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MINIMAL ALVEOLAR CONCENTRATION (MAC)

• Most important method for measuring potency of inhalational anesthetic agent.
• MAC is lowest concentration of anesthetic in pulmonary alveoli producing immobility for any painful stimulus (surgical incision) in 50% individuals.
  • Higher MAC, less potent anesthetic.

• Minimum MAC – Methoxyflurane (0.16%).
  • Hence, most potent inhalational agent.
• Maximum MAC – Nitrous oxide (105)
  • Hence, least potent inhalational agent.
• Order of potency in decreasing order (MAC in increasing order):
  • Methoxyflurane (0.16%) > Trilene (0.2%) > Halothane (0.74%) > Cholorform (0.8%) > Isoflurane (1.15%) > Enflurane (1.68%) > Ether (1.92%) > Sevoflurane (2.0%) > Desflurane (6.0%) > Cyclopropane (9.2%) > Nitrous oxide (104%).

Factor affecting MAC

• Age:
  • Young age increases & old age decreases MAC.
• Alcohol:
  • Chronic intoxication increases & acute intoxication decreases MAC.
• Temperature:
  • Both hypothermia & hyperthermia decrease MAC.
• Electrolyte:
  • Hypercalcemia, hypermagnesemia & hyponatremia decrease MAC.
  • Hypernatremia increases MAC.
• Anemia:
  • Decrease MAC.
• Gases in blood:
  • Hypoxia (p02 < 40) &hypercarbia (pCO2 > 95) decrease MAC.
• Pregnancy: Decreases MAC.
• Drugs:
  • Decreasing MAC: Local anesthetics (except cocaine) Opioids, Ketamine, Barbiturates, Benzodiazepines, Verapamil, Lithium, Sympatholytics (Methyldopa, reserpine, Clonidine, Dexmedetomidine), Chronic amphetamine use.
  • Increasing MAC: Acute amphetamine intake, Cocaine, ephedrine.

Meyer-Overton hypothesis:

• States, “Because inhalational agents act through lipid-rich CNS cells, anesthetic potency increases, MAC decreases with lipid solubility”.
• Suggests that anesthetic target sitemust behydrophobic (lipophilic)in nature.

Explanation:

• Inhalational anesthetics are soluble in fat.
• Relative potency as anesthetic depends on both fat & water affinity.
  • i.e., fat (oil): water partition coefficient (measurement of lipid solubility).

Exceptions to Meyer-Overton rule:

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1. Isomers:

• Structural isomers anesthetics with same oil: gas partition coefficient have different potency.
• Eg: Enflurane & isoflurane – Structural isomers.
• Potency of isoflurane much higher than enflurane.

• Oil: gas partition coefficient:
  • Also measures potency of inhalational anesthetic using lipid solubility property.
  • Higher lipid solubility = Higher oil:gas partition coefficient = More potency.
• Direct relationship between MAC & lipid solubility in terms of oil:gas partition coefficient.
  • Methoxyflurane has maximum oil:gas partition coefficient –> Hence, most lipid soluble & most potent.
  • N₂0 has minimum oil: gas partition coefficient –> Hence, least lipid soluble & least potent.

Exam Important

• MACis lowest concentration of anesthetic in pulmonary alveoli producing immobility for any painful stimulus (surgical incision) in 50% individuals.
• Minimal alveolar concentration (MAC) is the most important method for measuring potency of inhalational anesthetic agent.
• Higher MAC, less potent anesthetic.
• Minimum MAC is with Methoxyflurane (0.16%), hence most potent inhalational agent.
• Maximum MAC is with Nitrous oxide (105), hence least potent inhalational agent.
• Order of potency in decreasing order (MAC in increasing order):
  • Methoxyflurane (0.16%) > Trilene (0.2%) > Halothane (0.74%) > Cholorform (0.8%) > Isoflurane (1.15%) > Enflurane (1.68%) > Ether (1.92%) > Sevoflurane (2.0%) > Desflurane (6.0%) > Cyclopropane (9.2%) > Nitrous oxide (104%).
• Hypercalcemia, hypermagnesemia & hyponatremia decrease MAC.
• Hypothermia decreases MAC.
• Anemia & pregnancy decreases MAC.
• Meyer-Overton hypothesis suggests that anesthetic target sitemust behydrophobic (lipophilic)in nature.
• Exceptions to Meyer-Overton rule includes nonanesthetics (non-immobilised).
• Oil: gas partition coefficient also measures potency of inhalational anesthetic using lipid solubility property.

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Contents

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Identification Table of the Nazi concentration camps for Mac

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Last Word

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