Intraoperative xenon for prevention of delirium after on-pump cardiac surgery: a randomised, observer-blind, controlled clinical trial

Tmimi, Layth Al; Verbrugghe, Peter; Velde, Marc Van de; Meuris, Bart; Meyfroidt, Geert; Milisen, Koen; Fieuws, Steffen; Rex, Steffen

doi:10.1016/j.bja.2019.11.037

Cited by 23 publications

(25 citation statements)

References 57 publications

(54 reference statements)

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“…In our study, Dexm reduced POD after all types of anesthesia and after general anesthesia compared with the control group. These results are in close agreement with a previous report by Al Tmimi et al [ 13 ] and Shen et al [ 14 ] in which the risks of POD were decreased in elderly patients after non-cardiac surgery.…”

Section: Discussionsupporting

confidence: 94%

“…Of these, 182 studies were discarded after reviewing the title and abstracts for the following reasons: related to other topics, designed as systematic reviews, reviews or retrospective studies, and conference abstracts. The full texts of the 63 remaining studies were reviewed in detail; 12 studies were excluded for the following reasons: three were study protocols [ 25 – 27 ], two were editorials [ 13 , 28 ], four were systematic reviews, [ 9 – 12 ] and three did not report the outcome of our interest (two compared an inhalational agent [ 13 , 29 ] and one was compared in the PCA regimen [ 30 ]). Thus, 51 studies with a total of 22,565 patients that included 18 different pharmacological interventions were included in this NMA ( Fig.…”

Section: Resultsmentioning

confidence: 99%

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Pharmacological strategies to prevent postoperative delirium: a systematic review and network meta-analysis

et al. 2021

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Background: Postoperative delirium (POD) is a condition of cerebral dysfunction and a common complication after surgery. This study aimed to compare and determine the relative efficacy of pharmacological interventions for preventing POD using a network meta-analysis (NMA).Methods: We performed a systematic and comprehensive search to identify and analyze all randomized controlled trials until June 29, 2020, comparing two or more pharmacological interventions, including placebo, to prevent or reduce POD. The primary outcome was the incidence of POD. We performed a network meta-analysis and used the surface under the cumulative ranking curve (SUCRA) values and rankograms to present the hierarchy of the pharmacological interventions evaluated.Results: According to the SUCRA value, the incidence of POD decreased in the following order: the combination of propofol and acetaminophen (86.1%), combination of ketamine and dexmedetomidine (86.0%), combination of diazepam, flunitrazepam, and pethidine (84.8%), and olanzapine (75.6%) after all types of anesthesia; combination of propofol and acetaminophen (85.9%), combination of ketamine and dexmedetomidine (83.2%), gabapentin (82.2%), and combination of diazepam, flunitrazepam, and pethidine (79.7%) after general anesthesia; and ketamine (87.1%), combination of propofol and acetaminophen (86.0%), and combination of dexmedetomidine and acetaminophen (66.3%) after cardiac surgery. However, only the dexmedetomidine group showed a lower incidence of POD than the control group after all types of anesthesia and after general anesthesia.Conclusions: Dexmedetomidine reduced POD compared with the control group. The combination of propofol and acetaminophen and the combination of ketamine and dexmedetomidine seemed to be effective in preventing POD. However, further studies are needed to determine the optimal pharmacological intervention to prevent POD.

