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• W2988891224 abstract "Editor—A 1996 analysis by Mapleson1Mapleson W.W. Effect of age on MAC in humans: a meta-analysis.Br J Anaesth. 1996; 76: 179-185Abstract Full Text PDF PubMed Scopus (283) Google Scholar showed that the minimum alveolar concentration (MAC) of inhaled agents decreases by 6% per decade after age 40 yr. A subsequent analysis by Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar in 2001 found a similar age-dependent decrease in MAC of 6.7% per decade. An updated determination of the relationship between MAC and age is important to evaluate the reproducibility of prior results when including contemporary studies and to help determine what dose of volatile anaesthetic is appropriate for older patients. To this end, we performed a systematic search for published studies of MAC in individuals of varying ages, and a meta-regression analysis of these data to determine an updated age-dependent decrease in MAC (see Fig. 1). A systematic literature search was undertaken independently by authors KN and JT, which was then reviewed by MB. All studies in Mapleson's1Mapleson W.W. Effect of age on MAC in humans: a meta-analysis.Br J Anaesth. 1996; 76: 179-185Abstract Full Text PDF PubMed Scopus (283) Google Scholar and Eger's2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar analyses for the agents isoflurane, desflurane, sevoflurane, or halothane were manually searched and included if they met the criteria (discussed below). Further studies were identified with a PubMed database search in March 2018, using the search terms ‘minimum alveolar concentration’ and a specific anaesthetic (isoflurane, sevoflurane, desflurane, or halothane). Study groups were excluded if: the average study group age was <1 yr; the study was not conducted in humans; inhaled anaesthetic was given concomitantly with nitrous oxide, i.v. opioids, or i.v. non-depolarizing neuromuscular blockers; inhaled anaesthetic was given under altered physiologic conditions (hypocapnia, pregnancy, immediate post-partum period); an adjunct drug or treatment (such as i.v. opioids or epidural local anaesthetics) was administered; or subjects had a developmental delay or known central nervous system pathology. No ongoing trials or unpublished studies were included. Data extracted for each study subgroup included: volatile agent given; number of patients; calculated MAC in vol% (mean, standard deviation [sd]/standard error [se]/confidence interval [CI]); age in yr (mean [median when mean value was not reported], sd/se); geographical region (USA, Japan, Europe, India, Canada, China/Hong Kong/Taiwan, Korea, and Israel). Mean MAC and age were collected (or median when mean value was not reported).The meta-regression analysis used similar methods as those used by Mapleson.1Mapleson W.W. Effect of age on MAC in humans: a meta-analysis.Br J Anaesth. 1996; 76: 179-185Abstract Full Text PDF PubMed Scopus (283) Google Scholar To estimate change in MAC fraction per decade of age, we constructed a linear meta-regression model of the log-transformed mean MAC on mean age, adjusting for volatile agent administered and geographical region (proxy for altitude), and weighted by (1/number of observations) from each study subgroup. The formulation used was:log10MAC=β0+β1Age+γiDrug+δjRegion+ε,where i=1–3 (for halothane, isoflurane, sevoflurane) and j=1–7 (for Japan, Europe, India, Canada, China/Hong Kong/Taiwan, Korea, Israel); desflurane and USA are the reference levels in the model. We identified 73 patient subgroups from 48 separate studies (Table 1).1Mapleson W.W. Effect of age on MAC in humans: a meta-analysis.Br J Anaesth. 1996; 76: 179-185Abstract Full Text PDF PubMed Scopus (283) Google Scholar, 2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar, 3Ni K. Cooter M. Gupta D.K. et al.Paradox of age: older patients receive higher age adjusted MAC values, yet display higher average BIS values.Br J Anaesth. 2019; 12: 288-297Abstract Full Text Full Text PDF Scopus (40) Google Scholar, 4Van Cleve W.C. Nair B.G. Rooke G.A. Associations between age and dosing of volatile anesthetics in 2 academic hospitals.Anesth Analg. 