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Engström Elsa Anesthesia System (Engström Elsa) was modified to make sevoflurane administration possible, and low-flow sevoflurane anesthesia using this modified anesthesia machine was administered to 10 surgical patients. Among the breakdown products of sevoflurane, CF2 = C (CF3) OCH2F (compound A) was 14.0 +/- 7.8 ppm after the first hour of anesthesia, and remained at this level until 7 hours. CH3OCF2CH(CF3)OCH2F (compound B) was detected in 3 of 10 patients, and these concentrations were below 0.5 ppm. No patient had clinical or laboratory evidence of organ toxicity. Low-flow sevoflurane anesthesia using modified Engström Elsa can be performed safely and easily. Although low levels of two breakdown products were detected, clinical laboratory tests showed no abnormality in hepatic or renal function.
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