Increased minimum alveolar concentration-awake of Sevofluran
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Sleep disorders are commonly encountered in clinics . Evidence showed that sleep deprivation may modulate the effectiveness of general anesthetics in rats. However, this phenomenon has not been explored in humans. The study aimed to investigate whether the hypnotic potency of sevoflurane in patients with sleep disorders differ from patients with normal sleep habits.

According to the study posted in BMC Anesthesiology, 44 patients scheduled for elective breast surgery and eventually analyzed 38 patients, including 19 subjects with normal sleep habits and 19 subjects with sleep disorders. According to the Dixon ‘up-and-down’ design, patients received sevoflurane at preselected concentrations starting at 1.0 vol%. After a steady-state period, a verbal command for testing awakening was performed. Based on the negative or positive response to the verbal command, decrease or increase in the concentration of sevoflurane by 0.2 vol% in the next patient accordingly. Plasma orexin-A was also measured before observation.

The MACawake of sevoflurane was 0.80% in the sleep disordered group vs 0.60% in the control group. The relative median potency between groups was 0.750 . Patients with sleep disorders had significantly higher orexin-A levels than control. A significant, positive relationship was detected between orexin-A level and probability of awakening .
Conclusively, MACawake of sevoflurane is higher in mild-aged women of breast surgery with sleep disorders compared to those with normal sleep habits. The increased anesthetic requirement may be related to changes of orexin-A levels. These findings suggest that sleep may have a potential impact on clinical anesthesia, including changes of sensitivity to anesthetics or postoperative complications. Further research is needed to confirm this hypothesis.

Source: https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-020-0931-3
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