2015; 121: 645-651Crossref PubMed Scopus (21) Google Scholar, 5Wadhwa A. Durrani J. Sengupta P. Doufas A. Sessler D.I. Women have the same desflurane minimum alveolar concentration as men: a prospective study.Anesthesiology. 2003; 99: 1062-1065Crossref PubMed Scopus (27) Google Scholar, 6Lin C.M. Wu C. Lee S.-T. et al.Sitting position does not alter minimum alveolar concentration for desflurane.Can J Anaesth. 2007; 54: 523-530Crossref PubMed Scopus (6) Google Scholar, 7Drasner K. Bernards C.M. Ozanne G.M. Intrathecal morphine reduces the minimum alveolar concentration of halothane in humans.Anesthesiology. 1988; 69: 310-312Crossref PubMed Scopus (30) Google Scholar, 8Fahey M.R. Sessler D.I. Cannon J.E. Brady K. Stoen R. Miller R.D. Atracurium, vecuronium, and pancuronium do not alter the minimum alveolar concentration of halothane in humans.Anesthesiology. 1989; 71: 53-56Crossref PubMed Scopus (32) Google Scholar, 9Frei F.J. Haemmerle M.H. Brunner R. Kern C. Minimum alveolar concentration for halothane in children with cerebral palsy and severe mental retardation.Anaesthesia. 1997; 52: 1056-1060Crossref PubMed Scopus (58) Google Scholar, 10Houghton I.T. Aun C.S. Leung D.H. Minimum alveolar concentration of halothane: an ethnic comparison.J R Army Med Corps. 1993; 139: 117-119Crossref PubMed Scopus (1) Google Scholar, 11Inagaki Y. Mashimo T. Yoshiya I. Segmental analgesic effect and reduction of halothane MAC from epidural fentanyl in humans.Anesth Analg. 1992; 74: 856-864Crossref PubMed Scopus (23) Google Scholar, 12Kalman S. Bengtsson M. Lindmark D. Minimum alveolar concentration of halothane-diethyl-ether azeotrope.Acta Anaesthesiol Scand. 1991; 35: 190-195Crossref PubMed Scopus (7) Google Scholar, 13Licina M.G. Schubert A. Tobin J.E. Nicodemus H.F. Spitzer L. Intrathecal morphine does not reduce minimum alveolar concentration of halothane in humans: results of a double-blind study.Anesthesiology. 1991; 74: 660-663Crossref PubMed Scopus (12) Google Scholar, 14Schwieger I.M. Klopfenstein C.E. Forster A. Epidural morphine reduces halothane MAC in humans.Can J Anaesth. 1992; 39: 911-914Crossref PubMed Scopus (19) Google Scholar, 15Aantaa R. Jaakola M.L. Kallio A. Kanto J. Reduction of the minimum alveolar concentration of isoflurane by dexmedetomidine.Anesthesiology. 1997; 86: 1055-1060Crossref PubMed Scopus (175) Google Scholar, 16Chen B.Z. Chu Q.J. Yu J.R. Yao Y.S. Tan L. The effect of remifentanil on the minimum alveolar concentration of isoflurane in children.J Clin Anesth. 2015; 27: 504-507Crossref PubMed Scopus (6) Google Scholar, 17Gin T. Chan M.T. Decreased minimum alveolar concentration of isoflurane in pregnant humans.Anesthesiology. 1994; 81: 829-832Crossref PubMed Scopus (106) Google Scholar, 18Johansen J.W. Schneider G. Windsor A. Sebel P.S. Esmolol potentiates reduction of minimum alveolar isoflurane concentration by alfentanil.Anesth Analg. 1998; 87: 671-676PubMed Google Scholar, 19Kashyap L. Pawar D.K. Kaul H.L. Mohan V.K. Dwivedi S.N. Effect of epidural morphine on minimum alveolar concentration of isoflurane in humans.J Postgrad Med. 2003; 49: 211-213PubMed Google Scholar, 20Liu M. Hu X. Liu J. The effect of hypothermia on isoflurane MAC in children.Anesthesiology. 2001; 94: 429-432Crossref PubMed Scopus (57) Google Scholar, 21Zhou H.H. Norman P. DeLima L.G. Mehta M. Bass D. The minimum alveolar concentration of isoflurane in patients undergoing bilateral tubal ligation in the postpartum period.Anesthesiology. 1995; 82: 1364-1368Crossref PubMed Scopus (25) Google Scholar, 22Byon H.J. Choi B.M. Bang J.Y. Lee E.K. Lee S.S. Noh G.J. An open-label comparison of a new generic sevoflurane formulation with original sevoflurane in patients scheduled for elective surgery under general Anesthesia.Clin Ther. 2015; 37: 887-901Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 23Ezri T. Sessler D. Weisenberg M. et al.Association of ethnicity with the minimum alveolar concentration of sevoflurane.Anesthesiology. 2007; 107: 9-14Crossref PubMed Scopus (28) Google Scholar, 24Hamp T. Krammel M. Weber U. Schmid R. Graf A. Plochl W. The effect of a bolus dose of intravenous lidocaine on the minimum alveolar concentration of sevoflurane: a prospective, randomized, double-blinded, placebo-controlled trial.Anesth Analg. 