title: Effect-site half-time for burst suppression is longer than for hypnosis during anaesthesia with sevoflurane.
abstract: BACKGROUND
  The relationship between measures of drug effect such as bispectral index (BIS) and end-tidal (ET) levels of anaesthetic agents is described by the 'effect site equilibrium half-time', t(1/2)(ke0). There are limited data available on sevoflurane t(1/2)(ke0) during routine anaesthesia and surgery. Preliminary observations suggested t(1/2)(ke0) for the degree of hypnosis as estimated by BIS is different from that for burst suppression of the electroencephalograph, occurring at 'deep' levels of anaesthesia. This study aimed to determine and compare t(1/2)(ke0) for these two 'effects'.
  
  
  METHODS
  Large changes in ET sevoflurane were produced in 13 subjects during surgery. ET sevoflurane, BIS, and burst suppression ratio (BSR) were recorded every 10 s. Data were divided into epochs with BIS>30 (BIS) or with BSR>10% (burst suppression). Using a non-parametric modelling technique, t(1/2)(ke0) was determined for each epoch.
  
  
  RESULTS
  There were 36 'BIS' and 20 burst suppression zones. Mean (sd) t(1/2)(ke0) for BIS was 3.48 (1.12) min and for BSR 9.9 (6.4) min. In all subjects, t(1/2)(ke0) BIS<t(1/2)(ke0) BSR. These differences were statistically significant (P<0.01). The pooled mean effect-site sevoflurane concentration producing a BIS of 50 was 1.23 (sd 0.34) vol% and for a BSR of 50% was 3.3 (0.50) vol%. There were considerable intra- and inter-subject variabilities.
  
  
  CONCLUSIONS
  The different values of t(1/2)(ke0) for these effects suggest different sites or mechanisms of action. These results also establish values of t(1/2)(ke0) which can be used to provide the real-time estimates of effect-site sevoflurane concentration in clinical practice.
authors.affiliation: Department of Anaesthesia, Christchurch Hospital and University of Otago, Christchurch Rolleston Ave, Christchurch, New Zealand. ross.kennedy@chmeds.ac.nz
authors.forename: R R
authors.initials: RR
authors.lastname: Kennedy
authors.forename: C
authors.initials: C
authors.lastname: Minto
authors.forename: A
authors.initials: A
authors.lastname: Seethepalli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology*; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D006207:Half-Life; D006801:Humans; D006991:Hypnosis, Anesthetic; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology*; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D000077149:Sevoflurane; D012815:Signal Processing, Computer-Assisted
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane