title: High carboxyhemoglobin concentrations occur in swine during desflurane anesthesia in the presence of partially dried carbon dioxide absorbents.
abstract: BACKGROUND
  Increased carboxyhemoglobin concentrations in patients receiving inhalation anesthetics (desflurane, enflurane, and isoflurane) have been reported. Recent in vitro studies suggest that dry carbon dioxide absorbents may allow the production of carbon monoxide.
  
  
  METHODS
  The authors used high fresh oxygen flow (5 or 10 l/min) through a conventional circle breathing system of an anesthesia machine for 24 or 48 h to produce absorbent drying. Initial studies used 10 l/min oxygen flow with the reservoir bag removed or with the reservoir bag left in place during absorbent drying (this increases resistance to gas flow through the canister). A third investigation evaluated a lower flow rate (5 l/min) for absorbent drying. Water content of the absorbent and temperature were measured. Pigs received a 1.0 (human) minimum alveolar concentration desflurane anesthetic (7.5%) for 240 min using a 1 l/min oxygen flow rate with dried absorbent. Carbon monoxide concentrations in the circuit and carboxyhemoglobin concentrations in the pigs were measured.
  
  
  RESULTS
  Pigs anesthetized with desflurane using Baralyme exposed to 48 h of 10 l/min oxygen flow (reservoir bag removed) had extremely high carboxyhemoglobin concentrations (more than 80%). Circuit carbon monoxide concentrations during desflurane anesthesia using absorbents exposed to 10 l/min oxygen flow (reservoir bag removed, 24 h) reached peak values of 8,800 to 13,600 ppm, depending on the absorbent used. Carboxyhemoglobin concentrations reached peak values of 73% (Baralyme) and 53% (soda lime). The water content of Baralyme decreased from 12.1 +/- 0.3% (mean +/- SEM) to as low as 1.9 +/- 0.4% at the bottom of the lower canister (oxygen flow direction during drying was from bottom to top). Absorbent temperatures in the bottom canister increased to temperatures as high as 50 degrees C. With the reservoir bag in place during drying (10 l/min oxygen flow), water removal from Baralyme was insufficient to produce carbon monoxide (lowest water content = 5.5%). Use of 5 l/min oxygen flow (reservoir bag removed) for 24 h did not reduce water content sufficiently to produce carbon dioxide with desflurane.
  
  
  CONCLUSIONS
  An oxygen flow rate of 10 l/min for 24 h in a conventional anesthesia circuit can dry carbon dioxide absorbents sufficiently to produce extremely high levels of carbon monoxide with high carboxyhemoglobin concentrations in desflurane-anesthetized pigs. When the reservoir bag is in place on the anesthesia machine or when a lower oxygen flow rate (5 l/min) is used, carbon dioxide absorbent drying still occurs, but 24-48-h exposure time is insufficient to allow for carbon monoxide production with desflurane.
authors.affiliation: Department of Anesthesiology, The University of Arizona Health Sciences Center, Tucson 85724-5114, USA. efrink@u.arizona.edu
authors.forename: E J
authors.initials: EJ
authors.lastname: Frink
authors.forename: W M
authors.initials: WM
authors.lastname: Nogami
authors.forename: S E
authors.initials: SE
authors.lastname: Morgan
authors.forename: R C
authors.initials: RC
authors.lastname: Salmon
mesh_terms: D000327:Adsorption; D000769:Anesthesia, Inhalation / Q000295:instrumentation / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D000818:Animals; D017609:Barium Compounds / Q000737:chemistry; D017610:Calcium Compounds / Q000737:chemistry; D002126:Calcium Hydroxide / Q000737:chemistry; D002245:Carbon Dioxide / Q000737:chemistry*; D002263:Carboxyhemoglobin / Q000378:metabolism*; D000077335:Desflurane; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000737:chemistry; D010087:Oxides / Q000737:chemistry; D017680:Potassium Compounds / Q000737:chemistry; D012972:Sodium Hydroxide / Q000737:chemistry; D013552:Swine; D013997:Time Factors; D014867:Water / Q000737:chemistry
chemical_list: D018685:Anesthetics, Inhalation; D017609:Barium Compounds; D017610:Calcium Compounds; D010087:Oxides; D017680:Potassium Compounds; D014867:Water; D002245:Carbon Dioxide; C068927:Baralyme; C004569:soda lime; D012972:Sodium Hydroxide; D002263:Carboxyhemoglobin; D000077335:Desflurane; D007530:Isoflurane; D002126:Calcium Hydroxide