2013; 117: 323-328Crossref PubMed Scopus (20) Google Scholar, 25Luo L.L. Zhou L.X. Wang J. Wang R.R. Huang W. Zhou J. Effects of propofol on the minimum alveolar concentration of sevoflurane for immobility at skin incision in adult patients.J Clin Anesth. 2010; 22: 527-532Crossref PubMed Scopus (17) Google Scholar Of these, 30 patient subgroups had not been included in past meta-analysis studies. There were 1466 patients across all studies, of which 152 (10.4%), 355 (24.2%), 293 (20.0%), and 666 (45.4%) were given desflurane, halothane, isoflurane, or sevoflurane, respectively. The regression analysis showed that MAC decreased by 6.47% (95% CI, 5.17–7.76%) per decade after age 1 yr, with r2=0.98. The volatile anaesthetic agent percentages equal to 1.0 MAC at age 40 yr were 6.44%, 1.16%, and 2.03% for desflurane, isoflurane, and sevoflurane, respectively. The age-dependent decrease slope in MAC was similar for the various anaesthetic agents. In a subset analysis excluding patients over age 75 yr, MAC decreased by 6.59% (95% CI, 5.05–8.10%) per decade, with r2=0.99. Similarly, when excluding patients older than 65 yr, MAC decreased by 6.42% (95% CI, 4.76–8.05%) per decade, with r2=0.99. The similarity between slopes across these meta-regression analyses suggest that the MAC decline slope is log-linear across age, and is not ‘skewed’ by extreme values in patients older than 65 or 75 yr. However, of the 1466 patients included in this meta-regression analysis, only 84 (or 5.7%) were aged ≥65 yr, and only 46 (3.1%) were aged ≥75 yr (Table 1).Table 1Minimum alveolar concentration (MAC) data for desflurane, halothane, isoflurane, and sevoflurane. For studies that were referenced by prior Mapleson1Mapleson W.W. Effect of age on MAC in humans: a meta-analysis.Br J Anaesth. 1996; 76: 179-185Abstract Full Text PDF PubMed Scopus (283) Google Scholar and Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar meta-regressions, we have simply referenced these prior meta-regressions.DrugNMean age (yr)MAC (vol%)First authorDesflurane121.88.72Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar123.78.62Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar127.57.98Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar925.67.25Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar15276Wadwha5Wadhwa A. Durrani J. Sengupta P. Doufas A. Sessler D.I. Women have the same desflurane minimum alveolar concentration as men: a prospective study.Anesthesiology. 2003; 99: 1062-1065Crossref PubMed Scopus (27) Google Scholar15336.2Wadwha5Wadhwa A. Durrani J. Sengupta P. Doufas A. Sessler D.I. Women have the same desflurane minimum alveolar concentration as men: a prospective study.Anesthesiology. 2003; 99: 1062-1065Crossref PubMed Scopus (27) Google Scholar11486Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar24526.54Lin6Lin C.M. Wu C. Lee S.-T. et al.Sitting position does not alter minimum alveolar concentration for desflurane.Can J Anaesth. 2007; 54: 523-530Crossref PubMed Scopus (6) Google Scholar24526.7Lin6Lin C.M. Wu C. Lee S.-T. et al.Sitting position does not alter minimum alveolar concentration for desflurane.Can J Anaesth. 2007; 54: 523-530Crossref PubMed Scopus (6) Google Scholar1869.65.17Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google ScholarHalothane1235.20.76Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar1641.70.74Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar8300.75Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar2442.10.76Mapleson1Mapleson W.W. Effect of age on MAC in humans: a meta-analysis.Br J Anaesth. 1996; 76: 179-185Abstract Full Text PDF PubMed Scopus (283) Google Scholar1040.60.81Drasner7Drasner K. Bernards C.M. Ozanne G.M. Intrathecal morphine reduces the minimum alveolar concentration of halothane in humans.Anesthesiology. 1988; 69: 310-312Crossref PubMed Scopus (30) Google Scholar9310.74Fahey8Fahey M.R. Sessler D.I. Cannon J.E. Brady K. Stoen R. Miller R.D. Atracurium, vecuronium, and pancuronium do not alter the minimum alveolar concentration of halothane in humans.Anesthesiology. 