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Hopper CP, Wollborn J. Delivery of carbon monoxide via halogenated ether anesthetics. Nitric Oxide 2019; 89:93-95. [PMID: 31125687 DOI: 10.1016/j.niox.2019.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/04/2019] [Accepted: 05/21/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Christopher P Hopper
- Department of Medicinal Chemistry, College of Pharmacy, The University of Florida, Gainesville, Florida, USA; Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Germany; Institute for Experimental Biomedicine, University Hospital Wuerzburg, Germany.
| | - Jakob Wollborn
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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2
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Gavrilovska-Brzanov A, Shosholcheva M, Kuzmanovska B, Kartalov A, Mojsova-Mijovska M, Jovanovski-Srceva M, Taleska G, Brzanov N, Simeonov R, Miceska MS. The Influence of Smoking on the Variations in Carboxyhemoglobin and Methemoglobin During Urologic Surgery. Med Arch 2018; 71:178-182. [PMID: 28974829 PMCID: PMC5585797 DOI: 10.5455/medarh.2017.71.178-182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Surgery is supposed to modulate the production of carbon monoxide by the reduction of heme oxygenase activity or transcriptional regulation of inducible heme oxygenase. On the other hand, the inhalation of tobacco smoke can substantially raise the level of carboxyhemoglobin in the blood. Furthermore, methemoglobin is maintained at a constant level. However, excessive production of methemoglobin relative to total methemoglobin reductase activity results in methemoglobin increase. Aim: The aim of our study was to investigate the perioperative variations of carboxyhemoglobin and methemoglobin during urologic surgeries, and at the same time to evaluate the changes in methemoglobin as a possible indicator of nitric oxide generation. Our second aim was to evaluate the effect of preoxygenation on the level of carboxyhemoglobin and methemoglobin and the influence of blood transfusion on their changes. Material and methods: The study included 30 patients scheduled for urologic surgery under general endotracheal anesthesia, aged 18–60 years without any history of respiratory disease, divided into two groups. The study group comprised patients who were smoking cigarettes or tobacco pipe, while the control group included non-smokers. In both groups carboxyhemoglobin (COHb) and methemoglobin (MetHb) levels were determined preoperatively, after preoxygenation, and postoperatively. Results: COHb levels were decreased postoperatively in both groups. The average values of COHb between the two groups were statistically significantly different (p=0.00). MetHb levels increased postoperatively in the group of smokers and decreased in the group of non-smokers. There were no statistically significant differences in the average postoperative MetHb levels between the two groups. Conclusion: Changes in carboxyhemoglobin and methemoglobin concentrations in arterial blood occur during urologic surgery, although these amplitudes are small when compared with carbon monoxide intoxication and methemoglobinemia. It is likely that organ perfusion and functions are affected by these monoxide gas mediators during urologic surgery.
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Affiliation(s)
- Aleksandra Gavrilovska-Brzanov
- University Clinic for Traumatology, Orthopedic disease, Anesthesiology, Reanimation and Intensive Care Medicine and Emergency department, Faculty of Medicine, University "Ss. Cyril and Methodius", Skopje, R. Macedonia
| | - Mirjana Shosholcheva
- University Clinic for General Surgery "St. Naum Ohridski" Faculty of Medicine, University "Ss. Cyril and Methodius", Skopje, R. Macedonia
| | - Biljana Kuzmanovska
- University Clinic for General Surgery "St. Naum Ohridski" Faculty of Medicine, University "Ss. Cyril and Methodius", Skopje, R. Macedonia
| | - Andrijan Kartalov
- University Clinic for General Surgery "St. Naum Ohridski" Faculty of Medicine, University "Ss. Cyril and Methodius", Skopje, R. Macedonia
| | - Maja Mojsova-Mijovska
- University Clinic for General Surgery "St. Naum Ohridski" Faculty of Medicine, University "Ss. Cyril and Methodius", Skopje, R. Macedonia
| | - Marija Jovanovski-Srceva
- University Clinic for General Surgery "St. Naum Ohridski" Faculty of Medicine, University "Ss. Cyril and Methodius", Skopje, R. Macedonia
| | | | - Nikola Brzanov
- University Clinic for Traumatology, Orthopedic disease, Anesthesiology, Reanimation and Intensive Care Medicine and Emergency department, Faculty of Medicine, University "Ss. Cyril and Methodius", Skopje, R. Macedonia
| | - Risto Simeonov
- University Clinic for Pediatric Surgery, Faculty of Medicine, University "Ss. Cyril and Methodius", Skopje, R. Macedonia
| | - Maja Slaninka Miceska
- Department of Preclinical and Clinical Pharmacology and Toxicology, Faculty of Medicine, University "Ss. Cyril and Methodius", Skopje, R. Macedonia
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Abstract
Exposure to carbon monoxide (CO) during general anesthesia can result from volatile anesthetic degradation by carbon dioxide absorbents and rebreathing of endogenously produced CO. Although adherence to the Anesthesia Patient Safety Foundation guidelines reduces the risk of CO poisoning, patients may still experience subtoxic CO exposure during low-flow anesthesia. The consequences of such exposures are relatively unknown. In contrast to the widely recognized toxicity of high CO concentrations, the biologic activity of low concentration CO has recently been shown to be cytoprotective. As such, low-dose CO is being explored as a novel treatment for a variety of different diseases. Here, we review the concept of anesthesia-related CO exposure, identify the sources of production, detail the mechanisms of overt CO toxicity, highlight the cellular effects of low-dose CO, and discuss the potential therapeutic role for CO as part of routine anesthetic management.
