Concentrations of Desflurane and Propofol That Suppress Response to Command in Humans

Chortkoff, Ben S.; Eger, Edmond I.; Crankshaw, D. P.; Gonsowski, Charles T.; Dutton, Robert C.; Ionescu, Pompi

doi:10.1213/00000539-199510000-00014

Cited by 17 publications

(24 citation statements)

References 22 publications

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“…MACawake for desflurane or isoflurane is a third of MAC (16,17). By definition, such a level must be attained to have 50% of patients respond appropriately to command.…”

Section: Discussionmentioning

confidence: 99%

Tutorial: Context-Sensitive Decrement Times for Inhaled Anesthetics

Eger

Shafer

2005

Anesthesia & Analgesia

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Context-sensitive decrement times for inhaled anesthetics connect two values: a) the duration of anesthesia (nominally at a constant alveolar concentration)-the "context" and b) the time to decrease the alveolar or vital tissue (e.g., brain, heart, kidney, and liver, collectively called the vessel-rich group of tissues) concentration by some fractional "decrement" of the starting concentration. Increasing duration of anesthesia increases the time to a given decrement in a nonlinear manner that may considerably delay recovery. In the present report we use a commercially available simulation program (Gas Man) to confirm and enlarge on these concepts. In this simulation, increasing duration of anesthesia can markedly delay complete awakening for isoflurane. Increasing anesthesia duration imposes considerably less delay in awakening from sevoflurane compared with isoflurane. For desflurane, only prolonged anesthesia or decrements of 95% and more should delay awakening from anesthesia. These changes are shown to be the result of the relative solubility of each anesthetic in blood and tissue. An increase in cardiac output is also shown to delay awakening.

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“…MACawake for desflurane or isoflurane is a third of MAC (16,17). By definition, such a level must be attained to have 50% of patients respond appropriately to command.…”

Section: Discussionmentioning

confidence: 99%

Tutorial: Context-Sensitive Decrement Times for Inhaled Anesthetics

Eger

Shafer

2005

Anesthesia & Analgesia

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“…Administration of at least 0.5 MAC of a volatile anaesthetic agent should prevent awareness [15] and most anaesthetists employ this approach to prevent awareness in their daily practice [9]. Similar results can be obtained with total intravenous infusion devices that incorporate predicted plasma and effect site concentrations [16].…”

Section: Introductionmentioning

confidence: 95%

Monitoring the Depth of Anaesthesia

Musizza

Ribarič

2010

Sensors

112

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One of the current challenges in medicine is monitoring the patients’ depth of general anaesthesia (DGA). Accurate assessment of the depth of anaesthesia contributes to tailoring drug administration to the individual patient, thus preventing awareness or excessive anaesthetic depth and improving patients’ outcomes. In the past decade, there has been a significant increase in the number of studies on the development, comparison and validation of commercial devices that estimate the DGA by analyzing electrical activity of the brain (i.e., evoked potentials or brain waves). In this paper we review the most frequently used sensors and mathematical methods for monitoring the DGA, their validation in clinical practice and discuss the central question of whether these approaches can, compared to other conventional methods, reduce the risk of patient awareness during surgical procedures.

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“…The use of immobility as an experimental endpoint is helpful in that, for most general anaesthetics, anaesthetic concentrations two-to fourfold above the EC 50 (concentration of a compound which produces 50% of the maximal effect) for producing immobility are invariably lethal [13]. The anaesthetic concentrations that produce significant inhibition of cognitive functions and cortical activity, assessed using EEG-derived indicators, are lower than those required for producing immobility [135][136][137]. Thus, anaesthetic concentrations severalfold greater than those that produce immobility define the upper boundary of the concentration range that is clinically relevant.…”

Section: Pharmacological Criteria That a Candidate Receptor Must Meetmentioning

confidence: 99%

“…Table 1 lists concentrations of general anaesthetics that represent the EC 50 value for producing immobility in a variety of animal species. There is a growing database of studies that determine anaesthetic concentrations needed to produce other anaesthetic endpoints involving higher cortical functions [136,137,142]. However, such data are not yet available for all anaesthetics.…”

Section: Pharmacological Criteria That a Candidate Receptor Must Meetmentioning

confidence: 99%

General anaesthetic actions on ligand-gated ion channels

Krasowski

Harrison

1999

Cellular and Molecular Life Sciences (CMLS)

358

275

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The molecular mechanisms of general anaesthetics have remained largely obscure since their introduction into clinical practice just over 150 years ago. This review describes the actions of general anaesthetics on mammalian neurotransmitter-gated ion channels. As a result of research during the last several decades, ligand-gated ion channels have emerged as promising molecular targets for the central nervous system effects of general anaesthetics. The last 10 years have witnessed an explosion of studies of anaesthetic modulation of recombinant ligand-gated ion channels, including recent studies which utilize chimeric and mutated receptors to identify regions of ligand-gated ion channels important for the actions of general anaesthetics. Exciting future directions include structural biology and gene-targeting approaches to further the understanding of general anaesthetic molecular mechanisms.

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Concentrations of Desflurane and Propofol That Suppress Response to Command in Humans

Cited by 17 publications

References 22 publications

Tutorial: Context-Sensitive Decrement Times for Inhaled Anesthetics

Tutorial: Context-Sensitive Decrement Times for Inhaled Anesthetics

Monitoring the Depth of Anaesthesia

General anaesthetic actions on ligand-gated ion channels

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