, Volume 13, Issue 3, pp 149-155

The Response of Anesthetic Agent Monitors to Trifluoromethane Warns of the Presence of Carbon Monoxide from Anesthetic Breakdown

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Abstract

Objective. Trifluoromethane and CO are produced simultaneously duringthe breakdown of isoflurane and desflurane by dry CO2absorbents. Trifluoromethane interferes with anesthetic agent monitoring, andthe interference can be used as a marker to indicate anesthetic breakdown withCO production. This study tests representative types of gas monitors todetermine their ability to provide a clinically useful warning of COproduction in circle breathing systems. Methods. Isoflurane anddesflurane were reacted with dry Baralyme® at 45 °C. Standardizedsamples of breakdown products were created from mixtures of reacted andunreacted gases to simulate the partial degrees of reaction which might resultduring clinical episodes of anesthetic breakdown using 1% or 2% isoflurane and 6% or 12% desflurane. These mixtures were measured by the monitors tested, andthe indication of the wrong agent or a mixture of agents due to the presenceof trifluoromethane was recorded and related to the CO concentration in thegas mixtures. Results. When presented with trifluoromethane fromanesthetic breakdown, monochromatic infrared monitors displayedinappropriately large amounts of isoflurane or desflurane. Agent identifyinginfrared and Raman scattering monitors varied in their sensitivity totrifluoromethane. Mass spectrometers measuring enflurane at mass to charge= 69 were most sensitive to trifluoromethane. Conclusions. Monochromaticinfrared monitors were unable to indicate anesthetic breakdown viainterference by trifluoromethane, but did indicate falsely elevated anestheticconcentrations. Agent identifying infrared and Raman monitors provided warningof desflurane breakdown via the interference of trifluoromethane by displayingthe wrong agent or mixed agents, but may not be sensitive enough to warn ofisoflurane breakdown. Some mass spectrometers provided the most sensitivewarnings to anesthetic breakdown via trifluoromethane, but additional dataprocessing by some patient monitor units reduced their overall effectiveness.