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Minimum alveolar concentration of desflurane and hemodynamic responses in neonates, infants, and children
1Department of Anaesthesia, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Insights
This study found that the minimum alveolar concentration (MAC) for desflurane anesthesia in children peaks in infants aged 6-12 months. Hemodynamic responses varied by age group, with some showing decreased heart rate before skin incision.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Pharmacology
Background:
- Determining the minimum alveolar concentration (MAC) of anesthetic agents is crucial for safe and effective anesthesia in pediatric patients.
- Desflurane is a volatile anesthetic used in various age groups, but its MAC and associated hemodynamic effects in neonates, infants, and children require precise characterization.
Purpose of the Study:
- To ascertain the minimum alveolar concentration (MAC) of desflurane in fasting, unpremedicated neonates, infants, and children up to 12 years of age.
- To evaluate the hemodynamic responses, specifically heart rate and systolic arterial pressure, to desflurane anesthesia during surgical procedures in this pediatric population.
Main Methods:
- Seventy-two pediatric patients were divided into six age-based groups (0-1 month, 1-6 months, 6-12 months, 1-3 years, 3-5 years, 5-12 years).
- The "up-and-down technique" and logistic regression were employed to determine the MAC of desflurane.
- Hemodynamic parameters were recorded at baseline (awake), at approximately 1 MAC before skin incision, and during peak response to skin incision.
Main Results:
- The relationship between desflurane MAC and age was quadratic, with the highest MAC observed in infants aged 6-12 months (9.92 ± 0.44%).
- MAC values ranged from 7.98 ± 0.43% in children aged 5-12 years to 9.42 ± 0.06% in infants aged 1-6 months.
- A significant decrease in heart rate (16%) was noted before skin incision in infants aged 6-12 months and children aged 1-5 years compared to awake values.
Conclusions:
- Desflurane MAC exhibits a distinct age-dependent pattern in pediatric patients, peaking in mid-infancy.
- Anesthetic management with desflurane requires consideration of age-specific MAC values and potential hemodynamic alterations in neonates, infants, and children.
- Further research into desflurane's cardiovascular effects across different pediatric age groups is warranted.
Abstract:
We sought to determine the minimum alveolar concentration (MAC) and hemodynamic responses to desflurane in 72 fasting and unpremedicated full-term neonates, infants, and children up to 12 yr of age. The patients were divided into six groups (n = 12) according to age. After awake tracheal intubation, neonates were anesthetized with desflurane in oxygen and air. Infants greater than 1 month of age and all older children were anesthetized with desflurane in 100% oxygen, and their tracheas were intubated without muscle relaxation. MAC was determined using the "up-and-down technique" and logistic regression. Heart rate and systolic arterial pressure were recorded awake, at approximately 1 MAC desflurane before skin incision and at approximately 1 MAC during the peak hemodynamic responses to skin incision. We found that the relationship between MAC (mean +/- standard deviation) as determined by the up-and-down technique and age was quadratic, reaching a maximum value in infants 6-12 months of age: in neonates 0-1 month MAC was 9.16 +/- 0.02%, in infants 1-6 months 9.42 +/- 0.06%, in infants 6-12 months 9.92 +/- 0.44%, in children 1-3 yr 8.72 +/- 0.59%, in children 3-5 yr 8.62 +/- 0.45%, and in children 5-12 yr 7.98 +/- 0.43%. MAC values obtained using logistic regression were similar. Heart rate decreased an average of 16% before skin incision in infants 6-12 months of age and children 1-3 and 3-5 yr of age when compared to awake values (P less than 0.025) but did not change significantly in the remaining three groups.(ABSTRACT TRUNCATED AT 250 WORDS)