No compound a formation with Superia during minimal-flow sevoflurane anesthesia: a comparison with Sofnolime.
There is concern about the toxicity of Compound (Co) A. Absorbents differ in the production of Co A during minimal-flow sevoflurane anesthesia. Strong alkali-free Amsorb does not produce Co A. It was our aim to study Superia, another new NaOH- and KOH-free CO(2) absorbent, in minimal-flow anesthesia, compared with KOH-free Sofnolime. After Ethics Committee approval, 14 consenting adult patients were included randomly by using Superia or Sofnolime as the CO(2) absorbent in the compact 750-mL canister of an ADU ventilator. After propofol and remifentanil administration, sevoflurane was given in oxygen and air (500 mL/min; fraction of inspired oxygen, 0.4), aiming at an end-tidal concentration of 2.3%-2.5%; ventilation aimed for 33-35 mm Hg PETCO(2). Compound A inspired (Co A(insp)) and expired (Co A(exp)) samples were taken for analysis, and canister temperatures were measured for 150 min. Statistical analysis was performed with the Friedman test or the Mann-Whitney U-test where appropriate. Correction for multiple testing was used. In the Superia group, no significant amount of Co A was formed, whereas in the Sofnolime group, maximum median (range) inspiratory values of 25 ppm (16 ppm) were found. The intergroup difference was P < 0.05. No difference was noticed between the two groups for the canister CO(2) absorbent temperature.


CONCLUSIONS
During minimal-flow 2.3%-2.5% end-tidal sevoflurane, no compound A (Co A) is formed with the NaOH- and KOH-free CO(2) absorbent Superia. Although Co A values with KOH-free Sofnolime are still within reported safe limits, Superia is definitely an alternative for safe clinical practice.
Bouche
Marie-Paule L A
MP
Faculty of Pharmaceutical Sciences, Laboratory of Medical Biochemistry and Clinical Analysis, Ghent, Belgium.
Versichelen
Linda F M
LF
Struys
Michel M R F
MM
Van Bocxlaer
Jan F P
JF
De Leenheer
André P
AP
Mortier
Eric P
EP
Rolly
Georges
G
D000042:Absorption; D000328:Adult; D000368:Aged; D018685:Anesthetics, Inhalation / Q000737:chemistry*; D002245:Carbon Dioxide / Q000737:chemistry; D004987:Ethers / Q000737:chemistry*; D005260:Female; D006801:Humans; D006845:Hydrocarbons, Fluorinated / Q000737:chemistry*; D006878:Hydroxides / Q000737:chemistry; D008297:Male; D008738:Methyl Ethers / Q000737:chemistry*; D008875:Middle Aged; D017680:Potassium Compounds / Q000737:chemistry; D000077149:Sevoflurane; D012972:Sodium Hydroxide / Q000737:chemistry
D018685:Anesthetics, Inhalation; D004987:Ethers; D006845:Hydrocarbons, Fluorinated; D006878:Hydroxides; D008738:Methyl Ethers; D017680:Potassium Compounds; D002245:Carbon Dioxide; D000077149:Sevoflurane; D012972:Sodium Hydroxide; C078742:fluoromethyl 2,2-difluoro-1-(trifluoromethyl)vinyl ether; C029943:potassium hydroxide