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Minimum Alveolar Concentration-Awake of Sevoflurane Is Decreased in Patients With End-Stage Renal Disease

Wu, Yun MD*; Jin, Shiyun MD*; Zhang, Lei MD; Cheng, Jie MD; Hu, Xianwen MD, PhD*; Chen, Hong RN*; Zhang, Ye MD, PhD*

doi: 10.1213/ANE.0000000000003676
Anesthetic Clinical Pharmacology: Original Clinical Research Report
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BACKGROUND: End-stage renal disease (ESRD) has been shown to be associated with abnormal neural function. Clinically used inhaled anesthetic agents typically exert their effect through multiple target receptors in the central nervous system. Pathological changes in the brain may alter sensitivity to inhaled anesthetic agents. This study aimed to determine the minimum alveolar concentration-awake (MACawake) of sevoflurane in patients with ESRD compared to patients with normal renal function.

METHODS: Patients underwent inhalational induction of anesthesia and received sevoflurane at a preselected concentration according to a modified Dixon “up-and-down” method starting at 1.0% with a step size of 0.2%. The concentration of sevoflurane used for each consecutive patient was increased or decreased based on a positive or negative response to verbal command in the previous patient. Serum neuron-specific enolase, a biomarker of impaired neurons, was also measured.

RESULTS: Forty-one patients were enrolled: 20 with ESRD and 21 as controls. The MACawake of sevoflurane in patients with ESRD was significantly lower than that observed in the control group (0.56% [standard deviation {SD} = 0.10%] vs 0.67% [SD = 0.08%]; P = .031). Patients with ESRD exhibited higher serum neuron-specific enolase levels compared to the control group (16.4 ng/mL [SD = 5.0] vs 8.7 ng/mL [SD = 2.9]; P < .001).

CONCLUSIONS: MACawake of sevoflurane is somewhat lower in patients with ESRD compared to those with normal renal function. Impaired cerebral function may partly contribute to the reduction in anesthetic requirement.

From the *Department of Anesthesiology, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China

Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China

Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, China.

Published ahead of print 18 June 2018.

Accepted for publication June 18, 2018.

Funding: Priority Department of Second Affiliated Hospital of Anhui Medical University.

The authors declare no conflicts of interest.

Clinical trial number: ChiCTR-OPC-15007608. http://www.chictr.org.cn/edit.aspx?pid=12801&htm=4.

Reprints will not be available from the authors.

Address correspondence to Ye Zhang, MD, PhD, Department of Anesthesiology, Second Affiliated Hospital of Anhui Medical University, 678 Furong Rd, Hefei, Anhui Province, China. Address e-mail to zhangye_hassan@sina.com.

Copyright © 2018 International Anesthesia Research Society
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