Zx. Fang et al., CARBON-MONOXIDE PRODUCTION FROM DEGRADATION OF DESFLURANE, ENFLURANE,ISOFLURANE, HALOTHANE, AND SEVOFLURANE BY SODA LIME AND BARALYME(R), Anesthesia and analgesia, 80(6), 1995, pp. 1187-1193
Anecdotal reports suggest that soda lime and Baralyme(R) brand absorbe
nt can degrade inhaled anesthetics to carbon monoxide (GO). We examine
d the factors that govern CO production and found that these include:
1) The anesthetic used: for a given minimum alveolar anesthetic concen
tration (MAC)-multiple, the magnitude of CO production (greatest to le
ast) is desflurane greater than or equal to enflurane > isoflurane >>
halothane = sevoflurane. 2) The absorbent dryness: completely dry soda
lime produces much more CO than absorbent with just 1.4% water conten
t, and soda lime containing 4.8% or more water (standard soda lime con
tains 15% water) generates no CO. In contrast, both completely dry Bar
alyme(R) and Baralyme(R) with 1.6% water produce high concentrations o
f CO, and Baralyme(R) containing 4.7% water produces concentrations eq
ualing those produced by soda Lime containing 1.4% water. Baralyme(R)
containing 9.7% or more water and standard Baralyme(R) (13% water) do
not generate CO. 3) The type of absorbent: at a given water content, B
aralyme(R) produces more CO than does soda lime. 4) The temperature: a
n increased temperature increases CO production. 5) The anesthetic con
centration: more CO is produced from higher anesthetic concentrations.
These results suggest that CO generation can be avoided for all anest
hetics by using soda lime with 4.8% (or more) water or Baralyme(R) wit
h 9.7% (or more) water, and by using inflow rates of less than 2-3 L/m
in. Such inflow rates are low enough to ensure that the absorbent does
not dry out.