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Application of Dixon's Up-and-Down Design to Estimate the Minimum Alveolar Concentration of Sevoflurane in Rats with Refined Movement Classification
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Application of Dixon's Up-and-Down Design to Estimate the Minimum Alveolar Concentration of Sevoflurane in Rats with Refined Movement Classification

Published on: July 25, 2025

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The relationship between age and minimum alveolar concentration of sevoflurane for maintaining bispectral index below

J Tokuwaka1, T Satsumae, T Mizutani

  • 1Department of Anaesthesiology, University of Tsukuba, Tsukuba-city, Japan.

Anaesthesia
|October 2, 2014
PubMed

Insights

The minimum alveolar concentration (MAC) of sevoflurane needed to keep the bispectral index below 50 is higher in 2- to 4-year-olds than 5- to 9-year-olds. Sevoflurane MAC for bispectral index monitoring is unreliable in children under 2 years.

Area of Science:

  • Anesthesiology
  • Pediatric Anesthesia
  • Neurophysiology

Background:

  • The bispectral index (BIS) is used to monitor anesthetic depth.
  • Determining the minimum alveolar concentration (MAC) of sevoflurane is crucial for pediatric anesthesia.
  • Age-related differences in sevoflurane MAC and BIS responsiveness are not fully understood.

Purpose of the Study:

  • To evaluate the minimum alveolar concentration (MAC) of sevoflurane required to maintain a bispectral index (BIS) below 50 in pediatric patients.
  • To compare sevoflurane MAC values across different pediatric age groups (1-year-olds, 2-4-year-olds, and 5-9-year-olds).

Main Methods:

  • A study involving 55 children across three age groups: 1-year-old, 2-4-year-old, and 5-9-year-old.
  • Dixon's up-and-down method and probit analysis were employed to determine MAC.
  • End-tidal sevoflurane concentration and bispectral index were continuously monitored.

Main Results:

  • In 1-year-old children, BIS values remained above 50 even with end-tidal sevoflurane concentrations of 4.0% or higher.
  • The sevoflurane MAC for BIS < 50 was significantly higher in 2-4-year-olds (2.33%) compared to 5-9-year-olds (2.10%).
  • A statistically significant difference (p=0.005) was observed between the 2-4-year-old and 5-9-year-old groups.

Conclusions:

  • Assessing anesthetic depth using the bispectral index is unreliable in children younger than 2 years when using sevoflurane.
  • Age-specific considerations are necessary when interpreting BIS values during sevoflurane anesthesia in pediatric populations.
  • Further research may be needed to establish reliable BIS monitoring parameters for younger children.

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