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Anesthesia-Associated Carbon Monoxide Exposures Among Surgical Patients

Published online by Cambridge University Press:  02 January 2015

Michele L. Pearson ,
William C. Levine ,
Robert J. Finton ,
Charles T. Ingram ,
Kathleen B. Gay ,
Gerda Tapelband ,
J. David Smith  and
William R. Jarvis
Michele L. Pearson*
Affiliation:
Division of Healthcare Quality Promotion, Georgia Department of Human Resources, Atlanta, Georgia
William C. Levine
Affiliation:
National Center for Infections Diseases, and the Epidemiology Program Office, Centers for Disease Control and Prevention, Georgia Department of Human Resources, Atlanta, Georgia Epidemiology Office, Georgia Department of Human Resources, Atlanta, Georgia
Robert J. Finton
Affiliation:
Office of Epidemiology, Fulton County Health Department, Georgia Department of Human Resources, Atlanta, Georgia
Charles T. Ingram
Affiliation:
Department of Anesthesiology, Emory University School of Medicine, Georgia Department of Human Resources, Atlanta, Georgia
Kathleen B. Gay
Affiliation:
Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Georgia Department of Human Resources, Atlanta, Georgia
Gerda Tapelband
Affiliation:
Division of Healthcare Quality Promotion, Georgia Department of Human Resources, Atlanta, Georgia
J. David Smith
Affiliation:
Epidemiology Office, Georgia Department of Human Resources, Atlanta, Georgia
William R. Jarvis
Affiliation:
Division of Healthcare Quality Promotion, Georgia Department of Human Resources, Atlanta, Georgia
*
Division of Healthcare Quality Program, Centers for Disease Control and Prevention, MS E-68, 1600 Clifton Rd NE, Atlanta, GA 30333
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Abstract

Objective:

To estimate the extent of, and evaluate risk factors for, elevated carboxyhemoglobin levels among patients undergoing general anesthesia and to identify the source of carbon monoxide.

Design:

Matched case-control study to measure carboxyhemoglobin levels.

Setting:

Large academic medical center.

Participants:

45 surgical patients who underwent general anesthesia.

Results:

Case-patients were more likely than controls to undergo surgery on Monday or Tuesday (10/15 vs 7/30; matched odds ratio [mOR], 7.7; 95% confidence interval [CI95], 1.8-34; P=.01), in one particular room (7/15 vs 4/30; mOR, 8.5; CI95, 1.5-48; P=.03) or in a room that was idle for ≥24 hours (11/15 vs 1/30; mOR, 95.5; CI95, 8.0-1,138; P≤.001). In a multivariate model, only rooms, and hence the anesthesia equipment, that were idle for ≥24 hours were independently associated with elevated intraoperative carboxyhemoglobin levels (OR, 22.4; CI95, 1.5-338; P=.025). Moreover, peak carboxyhemoglobin levels were correlated with the length of time that the room was idle (r=0.7; CI95, 0.3-0.9). Carbon monoxide was detected in the anesthesia machine outflow during one case-procedure. No contamination of anesthesia gas supplies or CO2 absorbents was found.

Conclusions:

Carbon monoxide may accumulate in anesthesia circuits left idle for ≥24 hours as a result of a chemical interaction between CO2-absorbent granules and anesthetic gases. Patients administered anesthesia through such circuits may be at increased risk for elevated carboxyhemoglobin levels during surgery or the early postoperative period.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 6 , June 2001 , pp. 352 - 356
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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