Topics: Absorption; Anesthesia, Closed-Circuit; Anesthetics, Inhalation; Calcium Chloride; Calcium Compounds; Calcium Hydroxide; Carbon Dioxide; Color; Dust; Ethers; Gas Scavengers; Humans; Hydrocarbons, Fluorinated; Indicators and Reagents; Methyl Ethers; Oxides; Sevoflurane; Sodium Hydroxide

During long-term low-flow sevoflurane anesthesia, dew formation and the generation of compound A are increased in the anesthesia circuit because of elevated soda lime temperature. The object of this study was to develop a novel radiator for carbon dioxide absorbents used for long durations of low-flow sevoflurane anesthesia. Eleven female swine were divided into two groups comprising a "radiator" group (n = 5) that used a novel radiator for carbon dioxide absorbents and a "control" group (n = 6) that used a conventional canister. Anesthesia was maintained with N2O, O2, and sevoflurane, and low-flow anesthesia was performed with fresh gas flow at 0.6 L/min for 12 hr. In the "control" group, the soda lime temperature reached more than 40 degrees C and soda lime dried up with severe dew formation in the inspiratory valve. In the "radiator" group, the temperature of soda lime stayed at 30 degrees C, and the water content of soda lime was retained with no dew formation in the inspiratory valve. In addition, compound A concentration was reduced. In conclusion, radiation of soda lime reduced the amounts of condensation formed and the concentration of compound A in the anesthetic circuit, and allowed long term low-flow anesthesia without equipment malfunction.

Topics: Absorption; Anesthesia, Closed-Circuit; Anesthesia, Inhalation; Anesthetics, Inhalation; Animals; Body Temperature; Calcium Compounds; Carbon Dioxide; Chromatography, Gas; Ethers; Female; Hydrocarbons, Fluorinated; Methyl Ethers; Oxides; Sevoflurane; Sodium Hydroxide; Swine; Temperature; Water

Consequences of volatile anesthetic degradation by carbon dioxide absorbents that contain strong base include formation of compound A from sevoflurane, formation of carbon monoxide (CO) and CO toxicity from desflurane, enflurane and isoflurane, delayed inhalation induction, and increased anesthetic costs. Amsorb (Armstrong Ltd., Coleraine, Northern Ireland) is a new absorbent that does not contain strong base and does not form CO or compound A in vitro. This investigation compared Amsorb, Baralyme (Chemetron Medical Division, Allied Healthcare Products, St. Louis, MO), and sodalime effects on CO (from desflurane and isoflurane) and compound A formation, carboxyhemoglobin (COHb) concentrations, and anesthetic degradation in a clinically relevant porcine in vivo model.. Pigs were anesthetized with desflurane, isoflurane, or sevoflurane, using fresh or partially dehydrated Amsorb, Baralyme, and new and old formulations of sodalime. Anesthetic concentrations in the fresh (preabsorber), inspired (postabsorber), and end-tidal gas were measured, as were inspired CO and compound A concentrations and blood oxyhemoglobin and COHb concentrations.. For desflurane and isoflurane, the order of inspired CO and COHb formation was dehydrated Baralyme >> soda-lime > Amsorb. For desflurane and Baralyme, peak CO was 9,700 +/- 5,100 parts per million (ppm), and the increase in COHb was 37 +/- 14%. CO and COHb increases were undetectable with Amsorb. Oxyhemoglobin desaturation occurred with desflurane and Baralyme but not Amsorb or sodalime. The gap between inspired and end-tidal desflurane and isoflurane did not differ between the various dehydrated absorbents. Neither fresh nor dehydrated Amsorb caused compound A formation from sevoflurane. In contrast, Baralyme and sodalime caused 20-40 ppm compound A. The gap between inspired and end-tidal sevoflurane did not differ between fresh absorbents, but was Amsorb < sodalime < Baralyme with dehydrated absorbents.. Amsorb caused minimal if any CO formation, minimal compound A formation regardless of absorbent hydration, and the least amount of sevoflurane degradation. An absorbent like Amsorb, which does not contain strong base or cause anesthetic degradation and formation of toxic products, may have benefit with respect to patient safety, inhalation induction, and anesthetic consumption (cost).

