Sevoflurane degradation product concentrations with soda lime during prolonged anesthesia

Abstract

Study Objectives: To evaluate the decomposition of sevoflurane in soda lime during prolonged sevof lurane anesthesia in humans. To evaluate for evidence of renal or hepatotoxicity as a result of exposure to these sevoflurane degradation compounds. Design: Prospective evaluation in healthy volunteers. Setting: Clinical research unit and postanesthesia care unit of a university hospital. Patients: Six healthy male volunteers. Interventions: Subjects were anesthetized with sevoflurane 1 to 1.2 minimum alveolar concentration for greater than 9 hours with a semiclosed circuit anesthetic technique (5-liter total flow) with fresh soda lime as the absorbent. Measurements and Main Results: Laboratory tests of renal and hepatic function were performed before anesthesia and 1 and 5 days after anesthesia. During sevoflurane anesthesia, inhalation and exhalation circuit limb gas samples were obtained for degradation compound analysis. Only one degradation product, fluoromethyl-2,2-difluoro-l-(trifluoromethyl) vinyl ether (compound A), was detected. Inhalation concentration was maximal (7.6 ± 1.0 ppm) at 2 hours and did not increase further after this time point. There were no differences in preanesthesia and postanesthesia tests of hepatic and renal function. Conclusions:Levels of the degradation compound (compound A) produced in semiclosed circuit sevoflurane anesthesia with soda lime are well below potential toxic levels and thus appear safe. When sevoflurane is administered under these conditions for prolonged anesthesia, concentrations of compound A do not continue to increase throughout anesthesia.