title: Reduction in the incidence of carbon monoxide exposures in humans undergoing general anesthesia.
abstract: BACKGROUND
  Carbon monoxide forms via reaction of isoflurane, enflurane, and desflurane with dried CO2 absorbents. The authors hypothesize that interventions by nonphysician support personnel to decrease absorbent drying will decrease the exposure rate of patients to carbon monoxide from anesthetic breakdown.
  
  
  METHODS
  In the control group, all anesthetizing personnel were made aware of the factors enabling CO generation from anesthetic breakdown, and prevention techniques were left to the anesthetizing personnel. After data collection was complete, the following interventions were initiated to reduce absorbent drying: Anesthesia technicians and housekeeping personnel were instructed to turn off all anesthesia machines after the last case of the day in each room, and the CO2 absorbent was changed each morning if fresh gas was found flowing. Baralyme was used in all phases of this study.
  
  
  RESULTS
  Five cases of intraoperative carbon monoxide exposure occurred among 1,085 (0.46%) first cases in the control group. Postintervention, patient carbon monoxide exposures decreased (P < 0.05), with one exposure among 1,961 (0.051%) first cases in the main operating room. Two exposures among 68 (2.9%) first cases occurred in remote locations (P < 0.001) versus main operating room. Predisposing factors for absorbent drying include the prolonged use of anesthesia machines for monitored anesthesia care, inappropriate drying techniques for expiratory flowmeters, understaffing of support personnel, and anesthesia in remote locations.
  
  
  CONCLUSIONS
  These interventions reduced patient exposure to carbon monoxide. Monitoring for carbon monoxide exposures during general anesthesia may be necessary to recognize and end patient exposures that occur despite preventative measures.
authors.affiliation: Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, USA. rkost@mail.fmlh.edu
authors.forename: H J
authors.initials: HJ
authors.lastname: Woehlck
authors.forename: M
authors.initials: M
authors.lastname: Dunning
authors.forename: L A
authors.initials: LA
authors.lastname: Connolly
mesh_terms: D000327:Adsorption; D000768:Anesthesia, General / Q000295:instrumentation / Q000379:methods*; D002245:Carbon Dioxide / Q000737:chemistry*; D002249:Carbon Monoxide Poisoning / Q000517:prevention & control*; D002263:Carboxyhemoglobin / Q000032:analysis; D000077335:Desflurane; D004737:Enflurane / Q000737:chemistry*; D005069:Evaluation Studies as Topic; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000737:chemistry*
chemical_list: D002245:Carbon Dioxide; D002263:Carboxyhemoglobin; D004737:Enflurane; D000077335:Desflurane; D007530:Isoflurane