Topics: Absorption; Anesthetics, Inhalation; Animals; Barium Compounds; Calcium Chloride; Calcium Compounds; Calcium Hydroxide; Carbon Monoxide; Carboxyhemoglobin; Desflurane; Ethers; Female; Hydrocarbons, Fluorinated; Isoflurane; Male; Methyl Ethers; Oxides; Potassium Compounds; Sevoflurane; Sodium Hydroxide; Swine

In an in vitro study, less compound A was formed when a KOH-free carbon dioxide absorbent was used. To confirm this observation we used a lung model in which carbon dioxide was fed in at 160 ml min(-1) and sampling gas was taken out for analysis at 200 ml min(-1); ventilation aimed for a PE'CO2 of 5.4 kPa. The soda lime canister temperatures in the inflow and outflow ports (Tin and Tout) were recorded. In six runs of 240 min each, a standard soda lime, Sodasorb (Grace, Epernon, France) was used and in eight runs KOH-free Sofnolime (Molecular Products, Thaxted, UK) was used. Liquid sevoflurane was injected using a syringe pump to obtain 2.1% E'. Compound A was measured by capillary gas chromatography combined with mass spectrometry. Median (range) compound Ainsp increased to a maximum of 22.7 (7.9) ppm for Sodasorb and 33.1 (20) for Sofnolime at 60 min and decreased thereafter; the difference between groups was significant (P<0.05) at each time of analysis up to 240 min. The canister temperatures were similar in both groups and increased to approximately 40 degrees C at 240 min. Contrary to expectation, compound A concentrations were greater with the KOH-free absorbent despite similar canister temperatures with both absorbents.

Topics: Absorption; Anesthesia, Closed-Circuit; Anesthetics, Inhalation; Calcium Compounds; Carbon Dioxide; Ethers; Humans; Hydrocarbons, Fluorinated; Hydroxides; Lung; Methyl Ethers; Models, Biological; Oxides; Potassium Compounds; Sevoflurane; Sodium Hydroxide

Normal (hydrated) soda lime absorbent (approximately 95% calcium hydroxide [Ca(OH)2], the remaining 5% consisting of a mixture of sodium hydroxide [NaOH] and potassium hydroxide [KOH]) degrades sevoflurane to the nephrotoxin Compound A, and desiccated soda lime degrades desflurane, enflurane, and isoflurane to carbon monoxide (CO). We examined whether the bases in soda lime differed in their capacities to contribute to the production of these toxic substances by degradation of the inhaled anesthetics. Our results indicate that NaOH and KOH are the primary determinants of degradation of desflurane to CO and modestly augment production of Compound A from sevoflurane. Elimination of these bases decreases CO production 10-fold and decreases average inspired Compound A by up to 41%. These salutary effects can be achieved with only slight decreases in the capacity of the remaining Ca(OH)2 to absorb carbon dioxide.. The soda lime bases used to absorb carbon dioxide from anesthetic circuits can degrade inhaled anesthetics to compounds such as carbon monoxide and the nephrotoxin, Compound A. Elimination of the bases sodium hydroxide and potassium hydroxide decreases production of these noxious compounds without materially decreasing the capacity of the remaining base, Ca(OH)2, to absorb carbon dioxide.

Topics: Absorption; Anesthetics, Inhalation; Calcium Compounds; Carbon Dioxide; Carbon Monoxide; Chromatography, Gas; Desflurane; Desiccation; Ethers; Hydrocarbons, Fluorinated; Hydroxides; Isoflurane; Methyl Ethers; Oxides; Potassium Compounds; Sevoflurane; Sodium Hydroxide

We have investigated inspiratory and end-tidal gas composition during sevoflurane anaesthesia in a closed circle system with continuous gas flow (70 litre min-1, Physioflex) to determine possible accumulation of sevoflurane degradation products. During five abdominal operations in adults lasting more than 2 h, anaesthesia was maintained with an end-tidal concentration of 2% sevoflurane in 40% oxygen-air. The circle included an absorbing canister filled with 1 litre of fresh soda lime. Samples were obtained at the end of an expiration from the tracheal tube and from the inspiratory limb before, and at selected times after, addition of sevoflurane. The temperature of soda lime was 24.7 +/- 0.7 degrees C at the beginning and reached a maximum of 31.2 +/- 1.0 degrees C after 20-30 min, followed by a plateau. Inspiratory compound A (CH2F-O-C(= CF2)(CF3)) 3-8 ppm was detected after 10 min, but did not accumulate in the circle over 2 h without flushing. Expired concentrations were consistently lower with 1.5-3 ppm signalling absorption by patients. Calculated total amounts absorbed over 2 h varied between 2.0 and 7.2 ppm h. Other degradation products such as compound B or methanol were not detected. In summary, we did not detect sevoflurane metabolites with soda lime in significant amounts during closed circle anaesthesia with the Physioflex. The observed concentrations of compound A were below the threshold of nephrotoxicity in rats by a factor of more than 20.

