Factors affecting the concentration of compound A resulting from the degradation of sevoflurane by soda lime and Baralyme in a standard anesthetic circuit.

Carbon dioxide absorbents, such as soda lime and Baralyme brand absorbent, convert sevoflurane to CF2 = C(CF3)OCH2F, a vinyl ether called "Compound A," whose toxicity raises concerns regarding the safety of sevoflurane in rebreathing circuits. Because an increased inflow rate to an anesthetic circuit decreases rebreathing, we assumed that an increased rate would proportionately decrease the concentration of Compound A. In the present report, we measured the Compound A concentration resulting from the action of wet (standard) soda lime and wet (standard) Baralyme on 2% sevoflurane in a model anesthetic circuit, using inflow rates (0.5, 1.0, 2.0, 4.0, and 6.0 L/min), ventilations (5 and 10 L/min), and carbon dioxide production/removal (200 and 400 mL/min) found in clinical practice. An increase in inflow rate decreased Compound A concentration to lower levels as inflow rate approached minute ventilation. At lower inflow rates, increasing duration of sevoflurane inflow increased the concentration of Compound A, a finding consistent with a progressive increase in absorbent temperature from absorption of carbon dioxide and consequently greater sevoflurane degradation. There was no material difference between Baralyme and soda lime in the concentrations of Compound A produced at a particular inflow rate. An increase in ventilation increased the concentration of Compound A, having a much greater effect at high rather than low inflow rates. An increase in amount of carbon dioxide absorbed also increased the concentration of Compound A. We conclude that inflow rate, ventilation, and carbon dioxide production are major determinants of the concentration of Compound A.