1989; 71: 53-56Crossref PubMed Scopus (32) Google Scholar1839.10.73Eger q2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar1210.60.9Frei9Frei F.J. Haemmerle M.H. Brunner R. Kern C. Minimum alveolar concentration for halothane in children with cerebral palsy and severe mental retardation.Anaesthesia. 1997; 52: 1056-1060Crossref PubMed Scopus (58) Google Scholar141.50.97Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar194.10.91Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar88.40.87Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar1115.50.92Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar2224.90.84Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar24420.76Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar1081.40.64Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar1228.60.7Houghton10Houghton I.T. Aun C.S. Leung D.H. Minimum alveolar concentration of halothane: an ethnic comparison.J R Army Med Corps. 1993; 139: 117-119Crossref PubMed Scopus (1) Google Scholar1035.20.68Houghton10Houghton I.T. Aun C.S. Leung D.H. Minimum alveolar concentration of halothane: an ethnic comparison.J R Army Med Corps. 1993; 139: 117-119Crossref PubMed Scopus (1) Google Scholar1837.50.7Houghton10Houghton I.T. Aun C.S. Leung D.H. Minimum alveolar concentration of halothane: an ethnic comparison.J R Army Med Corps. 1993; 139: 117-119Crossref PubMed Scopus (1) Google Scholar12380.77Inagaki11Inagaki Y. Mashimo T. Yoshiya I. Segmental analgesic effect and reduction of halothane MAC from epidural fentanyl in humans.Anesth Analg. 1992; 74: 856-864Crossref PubMed Scopus (23) Google Scholar14250.65Kalman12Kalman S. Bengtsson M. Lindmark D. Minimum alveolar concentration of halothane-diethyl-ether azeotrope.Acta Anaesthesiol Scand. 1991; 35: 190-195Crossref PubMed Scopus (7) Google Scholar1131.20.78Licina13Licina M.G. Schubert A. Tobin J.E. Nicodemus H.F. Spitzer L. Intrathecal morphine does not reduce minimum alveolar concentration of halothane in humans: results of a double-blind study.Anesthesiology. 1991; 74: 660-663Crossref PubMed Scopus (12) Google Scholar1620.60.73Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar111.20.94Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar24420.77Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar10580.78Schwieger14Schwieger I.M. Klopfenstein C.E. Forster A. Epidural morphine reduces halothane MAC in humans.Can J Anaesth. 1992; 39: 911-914Crossref PubMed Scopus (19) Google ScholarIsoflurane1644.10.85Aantaa15Aantaa R. Jaakola M.L. Kallio A. Kanto J. Reduction of the minimum alveolar concentration of isoflurane by dexmedetomidine.Anesthesiology. 1997; 86: 1055-1060Crossref PubMed Scopus (175) Google Scholar1221.6Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar1241.6Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar205.41.5Chen16Chen B.Z. Chu Q.J. Yu J.R. Yao Y.S. Tan L. The effect of remifentanil on the minimum alveolar concentration of isoflurane in children.J Clin Anesth. 2015; 27: 504-507Crossref PubMed Scopus (6) Google Scholar1034.51.075Gin17Gin T. Chan M.T. Decreased minimum alveolar concentration of isoflurane in pregnant humans.Anesthesiology. 1994; 81: 829-832Crossref PubMed Scopus (106) Google Scholar20381.28Johansen18Johansen J.W. Schneider G. Windsor A. Sebel P.S. Esmolol potentiates reduction of minimum alveolar isoflurane concentration by alfentanil.Anesth Analg. 1998; 87: 671-676PubMed Google Scholar2434.911.14Kashyap19Kashyap L. Pawar D.K. Kaul H.L. Mohan V.K. Dwivedi S.N. Effect of epidural morphine on minimum alveolar concentration of isoflurane in humans.J Postgrad Med. 2003; 49: 211-213PubMed Google Scholar106.11.69Liu20Liu M. Hu X. Liu J. The effect of hypothermia on isoflurane MAC in children.Anesthesiology. 2001; 94: 429-432Crossref PubMed Scopus (57) Google Scholar72551Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar111.41.69Eger2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar1626.11.28Eger2Eger 2nd, E.I. 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Ogura A. et al.Oral tizanidine, an alpha2-adrenoceptor agonist, reduces the minimum alveolar concentration of sevoflurane in human adults.Anesth Analg. 