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Only carbon dioxide absorbents free of both NaOH and KOH do not generate compound A during in vitro closed-system sevoflurane: evaluation of five absorbents

(2001) ANESTHESIOLOGY. 95(3). p.750-755
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Abstract
Background insufficient data exist on the production of compound A during closed-system sevoflurane administration with newer carbon dioxide absorbents. Methods: A modified PhysioFlex apparatus (Drager, Lubeck, Germany) was connected to an artificial test lung (Inflow at the top of the bellow congruent to 160 ml/min CO2; outflow at the Y piece of the lung model congruent to 200 ml/min, simulating oxygen consumption). Ventilation was set to obtain an end-tidal carbon dioxide partial pressure of approximately 40 mmHg. Various fresh carbon dioxide absorbents were used: Sodasorb (n = 6), Sofnolime (n = 6), and potassium hydroxide (KOH)-free Sodasorb (n = 7), Amsorb (n = 7), and lithium hydroxide (n = 7). After baseline analysis, liquid sevoflurane was Injected into the circuit by syringe pump to obtain 2.1% end-tidal concentration for 240 min. At baseline and at regular intervals thereafter, end-tidal carbon dioxide partial pressure, end-tidal sevoflurane concentration, and canister inflow (T degrees (in)) and canister outflow (T degrees (out)) temperatures were measured. To measure compound A(insp) concentration in the inspired gas of the breathing circuit, 2-ml gas samples were taken and analyzed by capillary gas chromatography plus mass spectrometry. Results: The median (minimum-maximum) highest compound A(insp) concentrations over the entire period were, in decreasing order: 38.3 (28.4-44.2)* (Sofnolime), 30.1 (23.9-43.7) (KOH-free Sodasorb), 23.3 (20.0-29.2) (Sodasorb), 1.6 (1.3-2.1)* (lithium hydroxide), and 1.3 (1.1-1.8)* (Arnsorb) parts per million (*P < 0.01 vs. Sodasorb). After reaching their peak concentration, a decrease for Sofnolime, KOH-free Sodasorb, and Sodasorb until 240 min was found. The median (minimum-maximum) highest values for T degrees (out), were 39 (38-40), 40 (39-42), 41 (40-42), 46 (44-48)*, and 39 (38-41) IC (*P < 0.01 vs. Sodasorb), respectively. Conclusions: With KOH-free (but sodium hydroxide [NaOH]containing) soda limes even higher compound A concentrations are recorded than with standard Sodasorb. Only by eliminating KOH as well as NaoH from the absorbent (Amsorb and lithium hydroxide) is no compound A produced.
Keywords
BREATHING SYSTEMS, SODA LIME, DEGRADATION, MONOXIDE, ABSORPTION, PRODUCE

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Chicago
Versichelen, Linda, Marie-Paule Bouche, Georges Rolly, Jan Van Bocxlaer, Michel Struys, Andreas De Leenheer, and Eric Mortier. 2001. “Only Carbon Dioxide Absorbents Free of Both NaOH and KOH Do Not Generate Compound A During in Vitro Closed-system Sevoflurane: Evaluation of Five Absorbents.” Anesthesiology 95 (3): 750–755.
APA
Versichelen, L., Bouche, M.-P., Rolly, G., Van Bocxlaer, J., Struys, M., De Leenheer, A., & Mortier, E. (2001). Only carbon dioxide absorbents free of both NaOH and KOH do not generate compound A during in vitro closed-system sevoflurane: evaluation of five absorbents. ANESTHESIOLOGY, 95(3), 750–755. Presented at the Annual Meeting American Society of Anesthesiologists.
Vancouver
1.
Versichelen L, Bouche M-P, Rolly G, Van Bocxlaer J, Struys M, De Leenheer A, et al. Only carbon dioxide absorbents free of both NaOH and KOH do not generate compound A during in vitro closed-system sevoflurane: evaluation of five absorbents. ANESTHESIOLOGY. 2001;95(3):750–5.
MLA
Versichelen, Linda, Marie-Paule Bouche, Georges Rolly, et al. “Only Carbon Dioxide Absorbents Free of Both NaOH and KOH Do Not Generate Compound A During in Vitro Closed-system Sevoflurane: Evaluation of Five Absorbents.” ANESTHESIOLOGY 95.3 (2001): 750–755. Print.
@article{143130,
  abstract     = {Background insufficient data exist on the production of compound A during closed-system sevoflurane administration with newer carbon dioxide absorbents.
Methods: A modified PhysioFlex apparatus (Drager, Lubeck, Germany) was connected to an artificial test lung (Inflow at the top of the bellow congruent to 160 ml/min CO2; outflow at the Y piece of the lung model congruent to 200 ml/min, simulating oxygen consumption). Ventilation was set to obtain an end-tidal carbon dioxide partial pressure of approximately 40 mmHg. Various fresh carbon dioxide absorbents were used: Sodasorb (n = 6), Sofnolime (n = 6), and potassium hydroxide (KOH)-free Sodasorb (n = 7), Amsorb (n = 7), and lithium hydroxide (n = 7). After baseline analysis, liquid sevoflurane was Injected into the circuit by syringe pump to obtain 2.1\% end-tidal concentration for 240 min. At baseline and at regular intervals thereafter, end-tidal carbon dioxide partial pressure, end-tidal sevoflurane concentration, and canister inflow (T degrees (in)) and canister outflow (T degrees (out)) temperatures were measured. To measure compound A(insp) concentration in the inspired gas of the breathing circuit, 2-ml gas samples were taken and analyzed by capillary gas chromatography plus mass spectrometry.
Results: The median (minimum-maximum) highest compound A(insp) concentrations over the entire period were, in decreasing order: 38.3 (28.4-44.2)* (Sofnolime), 30.1 (23.9-43.7) (KOH-free Sodasorb), 23.3 (20.0-29.2) (Sodasorb), 1.6 (1.3-2.1)* (lithium hydroxide), and 1.3 (1.1-1.8)* (Arnsorb) parts per million (*P {\textlangle} 0.01 vs. Sodasorb). After reaching their peak concentration, a decrease for Sofnolime, KOH-free Sodasorb, and Sodasorb until 240 min was found. The median (minimum-maximum) highest values for T degrees (out), were 39 (38-40), 40 (39-42), 41 (40-42), 46 (44-48)*, and 39 (38-41) IC (*P {\textlangle} 0.01 vs. Sodasorb), respectively.
Conclusions: With KOH-free (but sodium hydroxide [NaOH]containing) soda limes even higher compound A concentrations are recorded than with standard Sodasorb. Only by eliminating KOH as well as NaoH from the absorbent (Amsorb and lithium hydroxide) is no compound A produced.},
  author       = {Versichelen, Linda and Bouche, Marie-Paule and Rolly, Georges and Van Bocxlaer, Jan and Struys, Michel and De Leenheer, Andreas and Mortier, Eric},
  issn         = {0003-3022},
  journal      = {ANESTHESIOLOGY},
  keyword      = {BREATHING SYSTEMS,SODA LIME,DEGRADATION,MONOXIDE,ABSORPTION,PRODUCE},
  language     = {eng},
  location     = {San Francisco, CA, USA},
  number       = {3},
  pages        = {750--755},
  title        = {Only carbon dioxide absorbents free of both NaOH and KOH do not generate compound A during in vitro closed-system sevoflurane: evaluation of five absorbents},
  volume       = {95},
  year         = {2001},
}

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