Background: Sevoflurane reacts with carbon dioxide absorbents, such as soda lime, to release the volatile products compounds A and B. These two products, which have been detected in anesthesia circuits, are among five formed when sevoflurane is degraded by soda lime at increased temperature; the others, compounds C, D, and E, have been detected only in heated sealed systems. The current study attempted to determine the influence of soda lime temperature on compounds A and B generation in an anesthesia circuit and whether a decrease in soda lime temperature could eliminate product formation in the circulating gases.
Methods: Sevoflurane (1.5% in oxygen) was circulated (6 l/min) in a partially closed, low-flow (215 ml/min fresh gas) anesthesia circuit that included a canister containing 1.2 kg fresh soda lime. Carbon dioxide was introduced into the circuit at 200 ml/min, and gas samples for analysis of sevoflurane, compounds A, B, C, and D, and carbon dioxide were taken at the opening of an attached artificial lung. The circuit was operated for 8 h under conditions whereby the soda lime temperature could increase freely or the soda lime was chilled with ice.
Results: A maximum core soda lime temperature of about 46 degrees C was measured when the experiment was run under conditions whereby the soda lime temperature was allowed to increase. Compounds A and B increased with time to a maximum of 23 and 9 ppm, respectively. At 4.5 h of circuit operation, compound C/D was found. Chilling of the soda lime canister, which produced a maximum core soda lime temperature of 25 degrees C, resulted in neither compound B nor C/D being detected during the 8-h period. Compound A was present in the circuit at all times at approximately 10 ppm; however, its concentration did not increase as occurred when the experiment was conducted under nonchilled conditions. Carbon dioxide levels at the opening of the lung remained at a constant 5% for 8 h with or without soda lime chilling.
Conclusions: This study demonstrates that the release of volatile sevoflurane degradation products in an anesthesia circuit is highly dependent on soda lime temperatures. A reduction of the temperature of soda lime may be a feasible method of preventing the release of significant levels of sevoflurane degradation products without interfering with carbon dioxide absorption or altering the sevoflurane concentration.