2002; 95: 393-396Crossref PubMed Google Scholar Open table in a new tab We found a high degree of reproducibility and similarity between the age-dependent decrease values for MAC found in this study and two prior studies.1Mapleson W.W. Effect of age on MAC in humans: a meta-analysis.Br J Anaesth. 1996; 76: 179-185Abstract Full Text PDF PubMed Scopus (283) Google Scholar,2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar This is reassuring both for our scientific understanding of how anaesthetic sensitivity changes with age, and for our clinical understanding of how these drugs should be dosed in older patients. This study has four main limitations. First, including data from prior meta-regressions1Mapleson W.W. Effect of age on MAC in humans: a meta-analysis.Br J Anaesth. 1996; 76: 179-185Abstract Full Text PDF PubMed Scopus (283) Google Scholar,2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar may have reduced potential differences from previous estimates of age-dependent changes in MAC. Second, few studies have measured MAC in patients older than 75 yr, so estimates of age-dependent changes in MAC over age 75 yr remain largely an extrapolation. Third, we used subgroup summary measures from the cited studies as we did not have access to individual subject data, which could possibly underestimate variability in the raw data. Fourth, we measured MAC, not MAC-Awake. However, Eger's2Eger 2nd, E.I. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.Anesth Analg. 2001; 93: 947-953Crossref PubMed Scopus (259) Google Scholar analysis notes that the ratio of MAC-Awake to MAC for isoflurane and sevoflurane remains the same as age increases. This suggests that the age-dependent decrease in MAC-Awake is likely similar to the age-dependent decrease in MAC determined here. Overall, this updated measurement of a 6.47% decrease in MAC per decade of age can help anaesthesia providers determine appropriate end-tidal anaesthetic concentrations in older patients, and can serve as a standard benchmark for quantitatively evaluating the extent to which anaesthesia providers are appropriately adjusting inhaled anaesthetic dose for patient age.3Ni K. Cooter M. Gupta D.K. et al.Paradox of age: older patients receive higher age adjusted MAC values, yet display higher average BIS values.Br J Anaesth. 2019; 12: 288-297Abstract Full Text Full Text PDF Scopus (40) Google Scholar,4Van Cleve W.C. Nair B.G. Rooke G.A. Associations between age and dosing of volatile anesthetics in 2 academic hospitals.Anesth Analg. 2015; 121: 645-651Crossref PubMed Scopus (21) Google Scholar Study design: all authors. Study conceptualization: MB. Literature search: KN, JT. Literature search adjudication: MB. Data interpretation: all authors. Data analysis: MC. Drafting of the manuscript: KN, MC, MB. Editing of the manuscript: JT, DG, TH, TM, MJ, MK, MB. All authors made substantial contributions to the conception and design, acquisition of data, or analysis and interpretation of data for this study; drafted or revised the article critically for important intellectual content; gave their final approval of the version to be published; and agree to be accountable for all aspects of the work thereby ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This correspondence is dedicated to the memory of Dr Edmund ‘Ted’ Eger and Dr Jeffrey Silverstein, and their respective lifelong passions for understanding anaesthetic mechanisms and for improving perioperative care for older adults. MB acknowledges income from a legal consulting case related to postoperative cognition in an older adult, and material support (i.e. EEG monitors) from Massimo for a study unrelated to the data presented here. The other authors have no conflicts to disclose. Foundation for Anesthesia Education and Research Medical Student Anesthesia Research Fellowship (to KN). NIH grants R03-AG050918 and K76-AG057022 (to MB), and a Jahnigen Scholar Award from the Foundation for Anesthesia Education and Research and the American Geriatrics Society (to MB). MB also acknowledges additional support from NIH grants T32-GM08600 and P30AG028716, and the Duke Anesthesiology Department." @default.
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