Inhaled Anesthetics: Metabolism and Toxicity

Martin, Jackie L.

doi:10.1016/b978-0-443-06959-8.00024-8

Cited by 17 publications

(21 citation statements)

References 237 publications

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“…Desflurane (2,2,2-trifluoro-1-fluoroethyl-difluoromethyl ether) is a highly fluorinated methyl ethyl ether. The structure of desflurane is particularly similar to isoflurane with the exception of the substitution of a fluorine atom for isoflurane's chlorine atom [ 20 ]. Studies on SG's adsorption of desflurane are not available, but this adsorption is easily anticipated given the structure of desflurane.…”

Section: Discussionmentioning

confidence: 99%

Adsorption of desflurane by the silica gel filters in breathing circuits: an in vitro study

Song

Lim

Ryu

2015

Korean J Anesthesiol

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BackgroundDuring general anesthesia, a heated breathing circuit (HBC) is used to replace the heat and moisture exchange function of the upper airway. One HBC uses an air dryer filter that employs silica gel (SG) as a desiccant. SG is capable of adsorbing many organic compounds. Therefore, we undertook an in vitro study of the adsorption of desflurane by SG filters.MethodsAn HBC was connected to an anesthesia machine, and a test lung was connected to the circuit. The test lung was mechanically ventilated with 2 or 4 L/min of fresh gas flow, with and without the air dryer filter. Desflurane was administered at a 6 vol% on the vaporizer dial setting. The experiment was repeated 15 times in each group. The end-tidal concentrations were measured during the experiments. The air dryer filter weights were measured before and after the experiments, and the times required to achieve the specific end-tidal desflurane concentrations were determined.ResultsSignificant differences in the end-tidal concentrations of desflurane were observed between the control and filter groups (P < 0.001). The filter weights increased significantly after the experiments (P < 0.001). The times required to achieve the same end-tidal desflurane concentrations were different with the application of the air dryer filter (P < 0.001).ConclusionsThe adsorption of desflurane with the use of an air dryer filter was verified in this in vitro study. Careful attention is needed when using air dryer gel filters during general anesthesia.

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Section: Discussionmentioning

confidence: 99%

Adsorption of desflurane by the silica gel filters in breathing circuits: an in vitro study

Song

Lim

Ryu

2015

Korean J Anesthesiol

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“…In fact, the practical cases are forced for prolonged periods of anesthesia. Moreover, the toxicity of CA is defined by the product concentration and time [ 18 ]. Therefore, further studies should examine the CA production after a prolonged period of anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Performance of a new carbon dioxide absorbent, Yabashi lime<sup>®</sup> as compared to conventional carbon dioxide absorbent during sevoflurane anesthesia in dogs

Kondoh

Atiba

Nagase

et al. 2015

The Journal of Veterinary Medical Science

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In the present study, we compare a new carbon dioxide (CO2) absorbent, Yabashi lime® with a conventional CO2 absorbent, Sodasorb® as a control CO2 absorbent for Compound A (CA) and Carbon monoxide (CO) productions. Four dogs were anesthetized with sevoflurane. Each dog was anesthetized with four preparations, Yabashi lime® with high or low-flow rate of oxygen and control CO2 absorbent with high or low-flow rate. CA and CO concentrations in the anesthetic circuit, canister temperature and carbooxyhemoglobin (COHb) concentration in the blood were measured. Yabashi lime® did not produce CA. Control CO2 absorbent generated CA, and its concentration was significantly higher in low-flow rate than a high-flow rate. CO was generated only in low-flow rate groups, but there was no significance between Yabashi lime® groups and control CO2 absorbent groups. However, the CO concentration in the circuit could not be detected (≤5ppm), and no change was found in COHb level. Canister temperature was significantly higher in low-flow rate groups than high-flow rate groups. Furthermore, in low-flow rate groups, the lower layer of canister temperature in control CO2 absorbent group was significantly higher than Yabashi lime® group. CA and CO productions are thought to be related to the composition of CO2 absorbent, flow rate and canister temperature. Though CO concentration is equal, it might be safer to use Yabashi lime® with sevoflurane anesthesia in dogs than conventional CO2 absorbent at the point of CA production.

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“…The concern of potential nephrotoxicity due to formation of compound A (fluoromethyl-2-2-difluoro-1-trifluoromethyl vinyl ether) following use of sevoflurane with decreased fresh gas flow rates [ 22 ] has now been negated in several clinical studies [ 23 – 26 ]. Clinical practice guidelines also no longer appear to impose restrictions on use of sevoflurane with reduced fresh gas flow rates [ 27 ], and to date no significant clinical renal toxicity has been associated with the use of sevoflurane [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Cost Analysis of Three Techniques of Administering Sevoflurane

Tyagi

Venkateswaran

Jain

et al. 2014

Anesthesiology Research and Practice

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Background. This study aimed to evaluate and compare total cost of sevoflurane and propofol for 1.0 MAC-hour of anaesthesia, employing three anaesthetic techniques. Methods. Adult patients scheduled for surgical procedures under general anaesthesia anticipated to last approximately an hour were randomized into three groups (n = 15 each), to receive anaesthesia using one of the following techniques: low flow technique involving induction with propofol, followed by sevoflurane delivered using initial fresh gas flows of 6 L/min till MAC reached 1.0 and then reduced to 0.5 L/min; alternate method of low flow entailing only a difference in fresh gas flow rates being maintained at 1 L/min throughout; the third technique involving use of sevoflurane for both induction and maintenance of anaesthesia. Results. Cost of sevoflurane to maintain 1 MAC-hour of anaesthesia was clinically least with low flow anaesthesia, though statistically similar amongst the three techniques. Once the cost of propofol used for induction in two of the three groups was added to that of sevoflurane, cost incurred was least with the technique using sevoflurane both for induction and maintenance of anaesthesia, as compared to low flow and alternative low flow techniques, a 26% and 32% cost saving, respectively (P < 0.05).

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Inhaled Anesthetics: Metabolism and Toxicity

Cited by 17 publications

References 237 publications

Adsorption of desflurane by the silica gel filters in breathing circuits: an in vitro study

Adsorption of desflurane by the silica gel filters in breathing circuits: an in vitro study

Performance of a new carbon dioxide absorbent, Yabashi lime<sup>®</sup> as compared to conventional carbon dioxide absorbent during sevoflurane anesthesia in dogs

Cost Analysis of Three Techniques of Administering Sevoflurane

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