The Minimum Alveolar Concentration (MAC) of Isoflurane in Preterm Neonates

Studies in fetal lambs suggested that the minimum alveolar concentration (MAC) in preterm neonates may be less than that in full-term neonates and older infants. To determine the MAC of isoflurane in preterm neonates, 20 patients < 32 weeks gestation at birth and 16 patients 32–37 weeks gestation at birth, all less than 1 month post-natal age, were studied. Following tracheal intubation, the neonates were anesthetized with a predetermined end-tidal concentration of isoflurane in oxygen and air. The move-no move responses to skin incision were recorded, and MAC was determined using the “up-and-down” technique. Heart rate and systolic arterial pressure were recorded awake, before skin incision, and after skin incision. MAC (mean ± SD) of isoflurane in preterm neonates < 32 weeks gestation was 1.28 ± 0.17%, and MAC in neonates 32–37 weeks gestation was 1.41 ± 0.18% (P < 0.05). Although heart rate did not decrease significantly in either group during the study, systolic arterial pressure decreased between 20 and 30% below awake values both before and after skin incision in both age groups (P < 0.01). We conclude that the MAC of isoflurane in preterm neonates < 32 weeks gestation is significantly less than that in pretern neonates 32–37 weeks gestation, and that systolic arterial pressure decreases to a similar extent at ∼1 MAC isoflurane in both age groups.