Baralyme dehydration increases and soda lime dehydration decreases the concentration of compound A resulting from sevoflurane degradation in a standard anesthetic circuit.
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.


CONCLUSIONS
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.
Eger
E I
EI
Department of Anesthesia, University of California, San Francisco 94143-0464, USA.
Ionescu
P
P
Laster
M J
MJ
Weiskopf
R B
RB
D018685:Anesthetics, Inhalation / Q000378:metabolism*; D017609:Barium Compounds / Q000494:pharmacology*; D017610:Calcium Compounds / Q000494:pharmacology*; D002126:Calcium Hydroxide / Q000494:pharmacology*; D004987:Ethers / Q000378:metabolism*; D006801:Humans; D006845:Hydrocarbons, Fluorinated / Q000378:metabolism*; D008738:Methyl Ethers; D010087:Oxides / Q000494:pharmacology*; D017680:Potassium Compounds / Q000494:pharmacology*; D000077149:Sevoflurane; D012972:Sodium Hydroxide / Q000494:pharmacology*; D013696:Temperature
D018685:Anesthetics, Inhalation; D017609:Barium Compounds; D017610:Calcium Compounds; D004987:Ethers; D006845:Hydrocarbons, Fluorinated; D008738:Methyl Ethers; D010087:Oxides; D017680:Potassium Compounds; D000077149:Sevoflurane; C068927:Baralyme; C004569:soda lime; D012972:Sodium Hydroxide; C078742:fluoromethyl 2,2-difluoro-1-(trifluoromethyl)vinyl ether; D002126:Calcium Hydroxide