The world’s first strong-alkali free absorbent AMSORB® PLUS The world’s first strong-alkali free absorbent

Free from Sodium, Potassium, Lithium and Barium Hydroxide AMSORB® PLUS Free from Sodium, Potassium, Lithium and Barium Hydroxide

The world’s first strong-alkali free absorbent AMSORB® PLUS The world’s first strong-alkali free absorbent

Chemical Formulations & Performance Composition of Absorbents AMSORB® PLUS Brochure Page 06 Chemical Formulations & Performance AMSORB® PLUS is not a soda lime since it does not contain sodium hydroxide (NaOH). None of the risks associated with soda limes apply to AMSORB® PLUS. Leading brands of soda lime all contain NaOH.

The significance of NaOH within a C02 absorbent Alkalinity of Soda Lime AMSORB® PLUS Brochure Page 10 The significance of NaOH within a C02 absorbent As the moisture content decreases, concentration of NaOH increases. At 5% moisture, soda lime causticity causes agent degradation. Desiccated soda limes are treated as hazardous waste. Desiccated soda limes are unsafe to handle. 4.1% 3.5% 16% 5% Moisture 0%

AMSORB® PLUS contains 0% NaOH

Colour Change Soda lime colour change is not a reliable indicator. AMSORB® PLUS Brochure Page 04 Colour Change Soda lime colour change is not a reliable indicator. Colour change in soda lime is based on alkalinity (pH). Coloration in soda lime reverts to original state when not used for a few hours. To use soda lime safely, it is necessary to dispose of a % of useable product. AMSORB® PLUS colour change is based on moisture content.

AMSORB® PLUS has a permanent colour change

Application / Clinical Realities When do you change Application / Clinical Realities When do you change? Change at ¼ colour change Change at ½ colour change Change at ¾ colour change

Scenario One – ¼ Colour Change APSF - Six steps to safely use soda lime. Turn off all gas flow when the machine is not in use. Change absorbent regularly, Monday morning for instance. Change absorbent whenever colour change indicates exhaustion. Change all absorbent, not just 1 canister in a 2 canister system. Change absorbent when uncertain of the state of hydration. If compact canisters are used, consider changing them more often. If these steps are followed the volume of absorbent used will increase significantly

Cost of safely using a soda lime ¼ Colour Change Cost of safely using a soda lime Analysis of Discarded Soda Lime; Economic & Practice Implications Franklin V. Cobos II, M.D., Max T. Baker, Ph.D., John H. Tinker, M.D Department of Anesthesiology, Nebraska Medical Center, Omaha, Nebraska Usable absorption capacity remaining ranged from 14% to 73%, with an average of 45%

Scenario 2 – ½ Colour Change Concerned about colour reversal Concerned about harmful toxins Wasting usable product

Scenario Three – ¾ Colour Change Carbon Monoxide Production AMSORB® PLUS Brochure Page 08 Scenario Three – ¾ Colour Change Carbon monoxide (CO) is not measured or monitored during anesthesia. The brand which produces CO at the lowest level is LoFloSorb – 525ppm. The brand which produces CO at the highest level is Medisorb – 13,317ppm!  

The significance of NaOH within a C02 absorbent Alkalinity of Soda Lime AMSORB® PLUS Brochure Page 10 The significance of NaOH within a C02 absorbent As the moisture content decreases, concentration of NaOH increases. At 5% moisture, soda lime causticity causes agent degradation. Desiccated soda limes are treated as hazardous waste. Desiccated soda limes are unsafe to handle. 4.1% 3.5% 16% 5% Moisture 0%

AMSORB® PLUS cannot produce CO

Formaldehyde AMSORB® PLUS is not a soda lime (NaOH). Leading brands of soda lime all contain NaOH. NaOH causes anaesthetic agent degradation which has three side effects. Production of: Carbon Monoxide (CO) Compound A Formaldehyde Formaldehyde (HCOH) is produced when passing sevoflurane through certain brands of desiccated absorbent. Bedi A et al state “Sevoflurane is degraded to formaldehyde when passed through dry CO2 absorbents that contain strong alkali. Point 1. None of the risks associated with soda limes apply to AMSORB® PLUS. Point 2. Self explanatory Point 3. Sodium hydroxide (NaOH) causes anaesthetic agent degradation which has three side effects; production of: Carbon Monoxide (CO) Compound A Formaldehyde Point 4. Formaldehyde (HCOH) is produced when passing sevoflurane through certain brands of desiccated absorbent. HCOH is a potent inhalation irritant and carcinogen and should never be administered to patients. Postoperative nausea and vomiting (PONV) is caused by HCOH inhalation. Point 5. Bedi A et al state “Sevoflurane is degraded to formaldehyde when passed through dry CO2 absorbents that contain strong alkali. Formaldehyde was not detected when sevoflurane was exposed to either fresh or dry Amsorb.

AMSORB® PLUS cannot produce HCOH

To Summarise - The significance of NaOH within a C02 absorbent Alkalinity of Soda Lime AMSORB® PLUS Brochure Page 10 To Summarise - The significance of NaOH within a C02 absorbent As the moisture content decreases, concentration of NaOH increases. At 5% moisture, soda lime causticity causes agent degradation. Desiccated soda limes are treated as hazardous waste. Desiccated soda limes are unsafe to handle. 4.1% 3.5% 16% 5% Moisture 0%

Agent Adsorption AMSORB® PLUS Brochure Page 09 Agent Adsorption Soda lime becomes more caustic as it dries out. A caustic soda lime has the ability to adsorb and break down the anaesthetic agent. Waste of anaesthetic drug. Implications for the hospital = increased drug costs.

The AMSORB® PLUS Approach Change only when indicated by capnometry Do NOT change until FiC02 exceeds 0.5%(5mmHg) Colour change is a visual indicator Efficient drug delivery Less time to equilibration Safe handling & disposal Affordable Cartridge options for all Anaesthesia workstations

Safety with Savings Mannion et al, 2011 Cost Implications Safety with Savings Mannion et al, 2011 Cost implications of replacing soda lime with AMSORB® PLUS Soda lime changed as per APSF guidelines. AMSORB® PLUS was used until breakthrough. 58% more soda lime was used than AMSORB® PLUS

Costing you Less The AMSORB® PLUS Challenge The Mannion study provides the basis for The AMSORB® PLUS Challenge The demonstrates that replacing soda lime with AMSORB® PLUS can achieve:  25.7% Annual Anaesthetic Gas Savings Annual savings of $272,818 per hospital with 50 operating rooms $7.96 savings per patient 58% less absorbent used A six–fold reduction in absorbent disposal costs What can AMSORB® PLUS do for your facility?

Take the AMSORB® PLUS Challenge Safety No risk to patient or end user Efficiency Excellent C02 Absorption Use less Anaesthetic Drug Lower gas flow Environmental Safe for Waste Disposal Non toxic Safe for land fill

Summary What have we learned?  AMSORB® PLUS is the safest C02 absorbent available, it’s not capable of anaesthetic degradation 70+ independent clinical publications Soda lime causticity increases as it’s moisture decreases (C02 absorption) AMSORB® PLUS has a Permanent colour change – Soda lime will colour revert How do I tell when my Soda lime becomes unsafe to use??? Adsorption – Soda lime is a subtle thief Safety with $avings – Compromise no longer!

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