title: The effects of fentanyl on sevoflurane requirements for loss of consciousness and skin incision.
abstract: BACKGROUND
  Fentanyl produces a minimal reduction in the minimum alveolar concentration of sevoflurane to prevent response to a verbal command in 50% of patients (MAC[awake]) at low but analgesic plasma concentrations. The reduction in MAC(awake), however, is still unknown at higher fentanyl concentrations. The reduction in the MAC of sevoflurane by fentanyl has not been described accurately. The purpose of this study was to determine the MAC(awake) and MAC reduction of sevoflurane by fentanyl.
  
  
  METHODS
  Ninety-two patients were randomly allocated to seven fentanyl concentration groups (target plasma concentrations of 0, 1, 1.5, 3, 6, 10, and 14 ng/ml). Responses to verbal command were observed for MAC(awake) assessment at predetermined sevoflurane concentrations. Thereafter, in patients whose target fentanyl concentration was 0 to 10 ng/ml, responses to skin incision were observed for MAC assessment at new steady-state sevoflurane concentrations. The reduction in the MAC(awake) and MAC of sevoflurane by the measured fentanyl concentration was calculated.
  
  
  RESULTS
  There was an initial steep reduction in the MAC of sevoflurane by fentanyl, with 3 ng/ml resulting in a 59% MAC reduction. A ceiling effect was observed, with 10 ng/ml providing only a further 17% reduction in MAC. The initial reduction in MAC(awake) was not as steep as that in MAC. Fentanyl reduced MAC(awake) by approximately 24% at a plasma concentration of 3 ng/ml. Although the reduction curve of MAC(awake) was parabolic, no manifest ceiling effect was observed at concentrations administered in the present study.
  
  
  CONCLUSIONS
  The reduction in sevoflurane requirements for loss of consciousness and skin incision by fentanyl was determined. Fentanyl reduced both requirements, but the mode of the reduction was not comparable.
authors.affiliation: Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Japan. tackatoh@hama-med.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Katoh
authors.forename: K
authors.initials: K
authors.lastname: Ikeda
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000494:pharmacology*; D000758:Anesthesia; D018685:Anesthetics, Inhalation / Q000493:pharmacokinetics*; D004347:Drug Interactions; D004987:Ethers / Q000493:pharmacokinetics*; D005260:Female; D005283:Fentanyl / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D011650:Pulmonary Alveoli / Q000378:metabolism; D000077149:Sevoflurane
chemical_list: D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D004987:Ethers; D008738:Methyl Ethers; D000077149:Sevoflurane; D005283:Fentanyl