Acute respiratory distress syndrome after an exothermic Baralyme-sevoflurane reaction.

ALL modern volatile anesthetics produce carbon monoxide in strongly exothermic reactions with anhydrous carbon dioxide absorbents. Although desflurane produces the most carbon monoxide, the reaction with sevoflurane produces the most heat. Using real anesthesia machines, sevoflurane, and desiccated Baralyme® (Allied Healthcare Products, Inc., St. Louis, MO), peak absorbent canister temperatures of 100–401°C have been documented. In six clinical cases, sevoflurane reacted with dry soda lime to produce hot canisters and, in two of these cases, 4–9% carboxyhemoglobin. We report a sevoflurane reaction with Baralyme® associated with melted absorbent cartridges, thermochemically-induced acute respiratory distress syndrome, and 29% carboxyhemoglobin.