WordNet

the spatial property of being crowded together (同)density, denseness, tightness, compactness
bringing together military forces
strengthening the concentration (as of a solute in a mixture) by removing diluting material
the strength of a solution; number of molecules of a substance in a given volume
complete attention; intense mental effort (同)engrossment, absorption, immersion
increase in density
the smallest possible quantity (同)lower_limit
the point on a curve where the tangent changes from negative on the left to positive on the right
pertaining to the tiny air sacs of the lungs
pertaining to the sockets of the teeth or that part of the upper jaw; "alveolar processes"
a British imperial capacity measure (liquid or dry) equal to 1/60th fluid dram or 0.059194 cubic centimeters
a United States liquid unit equal to 1/60 fluidram

PrepTutorEJDIC

〈U〉(…への)(光線・注意などの)集中;(仕事などへの)専念,専心《+『on』+『名』》 / 〈C〉(人口などの)集中 / 〈U〉濃縮;〈液体の〉濃度
《通例単数形で》『最小限』,最小量 / (数学で)極小,最小値,極小値 / 《名詞の前にのみ用いて》『最小限の』,最小量の
歯茎音の(舌先を上歯茎にふれて発音する) / 肺胞の;歯槽(しそう)の / 歯茎音
ミニム(液量の最小単位) / 《英》二分音符(《米》half note)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/07/13 23:47:27」(JST)

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Minimum alveolar concentration or MAC is the concentration of the vapour in the lungs that is needed to prevent movement (motor response) in 50% of subjects in response to surgical (pain) stimulus. MAC is used to compare the strengths, or potency, of anaesthetic vapours.^[1] MAC was introduced in 1965.^[2]

MAC actually is a median value, not a minimum as term implies. The use of minimum is from the original paper, where the term was minimal alveolar concentration. A lower MAC value represents a more potent volatile anesthetic.

Other uses of MAC include MAC-BAR (1.7-2.0 MAC), which is the concentration required to block autonomic reflexes to nociceptive stimuli, and MAC-awake (0.3-0.5 MAC), the concentration required to block voluntary reflexes and control perceptive awareness.

Formal definition

The MAC is the concentration of the vapour (measured as a percentage at 1 atmosphere, i.e. the partial pressure) that prevents patient movement in response to a supramaximal ^[3]stimulus (traditionally a set depth and width of skin incisions) in 50% of subjects. This measurement is done at steady state (assuming a constant alveolar concentration for 15 minutes), under the assumption that this allows for an equilibration between the gasses in the alveoli, the blood and the brain. MAC is accepted as a valid measure of potency of inhalational general anaesthetics because it remains fairly constant for a given species even under varying conditions.

Meyer-Overton hypothesis

The MAC of a volatile substance is inversely proportional to its lipid solubility (oil:gas coefficient), in most cases. This is the Meyer-Overton hypothesis put forward in 1899–1901 by Hans Horst Meyer and Charles Ernest Overton. MAC is inversely related to potency, i.e. high MAC equals low potency.

The hypothesis correlates lipid solubility of an anaesthetic agent with potency (1/MAC) and suggests that onset of anaesthesia occurs when sufficient molecules of the anaesthetic agent have dissolved in the cell's lipid membranes, resulting in anaesthesia. Exceptions to the Meyer-Overton hypothesis can result from:

convulsant property of an agent
specific receptor (various agents may exhibit an additional effect through specific receptors)
co-administration of Alpha₂ agonists (dexmedetomidine) and/or opioid receptor agonists (morphine/fentanyl) can decrease the MAC^[4]^[5]
Mullin's critical volume hypothesis
Positive modulation of GABA at GABA_A receptors by barbiturates or benzodiazepines

Altered MAC

Certain physiological and pathological states may alter MAC. MAC is higher in infants and lower in the elderly. Also, MAC increases with hyperthermia, alcoholism and thyrotoxicosis. Likewise, hypothermia, hypotension (MAP < 40 mmHg), and pregnancy seem to decrease MAC. Duration of anesthesia, gender, height and weight seem to have little effect on MAC. Opioid analgesics and sedative-hypnotics, often used as adjuvants to anesthesia, decrease MAC. It should also be noted that MAC values are additive. For instance, when applying 0.3 MAC of drug X and 1 MAC of drug Y the total MAC achieved is 1.3 MAC. In this way nitrous oxide is often used as a "carrier" gas to decrease the anesthetic requirement of other drugs.

Common MAC values

Values are known to decrease with age and the following are given are based on a 40 year old (MAC₄₀):^[6]

Nitrous oxide - 104 ^[6]
Xenon - 72 ^[6]
Desflurane - 6.6 ^[6]
Ethyl Ether - 3.2
Sevoflurane - 1.8 ^[6]
Enflurane - 1.63 ^[6]
Isoflurane - 1.17 ^[6]
Halothane - 0.75 ^[6]
Chloroform - 0.5
Methoxyflurane - 0.16

References

^ "Policy: Ban on Use of Ether". Laboratory Animal Science Center. Archived from the original on 2008-06-09. Retrieved 2008-11-10.
^ Eger EI, Saidman LJ, Brandstater B (1965). "Minimum alveolar anesthetic concentration: a standard of anesthetic potency". Anesthesiology 26 (6): 756–63. doi:10.1097/00000542-196511000-00010. PMID 5844267.
^ Miller ANESTHESIOLOGY
^ * Daniel M, Weiskopf RB, Noorani M, Eger EI (January 1998). "Fentanyl augments the blockade of the sympathetic response to incision (MAC-BAR) produced by desflurane and isoflurane: desflurane and isoflurane MAC-BAR without and with fentanyl". Anesthesiology 88 (1): 43–9. doi:10.1097/00000542-199801000-00009. PMID 9447854.
^ Katoh T, Kobayashi S, Suzuki A, Iwamoto T, Bito H, Ikeda K (February 1999). "The effect of fentanyl on sevoflurane requirements for somatic and sympathetic responses to surgical incision". Anesthesiology 90 (2): 398–405. doi:10.1097/00000542-199902000-00012. PMID 9952144.
^ ^a ^b ^c ^d ^e ^f ^g ^h * Nickalls, R. W. D., & Mapleson, W. W. (August 2003). "Age-related iso-MAC charts for isoflurane, sevoflurane, and desflurane in man". British Journal of Anaesthesia 91 (2): 170–4. doi:10.1093/bja/aeg132. PMID 12878613.

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BACKGROUND: We examined the hypothesis that the minimum alveolar concentration of desflurane for maintaining bispectral index (BIS) below 50 (MACBIS 50 ) decreases with advance of age.METHODS: Sixty young (20-30 year), middle-aged (31-65 year) and elderly (66-80 year) patients were included (n = 20,
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