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Affiliation(s)
- Richard J Levy
- From the Department of Anesthesiology, Columbia University Medical Center, New York, New York
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Wang L, Wang A, Supplee WW, Koffler K, Cheng Y, Quezado ZMN, Levy RJ. Carbon monoxide incompletely prevents isoflurane-induced defects in murine neurodevelopment. Neurotoxicol Teratol 2017; 61:92-103. [PMID: 28131877 DOI: 10.1016/j.ntt.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/17/2017] [Accepted: 01/24/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Commonly used anesthetics have been shown to disrupt neurodevelopment in preclinical models. It has been proposed that such anesthesia-induced neurotoxicity is mediated by apoptotic neurodegeneration in the immature brain. Low dose carbon monoxide (CO) exerts cytoprotective properties and we have previously demonstrated that CO inhibits isoflurane-induced apoptosis in the developing murine brain. Here we utilized anti-apoptotic concentrations of CO to delineate the role of apoptotic neurodegeneration in anesthesia-induced neurotoxicity by assessing the effect of CO on isoflurane-induced defects in neurodevelopment. METHODS C57Bl/6 mouse pups underwent 1-hour exposure to 0ppm (air), 5ppm, or 100ppm CO in air with or without isoflurane on postnatal day 7. Cohorts were evaluated 5-7weeks post exposure with T-maze cognitive testing followed by social behavior assessment. Brain size, whole brain cellular content, and neuronal density in primary somatosensory cortex and hippocampal CA3 region were measured as secondary outcomes 1-week or 5-7weeks post exposure along with 7-day old, unexposed controls. RESULTS Isoflurane impaired memory acquisition and resulted in abnormal social behavior. Low concentration CO abrogated anesthetic-induced defects in memory acquisition, however, it also resulted in impaired spatial reference memory and social behavior abnormalities. Changes in brain size, cellular content, and neuronal density over time related to the age of the animal and were unaffected by either isoflurane or CO. CONCLUSIONS Anti-apoptotic concentrations of CO incompletely prevented isoflurane-induced defects in neurodevelopment, lacked concentration-dependent effects, and only provided protection in certain domains suggesting that anesthesia-related neurotoxicity is not solely mediated by activation of the mitochondrial apoptosis pathway.
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Affiliation(s)
- Li Wang
- The Sheikh Zayed Institute for Pediatric Surgical Innovation, Division of Pain Medicine, Children's National Health System, Children's Research Institute, The George Washington University School of Medicine and Health Sciences, United States
| | - Aili Wang
- Department of Anesthesiology, Columbia University Medical Center, United States
| | | | - Kayla Koffler
- Department of Anesthesiology, Columbia University Medical Center, United States
| | - Ying Cheng
- Center for Genetic Medicine Research, Children's National Health System, Children's Research Institute, The George Washington University School of Medicine and Health Sciences, United States
| | - Zenaide M N Quezado
- The Sheikh Zayed Institute for Pediatric Surgical Innovation, Division of Pain Medicine, Children's National Health System, Children's Research Institute, The George Washington University School of Medicine and Health Sciences, United States
| | - Richard J Levy
- Department of Anesthesiology, Columbia University Medical Center, United States.
