Amsorb、碱石灰和Baralyme在猪体内对挥发性麻醉剂的降解以及一氧化碳和化合物A的形成比较。

Comparison of Amsorb, sodalime, and Baralyme degradation of volatile anesthetics and formation of carbon monoxide and compound a in swine in vivo.

作者信息

Kharasch Evan D, Powers Karen M, Artru Alan A

机构信息

Department of Anesthesiology, University of Washington, Seattle, 98195, USA.

出版信息

Anesthesiology. 2002 Jan;96(1):173-82. doi: 10.1097/00000542-200201000-00031.

DOI:10.1097/00000542-200201000-00031

PMID:11753018

Abstract

BACKGROUND

Consequences of volatile anesthetic degradation by carbon dioxide absorbents that contain strong base include formation of compound A from sevoflurane, formation of carbon monoxide (CO) and CO toxicity from desflurane, enflurane and isoflurane, delayed inhalation induction, and increased anesthetic costs. Amsorb (Armstrong Ltd., Coleraine, Northern Ireland) is a new absorbent that does not contain strong base and does not form CO or compound A in vitro. This investigation compared Amsorb, Baralyme (Chemetron Medical Division, Allied Healthcare Products, St. Louis, MO), and sodalime effects on CO (from desflurane and isoflurane) and compound A formation, carboxyhemoglobin (COHb) concentrations, and anesthetic degradation in a clinically relevant porcine in vivo model.

METHODS

Pigs were anesthetized with desflurane, isoflurane, or sevoflurane, using fresh or partially dehydrated Amsorb, Baralyme, and new and old formulations of sodalime. Anesthetic concentrations in the fresh (preabsorber), inspired (postabsorber), and end-tidal gas were measured, as were inspired CO and compound A concentrations and blood oxyhemoglobin and COHb concentrations.

RESULTS

For desflurane and isoflurane, the order of inspired CO and COHb formation was dehydrated Baralyme >> soda-lime > Amsorb. For desflurane and Baralyme, peak CO was 9,700 +/- 5,100 parts per million (ppm), and the increase in COHb was 37 +/- 14%. CO and COHb increases were undetectable with Amsorb. Oxyhemoglobin desaturation occurred with desflurane and Baralyme but not Amsorb or sodalime. The gap between inspired and end-tidal desflurane and isoflurane did not differ between the various dehydrated absorbents. Neither fresh nor dehydrated Amsorb caused compound A formation from sevoflurane. In contrast, Baralyme and sodalime caused 20-40 ppm compound A. The gap between inspired and end-tidal sevoflurane did not differ between fresh absorbents, but was Amsorb < sodalime < Baralyme with dehydrated absorbents.

CONCLUSION

Amsorb caused minimal if any CO formation, minimal compound A formation regardless of absorbent hydration, and the least amount of sevoflurane degradation. An absorbent like Amsorb, which does not contain strong base or cause anesthetic degradation and formation of toxic products, may have benefit with respect to patient safety, inhalation induction, and anesthetic consumption (cost).

摘要

背景

含有强碱的二氧化碳吸收剂导致挥发性麻醉剂降解的后果包括七氟醚生成化合物A、地氟醚、恩氟醚和异氟醚生成一氧化碳（CO）及CO毒性、吸入诱导延迟以及麻醉成本增加。Amsorb（阿姆斯特朗有限公司，北爱尔兰科勒雷恩）是一种新型吸收剂，不含强碱，在体外不会生成CO或化合物A。本研究在临床相关的猪体内模型中比较了Amsorb、碱石灰（Chemtron医疗部门，联合医疗产品公司，密苏里州圣路易斯）和钠石灰对CO（来自地氟醚和异氟醚）生成、化合物A生成、碳氧血红蛋白（COHb）浓度以及麻醉剂降解的影响。

方法

使用新鲜或部分脱水的Amsorb、碱石灰以及新旧配方的钠石灰，用地氟醚、异氟醚或七氟醚对猪进行麻醉。测量新鲜（吸收前）、吸入（吸收后）和呼气末气体中的麻醉剂浓度，以及吸入的CO和化合物A浓度、血液氧合血红蛋白和COHb浓度。

结果

对于地氟醚和异氟醚，吸入的CO和COHb生成顺序为：脱水碱石灰 >> 钠石灰 > Amsorb。对于地氟醚和碱石灰，CO峰值为9700±5100 ppm，COHb增加37±14%。使用Amsorb时未检测到CO和COHb增加。地氟醚和碱石灰导致氧合血红蛋白饱和度下降，而Amsorb和钠石灰则未导致。各种脱水吸收剂之间，吸入和呼气末地氟醚及异氟醚之间的差值无差异。新鲜或脱水的Amsorb均未导致七氟醚生成化合物A。相比之下，碱石灰和钠石灰导致20 - 40 ppm的化合物A生成。新鲜吸收剂之间，吸入和呼气末七氟醚之间的差值无差异，但脱水吸收剂的情况为Amsorb < 钠石灰 < 碱石灰。