Inspiratory Carbon Monoxide and Compound A Concentrations During Desflurane and Sevoflurane Anesthesia in Humans: An Observational Study

摘要

All modern vapor anesthetics are capable of carbon monoxide (CO) production as a result of interaction withdesiccated strong base containing carbon dioxide absorbents. In desiccated absorbents, desflurane produces the highestconcentrations of CO. Sevoflurane is known to produce the nephrotoxic compound A (CA) independently from watercontent of the carbon dioxide absorbent. The purpose of this study was to register the average CO concentrations in fortypatients receiving anesthesia with desflurane or sevoflurane after implementation of a safety protocol adapted fromWoehlck et al.. This protocol was developed to prevent desiccation of the strong base containing absorbent Dr?gersorb800 Plus?. Methods: In 40 patients a low-flow anesthesia was maintained using an oxygen/air mixture with either sevofluraneor desflurane in combination with the CO2 absorbent Dr?gersorb 800 plus?. CO and CA production was measured inthe inspiratory limb of the anesthesia machine using a portable gas chromatograph, with a sampling frequency of 12 samplesper hour. Results: No carbon monoxide was measured in any of the desflurane or sevoflurane anesthesia’s. The meanconcentration of CA for anesthesia with sevoflurane was 17.1 ± 5.5 parts per million. Conclusion: With the introductionof a safety protocol no carbon monoxide was measured in anesthesia performed with desflurane or sevoflurane. CompoundA is almost continuously detected in anesthetic procedures with the use of sevoflurane in very low concentrations.Implementation of a simple safety protocol possibly prevents desiccation of the absorbent and could subsequently reducethe risk of carbon monoxide intoxication.