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5
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[Evolution of the carboxyhemoglobinemia and methemoglobinemia during endoscopic resection: An observational study]. Prog Urol 2017; 27:98-102. [PMID: 28117232 DOI: 10.1016/j.purol.2016.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/30/2016] [Accepted: 12/17/2016] [Indexed: 11/23/2022]
Abstract
AIM OF THE STUDY Combustion of organic tissues due to endoscopic resection could induce methemoglobin (MetHb) and carboxyhemoglobin (COHb) formation. The aim of this study is to evaluate MetHb and COHb formation in patients undergoing prostatic or bladder endoscopic procedures. METHODS COHb and MetHb measurements were performed in 44 patients at the beginning and end of the procedure. A third measurement was done in patients who stayed more than one hour in the recovery room. Means were compared using Student t-test, simple regressions were used for quantitative variables and ANOVA for categorical variables. Multiple linear regressions were used for multivariate analysis. RESULTS COHb increased by 0.5±0.9 % (95 % CI: 0.2 to 0.7 % P=0.001). MetHb increase was 0.0±0.4 % (95 % CI: -0.1 to 0.2 % P=0.552). In univariate analysis, the variables associated with COHb increase are the length of surgery, the amount of irrigation fluid and location (prostate or bladder) of the procedure. In the multivariate model, COHb increase is associated with the amount of liquid and the location. CONCLUSION MetHb did not increase during endoscopic surgery. In contrast, COHb increases, and can, in some patients, exceed 2-4 %. This could be responsible for a decreased angina threshold in patients with ischemic heart disease. LEVEL OF EVIDENCE 4.
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6
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Levy RJ. Carbon monoxide and anesthesia-induced neurotoxicity. Neurotoxicol Teratol 2016; 60:50-58. [PMID: 27616667 DOI: 10.1016/j.ntt.2016.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 08/10/2016] [Accepted: 09/06/2016] [Indexed: 10/21/2022]
Abstract
The majority of commonly used anesthetic agents induce widespread neuronal degeneration in the developing mammalian brain. Downstream, the process appears to involve activation of the oxidative stress-associated mitochondrial apoptosis pathway. Targeting this pathway could result in prevention of anesthetic toxicity in the immature brain. Carbon monoxide (CO) is a gas that exerts biological activity in the developing brain and low dose exposures have the potential to provide neuroprotection. In recent work, low concentration CO exposures limited isoflurane-induced neuronal apoptosis in a dose-dependent manner in newborn mice and modulated oxidative stress within forebrain mitochondria. Because infants and children are routinely exposed to low levels of CO during low-flow general endotracheal anesthesia, such anti-oxidant and pro-survival cellular effects are clinically relevant. Here we provide an overview of anesthesia-related CO exposure, discuss the biological activity of low concentration CO, detail the effects of CO in the brain during development, and provide evidence for CO-mediated inhibition of anesthesia-induced neurotoxicity.
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Affiliation(s)
- Richard J Levy
- Department of Anesthesiology, Columbia University Medical Center, United States.
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7
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Cheng Y, Mitchell-Flack MJ, Wang A, Levy RJ. Carbon monoxide modulates cytochrome oxidase activity and oxidative stress in the developing murine brain during isoflurane exposure. Free Radic Biol Med 2015; 86:191-9. [PMID: 26032170 PMCID: PMC4568063 DOI: 10.1016/j.freeradbiomed.2015.05.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 05/01/2015] [Accepted: 05/21/2015] [Indexed: 12/22/2022]
Abstract
Commonly used anesthetics induce widespread neuronal degeneration in the developing mammalian brain via the oxidative-stress-associated mitochondrial apoptosis pathway. Dysregulation of cytochrome oxidase (CcOX), the terminal oxidase of the electron transport chain, can result in reactive oxygen species (ROS) formation. Isoflurane has previously been shown to activate this enzyme. Carbon monoxide (CO), as a modulator of CcOX, is of interest because infants and children are routinely exposed to CO during low-flow anesthesia. We have recently demonstrated that low concentrations of CO limit and prevent isoflurane-induced neurotoxicity in the forebrains of newborn mice in a dose-dependent manner. However, the effect of CO on CcOX in the context of anesthetic-induced oxidative stress is unknown. Seven-day-old male CD-1 mice underwent 1h exposure to 0 (air), 5, or 100ppm CO in air with or without isoflurane. Exposure to isoflurane or CO independently increased CcOX kinetic activity and increased ROS within forebrain mitochondria. However, exposure to CO combined with isoflurane paradoxically limited CcOX activation and oxidative stress. There were no changes seen in steady-state levels of CcOX I protein, indicating post-translational modification of CcOX as an etiology for changes in enzyme activity. CO exposure led to differential effects on CcOX subunit I tyrosine phosphorylation depending on concentration, while combined exposure to isoflurane with CO markedly increased the enzyme phosphorylation state. Phosphorylation of tyrosine 304 of CcOX subunit I has been shown to result in strong enzyme inhibition, and the relative reduction in CcOX kinetics following exposure to CO combined with isoflurane may have been due, in part, to such phosphorylation. Taken together, the data suggest that CO modulates CcOX in the developing brain during isoflurane exposure, thereby limiting oxidative stress. These CO-mediated effects could have implications for the development of low-flow anesthesia in infants and children to prevent anesthesia-induced oxidative stress.
