[Preventing toxic substances production during carbon dioxide absorption by soda lime with halogenate anesthetics.]

Since the beginning, soda lime use has presented some complications which resulted in its difficult application. However major advantages such as decreasing fresh gas flow, anesthetic consumption and operating room pollution, and improving breathing system and airway humidity, have pushed research forward to improve it and assure the continuity of its use. Currently, there are problems with dehydration, increased temperature and metabolic degradation of halogenate agents, which require special care to prevent toxic substances formation.

There is a chain reaction as from dehydrated or dried out soda lime with very low percent volume of water. There is increased temperature, more halogenate anesthetic absorption by lime granules, followed by higher metabolic degradation of these agents' molecules and, as a consequence, the production of toxic substances, such as Compound A by reaction of hydroxides with sevoflurane. There is also carbon monoxide production by reaction of halogenate anesthetics and strong lime bases. Compound A is nephrotoxic and carbon monoxide may lead to hypoxia and severe coagulation problems. In addition to care with soda lime hydration it is possible to use it without strong bases, such as potassium and sodium hydroxides, with just calcium hydroxide to prevent excessive temperature increase and major metabolic degradation of halogenate anesthetics without impairing carbon dioxide absorption.

Care should be taken to use the newest possible soda lime; and when it is exposed to environment (dry air) for many hours, such as during weekends (more than 48 hours) it is recommended to add distilled water in the ratio of 25 mL to 500 g of soda lime. Industry is currently well aware of lime composition problems so, soda lime containing exclusively calcium hydroxide and totally potassium and sodium hydroxide-free should be preferred.