Association of Ethnicity with the Minimum Alveolar Concentration of Sevoflurane

Ezri, Tiberiu; Sessler, Daniel I.; Weisenberg, Marian; Muzikant, Gleb; Protianov, Michael; Mascha, Edward J.; Evron, Shmuel

doi:10.1097/01.anes.0000267534.31668.62

Cited by 32 publications

(22 citation statements)

References 29 publications

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“…A limitation of this study is that data were all collected from an Asian population. Although the MAC of sevoflurane has limited variability within a population , ethnic differences may still exist and, therefore, our results might not be extrapolated to other populations. Our random sampling led to unequal sex ratios in the two groups, but we think this was unlikely to have influenced our results, as MAC does not seem to be influenced by sex in most published studies .…”

Section: Discussionmentioning

confidence: 97%

Sevoflurane‐induced isoelectricEEGand burst suppression: differential and antagonistic effect of added nitrous oxide

et al. 2017

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SummaryThe objective of this study was to investigate whether nitrous oxide influenced the ED50 of sevoflurane for induction of isoelectric electroencephalogram (ED50isoelectric) differently from its influence on the ED50 of sevoflurane for electroencephalogram burst suppression (ED50burst). In a prospective, randomised, double‐blind, parallel group, up–down sequential allocation study, 77 ASA physical status 1 and 2 patients received sevoflurane induction and, after tracheal intubation, were randomly allocated to receive sevoflurane with either 40% oxygen in air (control group) or 60% nitrous oxide in oxygen mixture (nitrous group). The ED50isoelectric in the two groups was determined using Dixon's up and down method, starting at 2.5% with 0.2% step size of end‐tidal sevoflurane. The electroencephalogram was considered as isoelectric when a burst suppression ratio of 100% lasted > 1 min. The subsequent concentrations of sevoflurane administered were determined by the presence or absence of isoelectric electroencephalogram in the previous patient in the same group. The ED50isoelectric in the nitrous group 4.08 (95%CI, 3.95–4.38)% was significantly higher than that in the control group 3.68 (95%CI, 3.50–3.78)% (p < 0.0001). The values for ED50burst were 3.05 (95%CI, 2.66–3.90)% and 3.02 (95%CI, 3.00–3.05)% in nitrous group and control group, respectively (p = 0.52). The addition of 60% nitrous oxide increases ED50isoelectric, but not the ED50burst of sevoflurane. Neither result indicates an additive effect of anaesthetic agents, as might be expected, and possible reasons for this are discussed.

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Section: Discussionmentioning

confidence: 97%

Sevoflurane‐induced isoelectricEEGand burst suppression: differential and antagonistic effect of added nitrous oxide

et al. 2017

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“…[2491516] In addition, there has been speculation about the influence of genetics and ethnic differences on anesthetic requirements; this may have also contributed to the low incidence of awareness in our study as compared to western population. [517]…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of awareness may vary among patient population due to differences in genetic make-up and anesthesia technique. [5] Awareness in the Indian population has never been studied; hence, we prospectively evaluated the incidence of awareness in cancer patients population would be no higher than 3%, which is the reported incidence in the Western world.…”

Section: Introductionmentioning

confidence: 99%

Awareness during general anesthesia: An Indian viewpoint

Ambulkar

Agarwal

Ranganathan

et al. 2016

J Anaesthesiol Clin Pharmacol

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Background and Aims:The incidence of intra-operative awareness with explicit recall in the Western world has been reported to be between 0.1% and 0.2% in the general surgical population and up to 1–2% of patients at high risk for this complication. Awareness in the Indian population has never been studied; we therefore wanted to detect the incidence of awareness in patients who were at high risk of experiencing awareness during surgery in our population.Material and Methods:We conducted a prospective single-center observational study at a 600-bedded tertiary cancer care referral hospital. We recruited adult patients posted for major cancer surgery who were considered to be at high risk for awareness. These patients were interviewed at three time-points using the structured modified Brice interview questionnaire. The primary outcome studied was the incidence of definite intra-operative awareness.Results:A total of 934 patients were included in the final analysis of which none reported awareness. Using the rule of three (Hanley and Lippman-Hand) we conclude that the upper 95% confidence interval for the incidence of awareness in this population is <1 in 300 (0.33%).Conclusion:Awareness under anesthesia is a distressing complication with a potential for long-term psychological consequences, and every effort should be undertaken to prevent it. It is reassuring though that our data in Indian cancer patients at high risk for intra-operative awareness suggests that it is an uncommon occurrence.

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“…Partial blinding was achieved by Ezri et al. in another, single‐centre study of ethnicity and the minimum alveolar concentration of sevoflurane [4]. Observers were not apparently blinded to patients’ ethnic group but were unaware of sevoflurane concentration when recording whether movement on incision occurred.…”

Section: Discussionmentioning

confidence: 99%

Effect of ethnicity on the hypnotic and cardiovascular characteristics of propofol induction

et al. 2010

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We compared the propofol dose causing loss of verbal response and suppression of bispectral index to 50, between 50 white and 50 black patients, aged 18-65 years. Propofol was administered at 40 mg.kg )1 .h )1 and reduced to 8 mg.kg.h )1 when bispectral index fell to 50. We recorded heart rate and mean arterial pressure for 15 min in total and calculated, for this period, maximal percentage change from baseline for each. A statistician, blinded to patient ethnicity, found mean (SD) propofol dose for loss of verbal response in white and black patients to be 1.41 (0.37) mg.kg change in heart rate were 14.1 (12.6) % and 7.5 (14.0) % (p = 0.015). Other differences were non-significant. The dose of propofol required for loss of verbal response, but not for suppression of bispectral index to 50, is lower in black than in white patients. In the last decade it has been suggested that ethnicity may affect the clinical response to general anaesthetics [1-4], with Caucasian subjects generally shown to be less susceptible to the anaesthetic effects of propofol than other races [1][2][3]. To date, however, the effect of ethnicity on the induction dose of propofol has not been fully investigated. In our earlier study on anxiety and propofol induction [5], we used multivariate analysis to investigate factors independently predictive of propofol dose requirement for loss of verbal response. In doing so, we established that white ethnicity was associated with greater propofol dose requirement than other ethnic groups.To investigate this incidental finding further, we studied a new group of patients using a study design better suited to address specifically the issue of ethnicity. Our aim was to determine whether the induction dose of propofol differs between British patients describing themselves as white and black. Our null hypothesis was that ethnicity does not affect the dose of propofol required to produce loss of verbal response. We also sought to establish whether the initial cardiovascular characteristics of propofol anaesthesia differ between white and black patients. MethodsWith Research Ethics Committee approval and written informed consent, we recruited 269 patients of ASA physical status 1-2, aged 18-65 years, scheduled for surgery under general anaesthesia. We did not study patients who were of neither white nor black ⁄ black

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Association of Ethnicity with the Minimum Alveolar Concentration of Sevoflurane

Abstract: The results suggest that minimum alveolar concentration varies as a function of ethnicity. However, the extent to which confounding characteristics contribute, including lifestyle choices and environmental factors, remains unknown.

Cited by 32 publications

References 29 publications

Sevoflurane‐induced isoelectricEEGand burst suppression: differential and antagonistic effect of added nitrous oxide

Sevoflurane‐induced isoelectricEEGand burst suppression: differential and antagonistic effect of added nitrous oxide

Awareness during general anesthesia: An Indian viewpoint

Effect of ethnicity on the hypnotic and cardiovascular characteristics of propofol induction

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