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Affiliation(s)
- Ying Cheng
- Division of Anesthesiology and Pain Medicine, Children's National Medical Center, The George Washington University School of Medicine and Health Sciences
| | - Marisa J Mitchell-Flack
- Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, 622W. 168th Street, New York, NY 10032, USA
| | - Aili Wang
- Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, 622W. 168th Street, New York, NY 10032, USA
| | - Richard J Levy
- Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, 622W. 168th Street, New York, NY 10032, USA.
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Overdijk LE, van Kesteren PJM, de Haan P, Schellekens NCJ, Dijksman LM, Hovius MC, van den Berg RG, Bakkum EA, Rademaker BMP. Carboxyhaemoglobin formation and ECG changes during hysteroscopic surgery, transurethral prostatectomy and tonsillectomy using bipolar diathermy. Anaesthesia 2014; 70:296-303. [PMID: 25346445 DOI: 10.1111/anae.12877] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2014] [Indexed: 12/01/2022]
Abstract
Diathermy is known to produce a mixture of waste products including carbon monoxide. During transcervical hysteroscopic surgery, carbon monoxide might enter the circulation leading to the formation of carboxyhaemoglobin. In 20 patients scheduled for transcervical hysteroscopic resection of myoma or endometrium, carboxyhaemoglobin was measured before and at the end of the surgical procedure, and compared with levels measured in 20 patients during transurethral prostatectomy, and in 20 patients during tonsillectomy. Haemodynamic data, including ST-segment changes, were recorded. Levels of carboxyhaemoglobin increased significantly during hysteroscopic surgery from median (IQR [range]) 1.0% (0.7-1.4 [0.5-4.9])% to 3.5% (2.0-6.1 [1.3-10.3]%, p < 0.001), compared with levels during prostatectomy or tonsillectomy. Significant ST-segment changes were observed in 50% of the patients during hysteroscopic surgery. Significant correlations were observed between the increase in carboxyhaemoglobin and the maximum ST-segment change (ρ = -0.707, p < 0.01), between the increase in carboxyhaemoglobin and intravasation (ρ = 0.625; p < 0.01), and between intravasation and the maximum ST-segment change (ρ = -0.761; p < 0.01). The increased carboxyhaemoglobin levels during hysteroscopic surgery appear to be related to the amount of intravasation and this could potentially be a contributing factor to the observed ST-segment changes.
