ArticleBritish journal of anaesthesia2019
Paradox of age: older patients receive higher age-adjusted minimum alveolar concentration fractions of volatile anaesthetics yet display higher bispectral index values.
Article in British journal of anaesthesia, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05279898 (Perioperative Multimodal General AnesTHesia Focusing on Specific CNS Targets in Patients Undergoing carDiac surgERies - the PATHFINDER II Study), which is not on this map. Cited by 48 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Perioperative Multimodal General AnesTHesia Focusing on Specific CNS Targets in Patients Undergoing carDiac surgERies - the PATHFINDER II Study
Who cites it
48 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Age-dependent decrease in minimum alveolar concentration of inhaled anaesthetics: a systematic search of published studies and meta-regression analysis.British journal of anaesthesia · 2020Pooled it
- Effect of serratus anterior plane block combined with oxycodone for transition analgesia on preventing emergence agitation after video-assisted thoracoscopic surgery: a randomized controlled trial.Scientific reports · 2024Trial
- Electroencephalographic guided propofol-remifentanil TCI anesthesia with and without dexmedetomidine in a geriatric population: electroencephalographic signatures and clinical evaluation.Journal of clinical monitoring and computing · 2024Trial
- Article
- From index to insight: clinical perspectives on electroencephalographic spectrogram-guided anesthesia-a narrative review.Korean journal of anesthesiology · 2026Review
- Characteristics of electroencephalographic changes induced by different hypnotics in elderly patients: a narrative review.Korean journal of anesthesiology · 2026Review
- Processed EEG Artifacts and Pitfalls: A Narrative Review and a Troubleshooting Mnemonic.Cureus · 2026Review
- The 95% effective dose of ciprofol-assisted sedation for knee arthroplasty in elderly patients: a prospective cohort study.International journal of surgery (London, England) · 2026Article
- Impact of ageing on sevoflurane's hypnotic potency and induction kinetics during wash-in period: A prospective observational study.Indian journal of anaesthesia · 2025Article
- Associations between anaesthetic dose-adjusted intraoperative EEG alpha power, processing speed, and postoperative delirium: analysis of data from three prospective studies.British journal of anaesthesia · 2025Article
- Impact of age on the reliability of GE Entropy™ module indices for guidance of maintenance of anaesthesia in adult patients: a single-centre retrospective analysis.British journal of anaesthesia · 2025Article
- Electroencephalogram monitoring during anesthesia and critical care: a guide for the clinician.Journal of clinical monitoring and computing · 2025Review
- Anesthesia depth monitoring during opioid free anesthesia - a prospective observational study.BMC anesthesiology · 2025Observational
- Predilection for Perplexion: Preoperative microstructural damage is linked to postoperative delirium.medRxiv : the preprint server for health sciences · 2025Article
- Age-dependent changes in the power spectrum conflate composite scores to assess brain frailty.Clinical neurophysiology practice · 2025Article
- Red-Haired People's Altered Responsiveness to Pain, Analgesics, and Hypnotics: Myth or Fact?-A Narrative Review.Journal of personalized medicine · 2024Review
- Electroencephalographic monitoring of anesthesia during surgical procedures in mice using a modified clinical monitoring system.Journal of clinical monitoring and computing · 2024Article
- Effect-Site Concentration of Remimazolam by Age Groups During Target-Controlled Infusion for Total Intravenous Anesthesia: A Retrospective Comparative Study.Drug design, development and therapy · 2024Article
- Schnider and Eleveld Models for Propofol Target-Controlled Infusion Anesthesia: A Clinical Comparison.Life (Basel, Switzerland) · 2023Article
- [Processed EEG for personalized dosing of anesthetics during general anesthesia].Die Anaesthesiologie · 2023Review
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Funding
Abstract
backgroundMinimum alveolar concentration (MAC) and MAC-awake decrease with age. We hypothesised that, in clinical practice, (i) end-tidal MAC fraction in older patients would decline by less than the predicted age-dependent MAC decrease (i.e. older patients would receive relatively excessive anaesthetic concentrations), and (ii) bispectral index (BIS) values would therefore be lower in older patients.
methodsWe examined the relationship between end-tidal MAC fraction, BIS values, and age in 4699 patients > 30 yr in age at a single centre using unadjusted local regression (locally estimated scatterplot smoothing), Spearman's correlation, stratification, and robust univariable and multivariable linear regression.
resultsThe end-tidal MAC fraction in older patients declined by 3.01% per decade (95% confidence interval [CI]: 2.56-3.45; P<0.001), less than the 6.47% MAC decrease per decade that we found in a meta-regression analysis of published studies of age-dependent changes in MAC (P<0.001), and less than the age-dependent decrease in MAC-awake. The BIS values correlated positively with age (ρ=0.15; 95% CI: 0.12-0.17; P<0.001), and inversely with the age-adjusted end-tidal MAC (aaMAC) fraction (ρ= -0.13; 95% CI: -0.16, -0.11; P<0.001).
conclusionsThe age-dependent decline in end-tidal MAC fraction delivered in clinical practice at our institution was less than the age-dependent percentage decrease in MAC and MAC-awake determined from published studies. Despite receiving higher aaMAC fractions, older patients paradoxically showed higher BIS values. This most likely suggests that the BIS algorithm is inaccurate in older adults.
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