The iso-MAC charts show clearly how patient age can be used to guide the choice of end-expired agent concentration. They also allow a consistent total MAC to be maintained when changing the inspired nitrous oxide concentration, thereby reducing the chance of inadvertent awareness, particularly at the extremes of age.
It is well known that MAC, the minimum alveolar concentration required to prevent movement in response to surgical incision in 50% of patients, decreases with age. Regression analysis showed that data for humans derived from a comprehensive literature survey were consistent, for age > 1 yr, with log10 MAC decreasing with increasing age at the same rate for all inhaled anaesthetics; approximately equivalent to 6% change per decade of age. With some slight reservation on differences between data from different institutions, the present data for humans are consistent (for age > 1 yr), with the equation MAC = a x 10bx where x = difference in age (in years) from 40, b = -0.00269 (95% confidence limits (CL) -0.0030, -0.0024) and a = MAC at age 40 yr, which, for anaesthetics currently in use clinically, is given by: halothane, 0.75%; isoflurane, 1.17%; enflurane, 1.63%; sevoflurane, 1.80%; desflurane 6.6%; nitrous oxide, 104%; with 95% CL of approximately +/- 7% (+/- 10% for desflurane, +/- 17% for enflurane).
SummaryIn a randomised cross-over study, 48 anaesthetists attempted to place a Frova single-use introducer, an Eschmann multiple-use introducer and a Portex single-use introducer in the trachea of a manikin set up to simulate a grade 3 laryngoscopic view. The anaesthetists were blinded to success (tracheal placement) or failure (oesophageal placement). Successful placement (proportion, 95% confidence interval) of either the Frova introducer (65%, 50-77%) or the Eschmann introducer (60%, 46-73%) was significantly more likely than with the Portex introducer (8%, 3-20%). There were no significant differences between the success rates for the Frova and the Eschmann introducers. A separate experiment revealed that the peak force exerted by the Frova and Portex introducers was two to three times greater than that which could be exerted by the Eschmann introducer, p < 0.0001, indicating that the single-use introducers are more likely to cause tissue trauma during placement.
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