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Affiliation(s)
- L E Overdijk
- Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
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9
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Cheng Y, Levy RJ. Subclinical carbon monoxide limits apoptosis in the developing brain after isoflurane exposure. Anesth Analg 2014; 118:1284-92. [PMID: 24413549 DOI: 10.1213/ane.0000000000000030] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Volatile anesthetics cause widespread apoptosis in the developing brain. Carbon monoxide (CO) has antiapoptotic properties, and exhaled endogenous CO is commonly rebreathed during low-flow anesthesia in infants and children, resulting in subclinical CO exposure. Thus, we aimed to determine whether CO could limit isoflurane-induced apoptosis in the developing brain. METHODS Seven-day-old male CD-1 mouse pups underwent 1-hour exposure to 0 (air), 5, or 100 ppm CO in air with or without isoflurane (2%). We assessed carboxyhemoglobin levels, cytochrome c peroxidase activity, and cytochrome c release from forebrain mitochondria after exposure and quantified the number of activated caspase-3 positive cells and TUNEL positive nuclei in neocortex, hippocampus, and hypothalamus/thalamus. RESULTS Carboxyhemoglobin levels approximated those expected in humans after a similar time-weighted CO exposure. Isoflurane significantly increased cytochrome c peroxidase activity, cytochrome c release, the number of activated caspase-3 cells, and TUNEL positive nuclei in the forebrain of air-exposed mice. CO, however, abrogated isoflurane-induced cytochrome c peroxidase activation and cytochrome c release from forebrain mitochondria and decreased the number of activated caspase-3 positive cells and TUNEL positive nuclei after simultaneous exposure with isoflurane. CONCLUSIONS Taken together, the data indicate that CO can limit apoptosis after isoflurane exposure via inhibition of cytochrome c peroxidase depending on concentration. Although it is unknown whether CO directly inhibited isoflurane-induced apoptosis, it is possible that low-flow anesthesia designed to target rebreathing of specific concentrations of CO may be a desired strategy to develop in the future in an effort to prevent anesthesia-induced neurotoxicity in infants and children.
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Affiliation(s)
- Ying Cheng
- From the Division of Anesthesiology and Pain Medicine, Children's National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, DC
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Kern D, Larcher C, Cottron N, Ait Aissa D, Fesseau R, Alacoque X, Delort F, Masquère P, Agnès E, Visnadi G, Fourcade O. [The choice of a pediatric anesthesia ventilator]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2013; 32:e199-e203. [PMID: 24209991 DOI: 10.1016/j.annfar.2013.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The technology of anesthesia ventilators has substantially progressed during last years. The choice of a pediatric anesthesia ventilator needs to be led by multiple parameters: requirement, technical (pneumatic performance, velocity of halogenated or oxygen delivery), cost (purchase, in operation, preventive and curative maintenance), reliability, ergonomy, upgradability, and compatibility. The demonstration of the interest of pressure support mode during maintenance of spontaneous ventilation anesthesia makes this mode essential in pediatrics. In contrast, the financial impact of target controlled inhalation of halogenated has not be studied in pediatrics. Paradoxically, complex and various available technologies had not been much prospectively studied. Anesthesia ventilators performances in pediatrics need to be clarified in further clinical and bench test studies.
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Affiliation(s)
- D Kern
- EA 4564 MATN, IFR 150, département d'anesthésie et de réanimation, CHRU Toulouse Purpan, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France.
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Cardwell K, Pan Z, Boucher R, Zuk J, Friesen RH. Screening by pulse CO-oximetry for environmental tobacco smoke exposure in preanesthetic children. Paediatr Anaesth 2012; 22:859-64. [PMID: 22587734 PMCID: PMC3407336 DOI: 10.1111/j.1460-9592.2012.03867.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the ability of multiple wavelength pulse CO-oximetry (SpCO) to screen for environmental tobacco smoke (ETS) exposure in children. BACKGROUND Exposure to ETS is associated with an increased risk of perioperative respiratory complications in children. It is often difficult to obtain an accurate history for ETS exposure, so a preoperative screening tool is desirable. Carbon monoxide is a measurable product of tobacco combustion. Multiple wavelength pulse CO-oximetry is a recently developed point-of-care monitor. METHODS Following IRB approval and parental consent, 220 children aged 1-16 years having outpatient surgical procedures were enrolled. SpCO was measured preoperatively three times with the Radical-7 Rainbow SET CO-oximeter (Masimo, Irvine, CA, USA). Immediately following induction of anesthesia, a blood sample for laboratory measurement of carboxyhemoglobin (COHb) and serum cotinine was obtained. Regression analysis determined the correlation of SpCO with serum cotinine values. Receiver operator characteristic (ROC) curves analyzed the discriminating ability of SpCO or COHb to predict ETS exposure based on cotinine cutoff values known to be present in children exposed to ETS. Agreement of SpCO and COHb values was assessed using Bland-Altman plots. RESULTS SpCO did not correlate with cotinine (R(2) = 0.005). Both SpCO and COHb had poor discriminating ability for ETS exposure (area under the ROC curve = 0.606 and 0.562, respectively). SpCO values had poor agreement with COHb values. CONCLUSIONS The point-of-care multiple wavelength pulse CO-oximeter does not appear to be a useful preoperative screening tool for ETS exposure in children.
