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inimal alveolar concentration (MAC) has traditionally been used to measure potency of inhalational
anesthetics. Therefore, equi-MAC concentrations of
Received for publication June 11, 2008; accepted October 27, 2008.
From the Department of Neuroanaesthesiology, Neurosciences Center
All India Institute of Medical Sciences, New Delhi, India.
Reprints: Hemanshu Prabhakar, MD, Department of Neuroanesthesiology, Neurosciences Center, 7th oor, All India Institute of Medical
Sciences, New Delhi 110029, India (e-mail: prabhakarhemanshu@
redimail.com).
Copyright r 2009 by Lippincott Williams & Wilkins
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J Neurosurg Anesthesiol
volatile agent, the parameters tabulated during air/oxygen were compared with those during nitrous oxide/oxygen using Student t test for all paired data. A P value of
less than 0.05 was considered signicant.
RESULTS
All patients completed the study and none were
excluded from nal analysis. The groups did not dier in
demographic characteristics and baseline values of HR,
MAP, RE, and SE (Table 1). The HR and MAP during
both stages of anesthesia are tabulated (Table 2). With
air/oxygen as the carrier gas, isourane and sevourane
resulted in comparable RE and SE, whereas during 1.0
MAC, halothane RE and SE were signicantly higher.
Addition of 66% of nitrous oxide resulted in signicant
increase in both RE and SE at 1.0 MAC of all 3 agents
(P<0.05). At 1.5 MAC, RE, and SE decreased although
the change was not signicant (P>0.05) (Table 3). The
use of mephentermine sulfate did not dier between the
groups. Four patients in halothane group and 3 patients
each in isourane and sevourane groups required
vasopressor at 1.5 MAC concentrations.
DISCUSSION
Entropy has been eectively used in monitoring the
depth of hypnosis.3,4 In our study, we found that entropy
values in the halothane group remained high as compared
with isourane and sevourane group at all MAC
concentrations. It was also noted that entropy values
between isourane and sevourane groups were comparable at equi-MAC concentrations. In a study, Rao et al1
also showed that equi-MAC concentrations of isourane
and halothane do not produce similar BIS values. They
found BIS values signicantly lower under isourane
compared with halothane anesthesia at similar MAC
concentrations. Schwab et al2 had similar observations
while using sevourane and halothane at equal MAC
multiples. Our study diers from the earlier ones as none
have compared the 3 agents together.
A potential confounding factor in our study could
be the nonrandomized sequence of the carrier gases used.
TABLE 1. Patient Demographics and Baseline Values Measured Before Induction of General
Anesthesia
Age (years)
Weight (kg)
Male/female
HR
MAP
RE
SE
Isourane Group
(n = 10)
Sevourane Group
(n = 10)
Halothane Group
(n = 10)
38.1 (16.5)
55.0 (10.6)
8/2
88.8 (12.3)
99.8 (8.1)
98 (2)
88 (3)
38.2 (12.8)
56.9 (7.6)
6/4
84.4 (12.6)
102.8 (9.5)
98 (1)
90 (1)
38.2 (10.5)
62.7 (13.6)
7/3
81.0 (12.3)
105.4 (8.2)
98 (1)
87 (3)
NS
NS
NS
NS
NS
NS
NS
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Prabhakar et al
TABLE 2. Heart Rate and Blood Pressure Measurement for All Study Groups, Without and
With Nitrous Oxide
Isourane
Sevourane
Halothane
A
N
P
A
N
P
82.3 (11.8)
77.7 (18.2)
75.4 (17.2)
69.9 (13)
0.007*
78.1 (18.1)
69.9 (12.5)
0.001w
67.5 (12.1)
63.6 (8.4)
0.19
69.6 (10.6)
63.2 (6.9)
0.03
A
N
P
A
N
P
78.2 (15.8)
83.1 (12.3)
81.6 (15.1)
90.1 (13.1)
0.50
73.0 (12.5)
76.1 (15.4)
0.02*
81.1 (12.6)
86.9 (15.2)
0.08
78.9 (11.1)
83.9 (15.5)
0.23
MAC
Heart rate
1.0
1.5
89.0 (12.4)
81.7 (15.0)
68.4 (7.9)
72.2 (12.0)
entropy values also. We therefore, recorded all parameters after the surgery started. Opioids and muscle
relaxants are known to aect the EEG and thereby the
interpretations of EEG signal-based monitors like BIS
and entropy. We attempted to minimize such eects by
administering fentanyl and rocuronium at uniform doses
and intervals.
The dierence in entropy values can be explained on
the basis of dierential eects of halothane, isourane,
and sevourane on EEG. Halothane produces fast EEG
rhythms whereas isourane and sevourane produce
mainly slow waves. Halothane produces persistent 8 to
14 Hz activity despite increasing depth, whereas isourane
TABLE 3. Response Entropy and State Entropy Values for All Study Groups, Without and
With Nitrous Oxide
Isourane
Sevourane
Halothane
A
N
P
A
N
P
40.6 (9.9)
55.1 (18.4)
0.02*
30.8 (12.6)
30.1 (12.9)
0.004w
39.6 (11.9)
53.3 (22.3)
59.1 (14.5)
61.5 (19.2)
0.02
31.1 (18.9)
27.6 (13.4)
49.8 (10.2)
34.7 (17.8)
0.05
A
N
P
A
N
P
38.9 (8.5)
53.5 (18.5)
0.009w
28.5 (10.6)
29.1 (12.3)
0.002w
35.9 (10.6)
51.3 (20.9)
57 (14.2)
60.6 (19.4)
0.009
28.2 (5.8)
27.6 (12.7)
48.3 (17.7)
33.1 (17.4)
0.11
MAC
Response entropy
1.0
1.5
State entropy
1.0
1.5
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