• Carlos Gustavo Dos Santos Silva, Caetano Nigro Neto, Mario Hiroyuki Hirata, Maria Angela Tardelli, Gisele Medeiros Bastos, Joao Italo Dias França, and CardosoThiago Augusto Azevedo MaranhãoTAAMDepartment of Anesthesiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil..
• Department of Anesthesiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil. Electronic address: cgss_phb@hotmail.com.
• J. Cardiothorac. Vasc. Anesth. 2021 Aug 1; 35 (8): 2447-2453.

ObjectivesMinimum alveolar concentration (MAC) of volatile anesthetic agents to maintain bispectral index (BIS) below 50 in 50% of patients was defined as MACBIS50. The primary objective of this study was to determine the minimum alveolar concentration of sevoflurane as a single hypnotic agent to maintain BIS below 50 in patients during normothermic cardiopulmonary bypass.DesignProspective and observational study.SettingDante Pazzanese Institute of Cardiology, Brazil.ParticipantsEighteen consecutive patients scheduled for elective coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) under general anesthesia, American Society of Anesthesiologists physical status classes III and IV, between the ages of 40 and 70, were included in the study.MethodsAll patients underwent inhalation induction with facial mask using sevoflurane (Cristália) in 100% oxygen, pancuronium (Cristália) 0.1 mg/kg, and sufentanil (Cristália) 0.5 µg/kg intravenously (IV) administered. A single bolus dose of sufentanil, 1.0 µg/kg IV, was administered before surgical incision. MACBIS50 was calculated using the midpoint concentration of patients involving a crossover (BIS < or ≥50) according to Dixon's Up-and-Down method. The Up-and-Down sequence also was analyzed by probit test that enabled the authors to obtain the effective dose 50 (ED50) and effective dose 95 (ED95) of sevoflurane to maintain a BIS value <50, with a 95% confidence interval (95% CI) of the mean.ResultsA total of 15 patients were analyzed in this study. MACBIS50 of sevoflurane as a single hypnotic agent was 0.82% (95% CI 0.47-1.16) in patients aged 40 to 70 undergoing CABG during normothermic CPB. The ED50 and ED95 of sevoflurane to maintain a BIS value <50 for the same context were 0.73% (95% CI 0.45-1.00) and 1.39 (95% CI 0.42-2.37) by means of probit analysis, respectively.ConclusionMACBIS50 of sevoflurane as a single hypnotic agent was 0.82% in patients undergoing CABG during normothermic CPB.Copyright © 2020 Elsevier Inc. All rights reserved.

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