Molecular sieves: an alternative method of carbon dioxide removal which does not generate compound A during simulated low-flow sevoflurane anaesthesia

Recovery of Sevoflurane Anesthetic Gas Using an Organosilica Membrane in Conjunction with a Scavenging System

Approximately 95% of the anesthetic gas administered to a patient is exhaled and ultimately released into the atmosphere. Most anesthetic gases have high global warming potential and so this approach adds significantly to the global greenhouse gas footprint. In this work, we develop a feasible means to capture such an anesthetic gas (sevoflurane) before it is released to the hospital scavenging system so that it is retained within the anesthetic circuit. Sevoflurane is retained using a microporous 1,2-bis(triethoxysilyl)ethane (BTESE) membrane prepared by a sol-gel method. The use of a ceramic membrane facilitates sanitization at high temperatures. A rapid thermal processing (RTP) technique is employed to reduce production time and to create a looser organosilica network, resulting in higher gas permeances, compared with the membrane synthesized from conventional thermal processing. The RTP membrane shows a slight decline in gas permeance when used with a dry mixture of CO₂/N₂/sevoflurane. This permeance falls again under 20% relative humidity feed conditions but the CO₂/sevoflurane selectivity increases. The membrane performance shows little variation when the relative humidity is further increased. These promising results demonstrate that this microporous BTESE membrane has great potential for the recovery of sevoflurane in an anesthetic application.

Structural Characterization and Comparison of Monovalent Cation-Exchanged Zeolite-W

We report comparative structural changes of potassium-contained zeolite-W (K-MER, structural analogue of natural zeolite merlinoite) and monovalent extra-framework cation (EFC)-exchanged M-MERs (M = Li⁺, Na⁺, Ag⁺, and Rb⁺). High-resolution synchrotron X-ray powder diffraction study precisely determines that crystal symmetry of MERs is tetragonal (I4/mmm). Rietveld refinement results reveal that frameworks of all MERs are geometrically composed of disordered Al/Si tetrahedra, bridged by linkage oxygen atoms. We observe a structural relationship between a group of Li-, Na-, and Ag-MER and the group of K- and Rb-MER by EFC radius and position of M(1) site inside double 8-membered ring unit (d8r). In the former group, a-axes decrease reciprocally, c-axes gradually extend by EFC size, and M(1) cations are located at the middle of the d8r. In the latter group, a- and c-axes lengths become longer and shorter, respectively, than axes of the former group, and these axial changes come from middle-to-edge migration of M(1) cations inside the d8r channel. Unit cell volumes of the Na-, Ag-, and K-MER are ca. 2005 ų, and the volume expansion in the MER series is limited by EFC size, the number of water molecules, and the distribution of extra-framework species inside the MER channel. EFC sites of M(1) and M(2) show disordered and ordered distribution in the former group, and all EFC sites change to disordered distribution after migration of the M(1) site in the latter group. The amount of water molecules and porosities are inversely proportional to EFC size due to the limitation of volume expansion of MERs. The channel opening area of a pau composite building unit and the amount of water molecules are universally related as a function of cation size because water molecules are mainly distributed inside a pau channel.

A Comparison of the Effects of Prolonged (>10 Hour) Low-flow Sevoflurane, High-flow Sevoflurane, and Low-flow Isoflurane Anaesthesia on Hepatorenal Function in Orthopaedic Patients

This study compared the effects of low-flow sevoflurane, high-flow sevoflurane and low-flow isoflurane on hepatorenal function during and after more than 10 hours of anaesthesia. Twenty-five patients scheduled for elective orthopaedic surgery were categorized into three groups; low-flow sevoflurane (fresh gas flow at 1 litre/min, n=9), high-flow sevoflurane (5 l/min, n=7), or low-flow isoflurane (1 l/min, n=9). Inspiratory compound A concentrations were measured. The groups had similar duration of anaesthesia and exposure to anaesthetic agents. The area under the curve of concentration (mean, SD) of compound A in the low-flow sevoflurane group (359.8, 106.1 ppm.h) was greater than that in the high-flow sevoflurane group (61.1, 29.3 ppm.h; P<0.01). All groups showed normal plasma creatinine and creatinine clearance, and transient postoperative increases in plasma alanine aminotrans-ferase and alpha glutathione-S-transferase, as well as urinary glucose and alpha glutathione-S-transferase, with no significant differences between groups. There were no significant relationships between the area under the curve of concentration of compound A and the biomarkers. These findings suggest that prolonged anaesthesia with low-flow sevoflurane has similar effects on hepatorenal function to prolonged anaesthesia with high-flow sevoflurane and low-flow isoflurane.

Carbon dioxide and water co-adsorption on the low-index surfaces of TiC, VC, ZrC and NbC: a DFT study

We present a theoretical DFT study into the activation of CO₂ and H₂O by four low-index surfaces of TiC, VC, ZrC and NbC. Two distinct chemisorption pathways are found for CO₂ activation, whilst multiple surface mediated interactions between H₂O and CO₂ are reported.