Topics: Aged; Anesthesia, Closed-Circuit; Anesthetics, Inhalation; Calcium Compounds; Ethers; Female; Gas Scavengers; Humans; Hydrocarbons, Fluorinated; Inhalation; Male; Methyl Ethers; Middle Aged; Oxides; Sevoflurane; Sodium Hydroxide; Temperature

Sevoflurane anesthesia is usually performed with fresh gas flow rates greater than 2 l/min due to the toxicity of compound A in rats and limited clinical experience with sevoflurane in low-flow systems. However, to reduce costs, it would be useful to identify ways to reduce compound A concentrations in low-flow sevoflurane anesthesia. This goal of this study was to determine if compound A concentrations can be reduced by using soda lime with water added.. Low-flow sevoflurane anesthesia (fresh gas flow of 1 l/min) was performed in 37 patients using soda lime with water added (perhydrated soda lime) or standard soda lime as the carbon dioxide (CO2) absorbent. The soda lime was not changed between patients, but rather was used until CO2 rebreathing occurred. The perhydrated soda lime was prepared by spraying 100 ml distilled water onto 1 kg fresh soda lime, and water was added only when a new bag of soda lime was placed into the canister. Compound A concentrations in the circle system, soda lime temperatures, inspired and end-tidal CO2 and end-tidal sevoflurane concentrations, and CO2 elimination by the patient were measured during anesthesia.. Compound A concentrations were significantly lower for the perhydrated soda lime (1.9 +/- 1.8 ppm; means +/- SD) than for the standard soda lime (13.9 +/- 8.2 ppm). No differences were seen between the two types of soda lime with regard to the temperature of the soda lime, end-tidal sevoflurane concentrations, or CO2 elimination. Compound A concentration decreased with the total time of soda lime use for both types of soda lime. The CO2 absorption capacity was significantly less for perhydrated soda lime than for standard soda lime.. Compound A concentrations in the circuit can be reduced by using soda lime with water added. The CO2 absorption capacity of the soda lime is reduced by adding water to it, but this should not be clinically significant.

Topics: Anesthesia, Closed-Circuit; Anesthetics, Inhalation; Calcium Compounds; Carbon Dioxide; Ethers; Humans; Hydrocarbons, Fluorinated; Methyl Ethers; Oxides; Sevoflurane; Sodium Hydroxide; Water

In the presence of carbon dioxide absorbents, sevoflurane is degraded to CF2 = C(CF3)OCH2F, an olefin compound A. There remains some concern of the hepatic and renal toxicity that compound A poses when using low-flow anaesthetic techniques. We investigated a device to decrease the concentration of compound A products by decreasing the temperature of exhaled air and soda lime in semi-closed low-flow anaesthesia technique in surgical patients.. Ten patients, ASA 1 or 2, were studied. Five received anaesthesia using a cooling circuit, that consisting of an anaesthetic circuit and an intercooler device interposed in the expiratory tube. The intercooler was dipped in an iced water tank. Anaesthesia was given through this circuit from induction to emergence. Another five patients received anaesthesia without cooling. Anaesthesia was maintained with sevoflurane and O2 50%/N2O during four to six hours of operation. A fixed concentration of sevoflurane 2% at a total flow of 1 L.min-1 was administered. Gas samples were taken every hour and compound A was quantitated by gas chromatography. The temperatures of canister, circuit and body were measured every hour.. The device effectively lowered the temperatures [24 +/- 3.4 to 5 +/- 1.3 degrees C] and the concentrations of compound A [27.1 +/- 3.8 ppm to 16.3 +/- 2.08 ppm, P < 0.05] in the circuit. The body temperatures were not lowered.. Compound A concentrations were reduced by cooling the anaesthetic circuit in clinical settings.

