Bell Medical’s mission is to introduce innovative technology to anesthesia providers in hospitals and surgery centers. We show our commitment to this mission by supporting anesthesia societies such as the American Association of Anesthesiologist or ASA, the American Association of Nurse Anesthetist or AANA and the American Society of Technicians and Technologists or the ASATT. We also attend numerous state anesthesia meetings for both MDs and CRNAs. We invest over $50,000 annually to attend both national, regional and state association meetings. The listing below is some of the anesthesia meetings we attend to exhibit our innovative technologies. Please visit our booth!
When choosing a type of CO2 absorbent, it is important to understand the absorbents environmental impact, effect on patient safety, ease of use and the effect on the consumption of volatile anesthetics. Today we are going to review Amsorb vs. soda limes that contain traces of Sodium Hydroxide, NaOH, such as Medisorb, Sodasorb, Dragersorb and others.
Soda limes can have a pH of up to 14 and may require disposal as a hazardous waste according to U.S. Federal Code of Regulations. Soda limes contain sodium hydroxide and are considered corrosive.
Amsorb Plus has a pH of less than 12.5 and is safe for our water table and landfills where it will break down into harmless organic compounds. Amsorb Plus comes with certification of such (see Amsorb Plus disposal document). Kaiser Permanente independently tested all the types of CO2 absorbents readily available on the market and determined Amsorb Plus to be the only one that was safe for disposal in regular landfills. Other types of CO2 absorbents had higher pH and needed to be red bagged and incinerated at greater expense. Amsorb Plus is not harmful in disposal to the environment which translates into a cost savings for hospitals and surgery centers since red bagging is expensive and time consuming.
Soda limes are known to degrade volatile anesthetics to Carbon Monoxide, Compounds A – F, and Formaldehyde.
Amsorb Plus has no strong alkali and is incapable of producing any of these toxins. Clinical Anesthesia by Barash, 2012, recommends using Amsorb Plus by name and states doing so: (Amsorb Plus)
eliminates all of the potential complications related to anesthetic breakdown and therefore minimizes the possibility of additional costs from those complications, including additional laboratory tests, hospital days, and medical/legal expenses. Adoption of [Amsorb Plus] into routine clinical practice is consistent with the patient safety goals of our anesthesia society.
Ease of Use & Consumption of Volatile Anesthetic
Soda Lime users generally change absorbent based on color change and never know for sure when to change product. Users usually error on the side of caution and change soda lime more often (a wasteful and confusing practice) because if they don’t change soda lime it is possible to endanger the patient by producing toxins such as Compound A, Formaldehyde and Carbon Monoxide. Soda Lime includes a dye that changes color to indicate exhaustion. However, it does not retain color change for long before reverting back to looking fresh. The user can never be sure when product should be changed. Ask any clinician that has used a soda lime and they will verify it is not uncommon to begin a case with what they think is fresh absorbent only to immediately find out they have high levels of FiCO2 and rapid color change of their absorbent.
Soda Limes “adsorbs” (significant amounts of volatile anesthetic which means clinicians wait longer periods of time for their machines and vaporizers to equilibriate. They are less able to reach desired drug percentages without increasing vaporizer settings.
Amsorb Plus has permanent, consistent, and reliable color change. Thus allowing the user to easily tell the state of the absorbent at a glance. Amsorb Plus also adsorbs far less anesthetic vapor than soda limes so machines and vaporizers reach equilibriation faster and accurately reach desired drug percentages without needing to increase vaporizer settings above what is desired for patient inspiration. This saves time and money (utilizing less anesthetic vapor).
Richard J. Levy, MD,* Viviane G. Nasr, MD,* Ozzie Rivera, BS,† Renee Roberts, MD,* Michael Slack, MD,‡ Joshua P. Kanter, MD,‡ Kanishka Ratnayaka, MD,‡ Richard F. Kaplan, MD,*and Francis X. McGowan, Jr., MD§ (Anesth Analg 2010;110:747–53)
Excerpts and quotes from the study:
Carbon Monoxide was detected routinely during general anesthesia in infants and children when using fresh GE Medisorb, a soda lime. (It has long been known that CO is produced in desiccated soda lime yet surprising to be found when using fresh soda lime.)
Carbon Monoxide is a known neurotoxin. Exposure to low concentrations of CO (12.5ppm) can cause neurotoxicity in the developing brain and may lead to neuro developmental impairment. Peak CO levels measured in the anesthesia breathing circuit were in the range thought to impair the developing brain.
The study suggests that use of carbon dioxide adsorbents that lack strong metal hydroxide (ie. the Amsorb Plus CO2 absorbent) could limit inspired CO if detection was attributed to degradation of volatile anesthetic. …findings suggest the use of carbon dioxide absorbents that lack strong metal hydroxide (the Amsorb Plus CO2 absorbent does not use strong metal hydroxides).
Young children exposed to inhaled anesthetics were twice as likely to develop behavioral or developmental disorders after exposure.
The study measured CO levels in the circuit and in the blood stream via COHb.
CO binds 240 times more avidly to hemoglobin than oxygen.
The APSF recommends using adsorbents that do not use strong metal hydroxides(sodium hydroxide), (the Amsorb Plus CO2 absorbent does not use strong metal hydroxides or sodium hydroxide).
The APSF recommended not using absorbents based on strong alkali or metal hydroxides. The Amsorb Plus CO2 absorbent does not contain strong alkali or metal hydroxides and is thus recommended by the APSF.
Come visit our booth #2812 at the American Association of Anesthesiologist (ASA Meeting 2015) in San Diego! We are introducing the Alar Nasal Sensor, the Stimpod 450 TOF Monitor and BevMD to anesthesiologists.
Amsorb Plus CO2 Absorbent improves patient safety by eliminating potential toxins plus it provides permanent color change so you always know the status of your absorbent. Your health organization is currently using GE Medisorb which is a traditional sodalime that can produce toxins when desiccated or fully spent. Since your facility does not change your absorbent until you have a reading of over 5 mmHg inspired CO2 the risk of exposure to toxins such as Compound A, Carbon Monoxide and Formaldehyde is increased. With Amsorb Plus you can continue to push your absorbent to complete exhaustion with no worry of toxins. Because Amsorb Plus CO2 Absorbent produces no toxins ever, your clinicians may also deliver lower flows while administering Sevoflurane and thus save the hospital system thousands. Amsorb Plus CO2 Absorbent is part of many health systems “green initiative” because Amsorb Plus has a lower pH than sodalimes such as GE Medisorb when spent. Amsorb Plus is NOT a sodalime. Amsorb Plus CO2 Absorbent is safe for the environment and safe for landfills. GE Medisorb and sodalime are often required to be “red bagged” for incineration at great expense due to spent sodalime’s high pH (see attached Kaiser Permanente disposal document).
Amsorb Plus CO2 Absorbent
Amsorb Plus offers numerous benefits at no additional cost for the actual absorbent. We offer Amsorb Plus CO2 Absorbent under our price matching program that guarantees savings since you save on anesthetic agent and on product disposal.
Bell Medical would be happy to provide you with product to conduct your own evaluation and trial with the hopes that your positive experience would allow Amsorb Plus to be considered as a product of choice. Please review the attachments and let us know how best to proceed with a local or corporate evaluation. Thank you for your interest and support.