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Affiliation(s)
- Kathryn Cardwell
- Department of Anesthesiology, Children’s Hospital Colorado and University of Colorado School of Medicine, Denver, Colorado, USA
| | - Zhaoxing Pan
- Department of Research Institute, Children’s Hospital Colorado and University of Colorado School of Medicine, Denver, Colorado, USA
| | - Rebecca Boucher
- Department of Anesthesiology, Children’s Hospital Colorado and University of Colorado School of Medicine, Denver, Colorado, USA
| | - Jeannie Zuk
- Department of Anesthesiology, Children’s Hospital Colorado and University of Colorado School of Medicine, Denver, Colorado, USA
| | - Robert H. Friesen
- Department of Anesthesiology, Children’s Hospital Colorado and University of Colorado School of Medicine, Denver, Colorado, USA
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The current status of continuous noninvasive measurement of total, carboxy, and methemoglobin concentration. Anesth Analg 2012; 114:972-8. [PMID: 21965370 DOI: 10.1213/ane.0b013e318233041a] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intraoperative early detection of anemia, identifying toxic levels of carboxyhemoglobin after carbon monoxide exposure and titrating drug dosage to prevent toxic levels of methemoglobin are important goals. The pulse oximeter works by illuminating light into the tissue and sensing the amount of light absorbed. The same methodology is used by laboratory hemoglobinometers to measure hemoglobin concentration. Because both devices work in the same way, efforts were made to modify the pulse oximeter to also measure hemoglobin concentration. Currently there are 2 commercial pulse oximeters (Masimo Rainbow SET and OrSense NBM-200MP) that measure total hemoglobin concentration and one (Masimo) that also measures methemoglobin and carboxyhemoglobin. In this review, we describe the peer-reviewed literature addressing the accuracy of these monitors.
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13
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Levy R. Reply from the authors. Br J Anaesth 2012. [DOI: 10.1093/bja/aer465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Tomatir E, Bozkurt-Sutas P. Low-flow anaesthesia and carbon monoxide in paediatric patients. Br J Anaesth 2012; 108:324; author reply 824-5. [DOI: 10.1093/bja/aer470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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15
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Levy R. Reply from the authors. Br J Anaesth 2011. [DOI: 10.1093/bja/aer017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Nasr V, Emmanuel J, Deutsch N, Slack M, Kanter J, Ratnayaka K, Levy R. Carbon monoxide re-breathing during low-flow anaesthesia in infants and children. Br J Anaesth 2010; 105:836-41. [PMID: 20947594 DOI: 10.1093/bja/aeq271] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Carbon monoxide (CO) has been detected within anaesthesia breathing systems. One potential source in this setting is exhaled endogenous CO. We hypothesized that CO is re-breathed during low-flow anaesthesia (LFA) in infants and children. METHODS Twenty children (age 2 months-7 yr) undergoing general anaesthesia were evaluated in a prospective observation study. LFA was established for 60 min followed by high-flow anaesthesia (HFA) for the next 60 min. Exhaled and inspired CO were measured every 5 min within the breathing circuit. Carboxyhaemoglobin (COHb%) was measured at baseline, at 60 min, after LFA, and at 120 min, after HFA. RESULTS CO concentrations increased during LFA. Inspired CO peaked at 14 ppm. During HFA, exhaled CO levels remained constant whereas inspired CO decreased markedly. Exhaled and inspired CO during HFA differed significantly from LFA. The trajectory of change in exhaled and inspired CO was most closely associated with the fresh-gas flow (FGF):minute ventilation ratio. COHb% significantly increased in children <2 yr of age at 60 min after LFA and remained increased. CONCLUSIONS LFA increased exhaled and inspired CO and increased COHb% in children <2 yr of age. Thus, LFA resulted in re-breathing of exhaled CO and exposure, especially in the youngest children. Re-breathing exhaled gas during LFA could pose a risk for an acute CO exposure in patients who have elevated COHb and high baseline levels of exhaled CO. If practitioners match or exceed minute ventilation with FGF to avoid LFA, CO re-breathing can be limited.
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Affiliation(s)
- V Nasr
- Division of Anesthesiology and Pain Medicine, Children's National Medical Center, The George Washington University School of Medicine and Health Sciences, 111 Michigan Ave., NW, Washington, DC 20010, USA
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