Topics: Absorption; Anesthesia, Inhalation; Anesthetics, Inhalation; Body Temperature; Calcium Compounds; Carbon Dioxide; Chromatography, Gas; Cold Temperature; Equipment Design; Ethers; Female; Follow-Up Studies; Humans; Hydrocarbons, Fluorinated; Ice; Male; Methyl Ethers; Middle Aged; Nitrous Oxide; Oxides; Oxygen; Respiration; Sevoflurane; Sodium Hydroxide; Water

Soda lime and Baralyme brand carbon dioxide absorbents degrade sevoflurane to CF2 = C(CF3)OCH2F, a potentially nephrotoxic vinyl ether called Compound A. Dehydration of these absorbents increases both the degradation of sevoflurane to Compound A and the degradation of Compound A. The balance between sevoflurane degradation and Compound A degradation determines the concentration of Compound A issuing from the absorbent (the net production of Compound A). We studied the effect of dehydration on the net production of Compound A in a simulated anesthetic circuit. Mimicking continuing oxygen delivery for 1, 2, or 3 days after completion of an anesthetic, we directed a "conditioning" fresh gas flow of 5 L/min or 10 L/min retrograde through fresh absorbent in situ in a standard absorbent system for 16, 40, and/or 64 h. The conditioned absorbent was subsequently used (without mixing of the granules) in a standard anesthetic circuit in which a 3-L rebreathing bag substituted for the lung. Metabolism was mimicked by introducing 250 mL/min carbon dioxide into the "lung," and the lung was ventilated with a minute ventilation of 10 L/ min. At the same time, we introduced sevoflurane in a fresh gas inflow of 2 L/min at a concentration sufficient to produce an inspired concentration of 3.2%. Because of increased sevoflurane destruction by the absorbent, progressively longer periods of conditioning (dehydration) and/or higher inflow rates increased the delivered (vaporizer) concentration of sevoflurane required to sustain a 3.2% concentration. Dehydration of Baralyme increased the inspired concentration of Compound A by up to sevenfold, whereas dehydration of soda lime markedly decreased the inspired concentration of Compound A.. Economical delivery of modern inhaled anesthetics requires rebreathing of exhaled gases after removal of carbon dioxide. However, carbon dioxide absorbents (Baralyme/soda lime) may degrade anesthetics to toxic substances. Baralyme dehydration increases, and soda lime dehydration decreases, degradation of the inhaled anesthetic sevoflurane to the toxic substance, Compound A.

Topics: Anesthetics, Inhalation; Barium Compounds; Calcium Compounds; Calcium Hydroxide; Ethers; Humans; Hydrocarbons, Fluorinated; Methyl Ethers; Oxides; Potassium Compounds; Sevoflurane; Sodium Hydroxide; Temperature

Various alkali (e.g., soda lime) convert sevoflurane to CF2=C(CF3)OCH2F, a vinyl ether called "Compound A, " whose toxicity raises concerns regarding the safe administration of sevoflurane via rebreathing circuits. In the present investigation, we measured the sevoflurane degradation and output of Compound A caused by standard (13% water) Baralyme brand absorbent and standard (15% water) soda lime, and Baralyme and soda lime having various water contents (including no water). We used a flow-through system, applying a gas flow rate relative to absorbent volume that roughly equaled the rate/volume found in clinical practice. Both absorbents, at similar water contents, temperatures, and sevoflurane concentrations, produced roughly equal concentrations of Compound A. Dry and nearly dry absorbents produced less Compound A early in exposure to sevoflurane, and more later, than standard absorbents. Increases in temperature and sevoflurane concentration increased output of Compound A. Both absorbents, especially when dry, also destroyed Compound A, the concentration exiting from absorbent resulting from a complex sum of production and destruction. We conclude that the variability of concentrations of Compound A found in clinical practice may be largely explained by the inflow rate used (i.e., by rebreathing), sevoflurane concentration, and absorbent temperature and dryness. The effect of dryness is complex, with fresh dry absorbent destroying Compound A as it is made, and with dry absorbent that has been exposed to sevoflurane for a period of time providing a sometimes unusually high output of Compound A.

