Long-duration, low-flow sevoflurane anesthesia using two carbon dioxide absorbents. Quantification of degradation products in the circuit.
BACKGROUND
Sevoflurane reacts with soda lime, generating degradation products. The concentrations of sevoflurane degradation products in a low-flow circuit have been reported for anesthesia times of less than 5 h. In this study, sevoflurane degradation products generated during low-flow anesthesia exceeding 10 h were examined.


METHODS
Sixteen patients received sevoflurane anesthesia with a fresh gas flow rate of 11/min. In eight patients, soda lime was used as the CO2 absorbent; in the other eight patients, Baralyme was used. During anesthesia, the concentrations of degradation products in the circuit, the temperature of the CO2 absorbent, inspired and end-tidal sevoflurane concentrations, and the volume of CO2 eliminated by the patient were measured. Gas was sampled from the inspiratory limb of the circuit and analyzed by gas chromatography.


RESULTS
Two degradation products, CF2 = C(CF3)-O-CH2F (compound A) and CH3OCF2CH(CF3)OCH2F (compound B), were detected. In the soda lime group, the individual maximum concentration of compound A was 23.6 +/- 2.9 (12.0-37.4) ppm. In the Baralyme group, the concentration was 32.0 +/- 2.3 (23.5-41.3) ppm. The individual maximum concentration of compound A in the Baralyme group was significant higher than A in the Baralyme group was significant higher than that in the soda lime group. Compound B was detected in two patients, reaching a maximum concentration of 0.2 ppm. The end-tidal sevoflurane concentration, temperature of the CO2 absorbent, and volume of CO2 eliminated by the patient were the same in both groups.


CONCLUSIONS
The degradation products detected were at low concentrations in long-duration, low-flow anesthesia with sevoflurane. Baralyme produced higher concentrations of degradation products than soda lime.
Bito
H
H
Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Japan.
Ikeda
K
K
D000327:Adsorption; D000764:Anesthesia, Closed-Circuit; D017609:Barium Compounds / Q000737:chemistry; D017610:Calcium Compounds; D002126:Calcium Hydroxide / Q000737:chemistry; D002245:Carbon Dioxide / Q000737:chemistry*; D004355:Drug Stability; D004987:Ethers / Q000737:chemistry*; D006801:Humans; D008738:Methyl Ethers; D010087:Oxides; D017680:Potassium Compounds / Q000737:chemistry; D000077149:Sevoflurane; D012972:Sodium Hydroxide / Q000737:chemistry; D013696:Temperature; D013997:Time Factors
D017609:Barium Compounds; D017610:Calcium Compounds; D004987:Ethers; D008738:Methyl Ethers; D010087:Oxides; D017680:Potassium Compounds; D002245:Carbon Dioxide; D000077149:Sevoflurane; C068927:Baralyme; C004569:soda lime; D012972:Sodium Hydroxide; D002126:Calcium Hydroxide