Carbon Monoxide Accumulation in Closed Circle Anesthesia Systems

Middleton, Victoria; Poznak, Alan Van; Artusio, Joseph F.; Smith, Scott M.

doi:10.1097/00000542-196511000-00004

Cited by 30 publications

(11 citation statements)

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“…7 In this study, the authors documented levels of CO as high as 810 parts per million (ppm) within the breathing circuit and concluded that “complete closure of the anesthetic system [allowed] build up” of CO. 7 Although it is over 50 years old, this work insightfully identified the patient's own alveolar gas as a potential source of CO. 7 …”

Section: Co Exposure During General Endotracheal Anesthesiamentioning

confidence: 86%

Anesthesia-Related Carbon Monoxide Exposure: Toxicity and Potential Therapy

Levy

2016

Anesthesia &Amp; Analgesia

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Exposure to carbon monoxide (CO) during general anesthesia can result from volatile anesthetic degradation by carbon dioxide absorbents as well as re-breathing of endogenously produced CO. Although adherence to the Anesthesia Patient Safety Foundation guidelines reduces the risk of CO poisoning, patients may still experience a sub-toxic CO exposure during low-flow anesthesia. The consequences of such exposures are relatively unknown. In contrast to the widely recognized toxicity of high CO concentrations, the biological activity of low concentration CO has recently been shown be cytoprotective. As such, low dose CO is being explored as a novel treatment for a variety of different diseases. Here we review the concept of anesthesia-related CO exposure, identify the sources of production, detail the mechanisms of overt CO toxicity, highlight the cellular effects of low dose CO, and discuss the potential therapeutic role for CO as a part of routine anesthetic management.

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Section: Co Exposure During General Endotracheal Anesthesiamentioning

confidence: 86%

Anesthesia-Related Carbon Monoxide Exposure: Toxicity and Potential Therapy

Levy

2016

Anesthesia &Amp; Analgesia

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“…Likewise, the effect of oxygen flow manipulation was not investigated in the present investigation (ie, low oxygen flow [closed circuit] vs. high flow [semi‐closed circuit]). Middleton et al showed that CO concentration increased with time during closed circuit anesthesia of human beings 14 . Based on their findings, they recommended hourly flushing of the anesthetic circuit to prevent CO buildup 14 .…”

Section: Discussionmentioning

confidence: 99%

“…Middleton et al showed that CO concentration increased with time during closed circuit anesthesia of human beings 14 . Based on their findings, they recommended hourly flushing of the anesthetic circuit to prevent CO buildup 14 . Similarly, in 1992 Ingram et al recommended high oxygen flow rates (5 L/min) to prevent CO buildup 9 .…”

Section: Discussionmentioning

confidence: 99%

“…14 Based on their findings, they recommended hourly flushing of the anesthetic circuit to prevent CO buildup. 14 Similarly, in 1992 Ingram et al recommended high oxygen flow rates (5 L/min) to prevent CO buildup. 9 With the knowledge that desiccated CO 2 absorbents generate CO in the presence of volatile anesthetics, one might speculate that low flow anesthesia should decrease CO production by virtue of its ability to preserve circuit moisture.…”

Section: Discussionmentioning

confidence: 99%

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Inhaled Carbon Monoxide Concentration During Halothane or Isoflurane Anesthesia in Horses

et al. 1999

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“…Consequently, it seemed appropriate to investigate if the denitrogenation could be simplified. Since there was no accumulation of nitrogen, other potentially toxic gases dissolved in the body, such as carbon monoxide (15) and methane (4), should not accumulate in the anaesthetic circuit either. However, although double-length tubings were employed, the circle system volume was only 3.6 1.…”

Section: Discussionmentioning

confidence: 99%

Gaseous homeostasis during low‐flow anaesthesia

Bengtson

Sonander

Stenqvist

1988

Acta Anaesthesiol Scand

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The object of this clinical study was to investigate the circle system gas homeostasis during low-flow anaesthesia using a technique designed to keep a constant inspired oxygen fraction of 0.30. Denitrogenation was adequately accomplished with mask preoxygenation, 10 l/min, for 1 min and an initial fresh gas flow of 5 l/min for 6 min after intubation. There was no need to wash out accumulated nitrogen at intervals, since the already low nitrogen concentration in the system tended to decrease after 1 h. The fresh gas flow of nitrous oxide to oxygen ratio and the inspiratory to end-expiratory oxygen concentration difference both reflected the uptake of nitrous oxide. The calculated rates of uptake of nitrous oxide, a subject of controversy, were in accordance with those found by Severinghaus and Barton & Nunn.

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Carbon Monoxide Accumulation in Closed Circle Anesthesia Systems

Cited by 30 publications

References 0 publications

Anesthesia-Related Carbon Monoxide Exposure: Toxicity and Potential Therapy

Anesthesia-Related Carbon Monoxide Exposure: Toxicity and Potential Therapy

Inhaled Carbon Monoxide Concentration During Halothane or Isoflurane Anesthesia in Horses

Gaseous homeostasis during low‐flow anaesthesia

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