Carbon monoxide re-breathing during low-flow anaesthesia in infants and children.
BACKGROUND
Carbon monoxide (CO) has been detected within anaesthesia breathing systems. One potential source in this setting is exhaled endogenous CO. We hypothesized that CO is re-breathed during low-flow anaesthesia (LFA) in infants and children.


METHODS
Twenty children (age 2 months-7 yr) undergoing general anaesthesia were evaluated in a prospective observation study. LFA was established for 60 min followed by high-flow anaesthesia (HFA) for the next 60 min. Exhaled and inspired CO were measured every 5 min within the breathing circuit. Carboxyhaemoglobin (COHb%) was measured at baseline, at 60 min, after LFA, and at 120 min, after HFA.


RESULTS
CO concentrations increased during LFA. Inspired CO peaked at 14 ppm. During HFA, exhaled CO levels remained constant whereas inspired CO decreased markedly. Exhaled and inspired CO during HFA differed significantly from LFA. The trajectory of change in exhaled and inspired CO was most closely associated with the fresh-gas flow (FGF):minute ventilation ratio. COHb% significantly increased in children <2 yr of age at 60 min after LFA and remained increased.


CONCLUSIONS
LFA increased exhaled and inspired CO and increased COHb% in children <2 yr of age. Thus, LFA resulted in re-breathing of exhaled CO and exposure, especially in the youngest children. Re-breathing exhaled gas during LFA could pose a risk for an acute CO exposure in patients who have elevated COHb and high baseline levels of exhaled CO. If practitioners match or exceed minute ventilation with FGF to avoid LFA, CO re-breathing can be limited.
Division of Anesthesiology and Pain Medicine, Children's National Medical Center, The George Washington University School of Medicine and Health Sciences, 111 Michigan Ave., NW, Washington, DC 20010, USA.
V
V
Nasr
J
J
Emmanuel
N
N
Deutsch
M
M
Slack
J
J
Kanter
K
K
Ratnayaka
R
R
Levy
D000764:Anesthesia, Closed-Circuit / Q000379:methods*; D002248:Carbon Monoxide / Q000502:physiology*; D002263:Carboxyhemoglobin / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D015920:Gas Scavengers; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D011446:Prospective Studies
D002248:Carbon Monoxide; D002263:Carboxyhemoglobin