Topics: Absorption; Anesthetics, Inhalation; Barium Compounds; Calcium Compounds; Calcium Hydroxide; Ethers; Hydrocarbons, Fluorinated; Hydrogen-Ion Concentration; Methyl Ethers; Oxides; Potassium Compounds; Sevoflurane; Sodium Hydroxide; Temperature; Water

Molecular sieves are used in industry to 'scrub' industrial gases. We examined, during simulated low-flow closed system anaesthesia, (1) the carbon dioxide adsorbing potential of molecular sieves and (2) the reactivity of the sieves compared to soda lime using sevoflurane as an indicator. A low-flow anaesthetic system containing 13X molecular sieves was connected to a model lung. End-tidal concentrations of CO2 were measured continuously at an O2 flow of 800 ml.min-1 and a CO2 flow of 200 ml.min-1. In the second study, sevoflurane (FE'sevo 1.7%) was added to the system after which samples were taken from the inspiratory limb of the anaesthetic system. This experiment was performed both during carbon dioxide removal with soda lime and with the molecular sieves. The samples were stored in gas-tight syringes and analysed by gas chromatography. The temperature of both absorbents was measured throughout the study. The molecular sieves adsorbed carbon dioxide (20%) efficiently for a period of 5 h. There was a gradual increase from the baseline of 4.4% to 4.5, 5.4, and 6.0% at 90, 180, and 300 min, respectively. When sevoflurane was added to the system, compound A was detected at the start of both experiments. However, when soda lime was used the concentrations of compound A increased 10-fold after 2.5 h compared with baseline values. No increase in compound A was observed when molecular sieves were used for carbon dioxide removal. The highest mean (SD) temperature of the molecular sieves was 41.5 (3.2) degrees C. Molecular sieves are effective adsorbents of carbon dioxide when used in a simulated low-flow, closed anaesthetic system.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adsorption; Anesthesia; Anesthetics; Calcium Compounds; Carbon Dioxide; Chromatography, Gel; Ethers; Humans; Hydrocarbons, Fluorinated; Methyl Ethers; Oxides; Sevoflurane; Sodium Hydroxide

Carbon dioxide absorbents, such as soda lime and Baralyme brand absorbent, convert sevoflurane to CF2 = C(CF3)OCH2F, a vinyl ether called "Compound A," whose toxicity raises concerns regarding the safety of sevoflurane in rebreathing circuits. Because an increased inflow rate to an anesthetic circuit decreases rebreathing, we assumed that an increased rate would proportionately decrease the concentration of Compound A. In the present report, we measured the Compound A concentration resulting from the action of wet (standard) soda lime and wet (standard) Baralyme on 2% sevoflurane in a model anesthetic circuit, using inflow rates (0.5, 1.0, 2.0, 4.0, and 6.0 L/min), ventilations (5 and 10 L/min), and carbon dioxide production/removal (200 and 400 mL/min) found in clinical practice. An increase in inflow rate decreased Compound A concentration to lower levels as inflow rate approached minute ventilation. At lower inflow rates, increasing duration of sevoflurane inflow increased the concentration of Compound A, a finding consistent with a progressive increase in absorbent temperature from absorption of carbon dioxide and consequently greater sevoflurane degradation. There was no material difference between Baralyme and soda lime in the concentrations of Compound A produced at a particular inflow rate. An increase in ventilation increased the concentration of Compound A, having a much greater effect at high rather than low inflow rates. An increase in amount of carbon dioxide absorbed also increased the concentration of Compound A. We conclude that inflow rate, ventilation, and carbon dioxide production are major determinants of the concentration of Compound A.

Topics: Absorption; Anesthesia; Barium Compounds; Calcium Compounds; Calcium Hydroxide; Carbon Dioxide; Ethers; Hydrocarbons, Fluorinated; Methyl Ethers; Oxides; Potassium Compounds; Respiration, Artificial; Sevoflurane; Sodium Hydroxide; Vinyl Compounds

