Interaction of inhalational anaesthetics with CO2 absorbents.
We review the currently available carbon dioxide absorbents: sodium hydroxide lime (=soda lime), barium hydroxide lime, potassium-hydroxide-free soda lime, calcium hydroxide lime and non-caustic lime. In general, all of these carbon dioxide absorbents are liable to react with inhalational anaesthetics. However, there is a decreasing reactivity of the different absorbents with inhalational anaesthetics: barium hydroxide lime >> soda lime > potassium-hydroxide-free soda lime > calcium hydroxide lime and non-caustic lime. Gaseous compounds generated by the reaction of the anaesthetics with desiccated absorbents are those that threaten patients. All measures are comprehensively described to--as far as possible--prevent any accidental drying out of the absorbent. Whether or not compound A, a gaseous compound formed by the reaction of sevoflurane with normally hydrated absorbents, is still a matter of concern is discussed. Even after very high loading with this compound, during long-lasting low-flow sevoflurane anaesthesias, no clinical or laboratory signs of renal impairment were observed in any of the surgical patients. Finally, guidelines for the judicious use of different absorbents are given.
Department of Anaesthesia, Hospital St Elisabeth-Stift, Lindenstrasse 3-7, D-49401 Domme, Germany. j.baum.damme@t-online.de
Jan A
JA
Baum
Harvey J
HJ
Woehlck
D000042:Absorption; D018685:Anesthetics, Inhalation / Q000737:chemistry*; D017609:Barium Compounds / Q000737:chemistry; D017610:Calcium Compounds / Q000737:chemistry; D002126:Calcium Hydroxide / Q000737:chemistry; D002245:Carbon Dioxide / Q000737:chemistry*; D000077335:Desflurane; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000737:chemistry; D008738:Methyl Ethers / Q000737:chemistry; D010087:Oxides / Q000737:chemistry; D017680:Potassium Compounds / Q000737:chemistry; D000077149:Sevoflurane; D012972:Sodium Hydroxide / Q000737:chemistry
D018685:Anesthetics, Inhalation; D017609:Barium Compounds; D017610:Calcium Compounds; D008738:Methyl Ethers; D010087:Oxides; D017680:Potassium Compounds; D002245:Carbon Dioxide; D000077149:Sevoflurane; C068927:Baralyme; C004569:soda lime; D012972:Sodium Hydroxide; D000077335:Desflurane; D007530:Isoflurane; D002126:Calcium Hydroxide