BACKGROUND: The requisite anesthetic concentration of sevoflurane required to obtain adequate sedation when sufficient analgesics are supplied has not been determined. The purpose of this study was to determine the requisite age-associated concentration of sevoflurane to obtain an adequate level of anesthesia during combined epidural-general anesthesia by bispectral index (BIS) monitoring. METHODS: Twenty-seven elective abdominal surgery patients (American Society of Anesthesiologists physical status I-II) were enrolled. The patients were divided into two groups of more or less than 60 years of age. We investigated the concentration of sevoflurane required to obtain an adequate sedation level during combined epidural-general anesthesia, maintaining the BIS value between 40 and 60. RESULTS: The requisite sevoflurane concentration required to keep the BIS value at 40-60 was not stable during surgery. In the younger group, the maximum concentration of sevoflurane needed during surgery was 1.95 +/- 0.14 (95% confidence interval: 1.87-2.10) vol%, while it was 1.54 +/- 0.44 (95% confidence interval: 1.27-1.80) vol% in the older group (P < 0.01). CONCLUSIONS: The requisite concentration of sevoflurane required with combined epidural-general anesthesia was 2.5 vol% for the younger group and 2.0 vol% for the older group as determined by BIS monitoring. We believe that these percentages are sufficient to avoid awareness during surgery with adequate analgesia.
Analgesia ; Analgesics ; Anesthesia ; Anesthesia, Epidural ; Anesthetics, Inhalation ; Humans ; Methyl Ethers

It is important to understand the impact of the COVID-19 pandemic on inpatient care and the needs of inpatients and their families. We conducted an anonymous self-administered questionnaire survey of inpatients who had been referred to our palliative care team, their families (hereafter referred to as patients' families), and their primary nurses (hereafter referred to as PNs). The EZR statistical software was used for statistical analysis, and p<0.05 was considered to indicate a significant difference. 31 patients [9 males, 22 females; median age 65 years (range 30-85 years)], 25 family members, and 26 PNs responded. The question “Do you ever feel depressed due to restricted visitation?” had a significantly stronger impact on patient families than on patients (p<0.05). Compared to patients, patient families tended to prefer face-to-face visits (p<0.05). The impact of visitation restrictions was greater on patients’ families than on the inpatients, suggesting that it is important to provide care and support to patients’ families especially during periods when there are visitation restrictions.