Sevoflurane, a new inhalational anesthetic agent has been shown to produce degradation products upon interaction with CO2 absorbants. Quantification of these sevoflurane degradation products during low-flow or closed circuit anesthesia in patients has not been well evaluated. The production of sevoflurane degradation products was evaluated using a low-flow anesthetic technique in patients receiving sevoflurane anesthesia in excess of 3 h. Sevoflurane anesthesia was administered to 16 patients using a circle absorption system with O2 flow of 500 ml/min and average N2O flow of 273 ml/min. Preoperative and postoperative hepatic and renal function studies were performed. Gas samples were obtained from the inhalation and exhalation limbs of the anesthetic circuit for degradation product analysis and analyzed by gas chromatography/mass spectrometry for four degradation products. The first eight patients received sevoflurane anesthesia using soda lime, and the following eight patients received anesthesia using baralyme as the CO2 absorbant. CO2 absorbant temperatures were measured during anesthesia. Of the degradation products analyzed, only one compound [fluoromethyl-2, 2-difluoro-1-(trifluoromethyl) vinyl ether], designated compound A, was detectable. Concentrations of compound A increased during the first 4 h of anesthesia with soda lime and baralyme and declined between 4 and 5 h when baralyme was used. Mean maximum inhalation concentration of compound A using baralyme was 20.28 +/- 8.6 ppm (mean +/- SEM) compared to 8.16 +/- 2.67 ppm obtained with soda lime, a difference that did not reach statistical significance. A single patient achieved a maximal concentration of 60.78 ppm during low-flow anesthesia with baralyme. Exhalation concentrations of compound A were less than inhalation concentrations, suggesting patient uptake.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Absorption; Anesthesia, Closed-Circuit; Anesthetics; Barium; Barium Compounds; Calcium Compounds; Calcium Hydroxide; Carbon Dioxide; Ethers; Gas Chromatography-Mass Spectrometry; Humans; Hydrocarbons, Fluorinated; Methyl Ethers; Oxides; Potassium; Potassium Compounds; Sevoflurane; Sodium Hydroxide; Surgical Procedures, Operative

Sevoflurane previously has been reported to undergo extensive degradation in the presence of soda lime. To more completely characterize the extent and significnce of this reaction, we studied degradation of sevoflurane with and without soda lime, as well as the toxicity and mutagenicity of the degradation products. Two degradation products detected were CF2 = C(CF3)OCH2F (compound A) and CH3OCF2CH(CF3)OCH2F (compound B). During circulation of 1%, 2%, and 3% sevoflurance in a closed anesthesia circuit for 8 h, peak concentrations of compound A were 13.3 +/- 0.27, 30.2 +/- 0.10, and 42.1 +/- 1.07 ppm at 2 h, respectively. The concentrations of compound B did not exceed 2 ppm. The temperature of the soda lime was 43.3 +/- 2.8 degrees C at 1 h and increased gradually to 47.9 +/- 1.5 degrees C after 8 h. In closed flasks with soda lime, the magnitude of the decrease in sevoflurance concentrations (3%) and of the increase in compound A concentrations was temperature dependent. The peak concentrations of compound A at 23 degrees C, 37 degrees C, and 54 degrees C were 32.8 +/- 6.8 at 2 h, 46.6 +/- 1.0 at 0.5 h, and 78.5 +/- 2.3 ppm at 0.5 h, respectively. The LC50 (50% lethal concentration) of compound A in Wistar rats was 1,090 ppm in males and 1,050 ppm in females exposed for 1 h. The LC50 was 420 ppm in males and 400 ppm in females exposed for 3 h. The chronic toxicity of compound A in Wistar rats was studied by exposing rats 24 times, for 3 h each, to initial concentrations of 30, 60, or 120 ppm in a ventilated chamber. At all concentrations, there were no apparent effects other than a loss of body weight in females (120 ppm) on the final day (P < 0.01). Compound A did not induce mutation on the reverse (Ames) test at less than 2,500 micrograms/dish (culture medium 2.7 ml) with activation by S-9 mixture, and below 1,250 micrograms/dish (culture medium 2.7 ml) without activation, in four strains of S. typhimurium and in 1 strain of E. coli. Exposure of fibroblasts to 7,500 ppm of compound A for 1 h, compound A did not induce structural change. In a study of acute toxicity of compound B, there was no toxicity in Wistar rats after 3 h of exposure at 2,400 ppm. The reverse (Ames) test for compound B was negative at 625-1,250 micrograms/dish.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Absorption; Acute Disease; Anesthetics; Animals; Calcium Compounds; Carbon Dioxide; Chronic Disease; Ethers; Female; Hydrocarbons, Fluorinated; Male; Methyl Ethers; Mutagenicity Tests; Oxides; Rats; Rats, Wistar; Sevoflurane; Sodium Hydroxide