VOLATILE ANESTHETIC TOXICITIES

VOLATILE ANESTHETIC

TOXICITIES

• Carbon monoxide can accumulate due to desflurane
degradation by dry CO 2 absorbent, especially barium
hydroxide . Th is can also occur with sevoflurane and
isoflurane. Avoid this by discarding desiccated CO 2
absorbent.
• High-output renal failure can result from fluoride
levels greater than 50 micromoles per liter produced by
methoxyflurane metabolism.
• Compound A accumulation results from sevoflurane
degradation with soda lime or barium hydroxide lime.
Ensure fresh gas fl ows greater than 2 L/min to avoid
rebreathing of Compound A.
• Macrocytic anemia can be caused by nitrous oxide
exposure because it irreversibly oxidizes the cobalt
atom in vitamin B12 and thus inhibits all vitamin
B12-dependent enzymes. Nitrous oxide increases the risk
of bone marrow suppression, macrocytic anemia, and
peripheral neuropathies .
• Fulminant hepatic necrosis and less severe hepatic
dysfunction have been associated with halothane
exposure. It is most likely in obese middle-aged women
who are exposed to multiple halothane anesthetics in a
short period of time.