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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Published in:

01-07-2014 | Reports of Original Investigations

Sensitivity to volatile anesthetics in patients with dementia: a case-control analysis

Authors: Silvia Perez-Protto, MD, Mariya Geube, MD, Daniel Ontaneda, MD, Jarrod E. Dalton, PhD, Andrea Kurz, MD, Daniel I. Sessler, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 7/2014

Abstract

Background

Patients with dementia are thought to be more sensitive to anesthesia, although volatile anesthetic requirement has not specifically been evaluated in this population. We tested the hypothesis that patients with dementia having non-cardiac surgery have a lower ratio of bispectral index (BIS) to minimal alveolar concentration (MAC) during the five minutes immediately preceding incision, thus exhibiting deeper hypnotic levels at a given MAC fraction.

Methods

We obtained records from our database registry on patients who had volatile general anesthesia during their most recent operation. We excluded patients premedicated with midazolam. Patients with dementia were identified and their diagnosis was confirmed by chart review. Each patient with dementia was successfully matched with a maximum of five patients without dementia using a multivariate nearest-neighbor distance-matching algorithm restricted to the following criteria: American Society of Anesthesiologists physical status, age, five-minute pre-incision time-weighted average (TWA) estimated effect-site concentration of propofol and fentanyl, and use of remifentanil. Our primary outcome was the TWA BIS-to-MAC ratio during the five minutes immediately preceding incision.

Results

We analyzed 31 patients with dementia matched with 151 patients without dementia. Median [quartiles] TWA BIS-to-MAC ratios for the matched patients were 85 [73, 100] for the patients with dementia and 78 [73, 84] for the patients without dementia. The percent difference in mean BIS-to-MAC ratios between patients with dementia and patients without dementia was 9% (95% confidence interval: −9% to 29%) (P = 0.35, Wald test).

Conclusions

Our results do not support the hypothesis that patients with dementia are more sensitive to volatile anesthetics than patients without dementia.

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Title: Sensitivity to volatile anesthetics in patients with dementia: a case-control analysis
Authors: Silvia Perez-Protto, MD
Mariya Geube, MD
Daniel Ontaneda, MD
Jarrod E. Dalton, PhD
Andrea Kurz, MD
Daniel I. Sessler, MD
Publication date: 01-07-2014
Publisher: Springer US
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 7/2014
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-014-0165-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Sensitivity to volatile anesthetics in patients with dementia: a case-control analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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