Circle (CO2 reabsorbing) breathing systems: Human applications

Artificial breathing systems to help humans survive extreme environments are used over a range of ambient pressures, using various gases of different volumetric concentrations. These activities include anaesthesia and intensive care activity, high-altitude mountaineering, firefighting, aerospace extravehicular space activity and underwater diving operations. A circle breathing system is one in which the exhaled carbon dioxide is absorbed by an alkali substance and the remaining unused gases are recirculated, usually for the sake of economy and environment. This allows the flow of the fresh gas to be considerably reduced, thereby saving on fresh-gas supply. Circle systems are often used in the circumstances cited above, although not always at low fresh-gas flows. The circle system used in anaesthesia and intensive care has the least engineering demands made on it, although it is used on patients who are highly vulnerable; it usually provides a mixture of air and oxygen, and perhaps a breathable anaesthetic gas, all at sea-level pressure. Mountaineering and firefighting applications involve an extreme earthbound environment, with the user undergoing extreme physical work. The astronaut's spacesuit and life support system contains a high-flow circle system, the breathing gases themselves pressurising the suit as well as providing respiratory life support and thermal comfort; the gas provided is pure oxygen at about a third of sea-level atmosphere. There are numerous varieties of breathing systems for diving, including a circle system, often for clandestine naval activity; the gases used are a combination of oxygen, nitrogen and helium, to minimise the possibility of decompression sickness, nitrogen narcosis and oxygen toxicity and must be provided at a varying pressure and concentration appropriate to depth.

Insights into the mechanism of the capture of CO2 by K2CO3 sorbent: a DFT study

The adsorption and reactions of CO₂ and H₂O on both monoclinic and hexagonal crystal K₂CO₃ were investigated using the density functional theory (DFT) approach.

Inhalational anaesthesia

Sevoflurane and desflurane have important advantages over isoflurane and halothane. Disadvantages, which the clinician should keep in mind, include the degradation of both agents by soda lime under certain circumstances during closed circuit anaesthesia. As a result compound A and carbon monoxide (CO) may be generated in soda lime canisters and may be inhaled by patients. The extent to which this constitutes a significant problem during routine anaesthesia in humans is not clear. Recent developments in absorbent technology have the potential to reduce any hazard to negligible proportions. Other undesirable properties of the newer inhalation agents include agitation with sevoflurane in children and cardiovascular and airway effects with desflurane.

[Adsorption of carbon dioxide gas]

OBJECTIVES

To analyse the various methods for carbon dioxide absorption in anaesthesia, the available absorbents and their modes of use.

DATA SOURCES

We searched the Medline and Internet databases for papers using the key words: carbon dioxide absorption, soda-lime, zeolite. We also had correspondence and contacts with soda lime manufacturers.

STUDY SELECTION

All types of articles containing data on CO2 absorption.

DATA EXTRACTION

The articles were analysed for the benefits and adverse effects of the various absorbents.

DATA SYNTHESIS

Carbon dioxide absorption enables the use of low flow anaesthesia, and a decreased consumption of medical gases and halogenated anaesthetics, as well as reduced pollution. Chemical absorbents (soda-lime and barium hydroxide lime (Baralyme) may produce toxic compounds: carbon monoxide with all halogenated anaesthetics and compound A with sevoflurane. Simple measures against desiccation of the lime prevent carbon monoxide production. The toxicity of compound A, shown in the rat, has not been proven in clinical anaesthesia. Recent improvements in manufacture processes have decreased the powdering of lime. Moreover, filters inserted between the anaesthesia circuit and the patient abolish the risk for powder inhalation.

Low and minimal flow inhalational anaesthesia

PURPOSE

To describe the pharmacokinetic behaviour and practical aspects of low (0.5-1 l.min-1) and minimal (0.25-0.5 l.min-1) flow anaesthesia.

METHODS

A Medline search located articles on low flow anaesthesia, and computer simulated anaesthetic uptake models are used.

PRINCIPAL FINDINGS

Most, 85-90%, of anaesthetists use high fresh gas flow rates during inhalational anaesthesia. Low/minimal flow anaesthesia with a circle circuit may avoid the need for in-circuit humidifiers, raise the temperature of inspired gases by up to 6 degrees C, reduce cost by about 25% by reduction of fresh gas flows to 1.5 l.min-1, and reduce environmental pollution with scavenged gas. Knowledge of volatile anaesthetic pharmacokinetic behaviour facilitates the use of minimal/low flow rates. Small amounts of nitrogen or minute amounts of methane, acetone, carbon monoxide, and inert gases in the circuit are of no concern, but the degradation of desflurane (to carbon monoxide by dry absorbent) and sevoflurane (to compound A by using a fresh gas flow of > 2 l.min-1) must be avoided. With modern gas monitoring technology, safety should be no more of a concern than with high flow techniques.

CONCLUSION

The use of fresh gas flow rates of < 1 l.min-1 for maintenance of anaesthesia has many advantages, and should be encouraged for inhalational anaesthesia with most modern volatile anaesthetics.