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Section: Discussionsupporting

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Pharmacological strategies to prevent postoperative delirium: a systematic review and network meta-analysis

et al. 2021

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“…However, the study involved a small sample size therefore generalization of these findings will not be appropriate unless backed by adequately powered randomized studies. Later Al Tmimi et al 26 conducted a randomized, observer-blind, controlled trial in which 190 patients involving 65 years or older patients underwent on-pump cardiac surgery. Patients were randomized to receive xenon or sevoflurane as anesthetic.…”

Section: Enon and P Ostoperative C Ognitive D Ysfunction In C mentioning

confidence: 99%

“…On analysis authors concluded that xenon anesthesia did not result in a significant reduction in POCD and therefore did not recommend xenon for preventing POCD. 26 Stoppe et al 27 randomized 30 patients undergoing coronary artery bypass grafting under CPB to receive either xenon anesthesia or sevoflurane anaesthesia. They compared systemic and pulmonary dynamics in both groups and also parameters like blood loss, inotropic support, regional cerebral tissue oxygenation, and postoperative delirium in both groups using CAM-ICU.…”

Section: Enon and P Ostoperative C Ognitive D Ysfunction In C mentioning

confidence: 99%

Efficacy of xenon anesthesia in preventing postoperative cognitive dysfunction after cardiac and major non-cardiac surgeries in elderly patients: a topical review

et al. 2021

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Elderly patients undergoing major cardiac and non-cardiac surgeries have a high propensity (up to 40–60%) of developing postoperative cognitive dysfunction, which are caused by patient’s factors, type of surgery, intraoperative and postoperative factors. All these pose a challenge to the clinicians. The noble gas xenon does not undergo metabolism or any kind of biotransformation in the body owing to its inert nature. Xenon confers excellent hemodynamic stability and provides excellent recovery at the end of surgery. This topical review discusses advantages of xenon anesthesia in elderly patients undergoing major cardiac and non-cardiac surgeries and whether it is worth using a costly anesthetic in elderly patients for preventing postoperative cognitive dysfunction.

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“… 30 A pilot study in off-pump cardiac surgery suggested that xenon anesthesia reduced the incidence of POD compared to conventional inhalational anesthesia 31 ; however a larger study from the same group investigating on-pump cardiac surgery showed no difference in POD incidence for xenon anesthesia when compared to the inhalational anesthesia group. 32 …”

Section: Introductionmentioning

confidence: 99%

Comparing the effect of xenon and sevoflurane anesthesia on postoperative neural injury biomarkers: a randomized controlled trial

et al. 2022

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General anesthesia and surgery are associated with an increase in neural injury biomarkers. Elevations of these neural injury biomarkers in the perioperative period are associated with postoperative delirium. Xenon has been shown to be protective against a range of neurological insults in animal models. It remains to be seen if xenon anesthesia is neuroprotective in the perioperative setting in humans. Twenty-four participants scheduled for lithotripsy were randomized to receive either xenon or sevoflurane general anesthesia. There was no statistically significant difference in the concentrations of postoperative neural injury biomarkers between the xenon and sevoflurane group. Following the procedure there was a significant increase in the concentration from baseline of all three biomarkers at 1 hour post-induction with a return to baseline at 5 hours. General anesthesia for lithotripsy was associated with a significant increase at 1 hour post-induction in the neural injury biomarkers total tau, neurofilament light and tau phosphorylated at threonine 181, a marker of tau phosphorylation. The protocol was approved by the St. Vincent’s Hospital Melbourne Ethics Committee (approval No. HREC/18/SVHM/221) on July 20, 2018 and was registered with the Australia New Zealand Clinical Trials Registry (registration No. ACTRN12618000916246) on May 31, 2018.

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Intraoperative xenon for prevention of delirium after on-pump cardiac surgery: a randomised, observer-blind, controlled clinical trial

Abstract: Initial results of the current study were presented as a chapter of the PhD thesis of L. Al tmimi, November 12, 2018.

Cited by 23 publications

References 57 publications

Pharmacological strategies to prevent postoperative delirium: a systematic review and network meta-analysis

Pharmacological strategies to prevent postoperative delirium: a systematic review and network meta-analysis

Efficacy of xenon anesthesia in preventing postoperative cognitive dysfunction after cardiac and major non-cardiac surgeries in elderly patients: a topical review

Comparing the effect of xenon and sevoflurane anesthesia on postoperative neural injury biomarkers: a randomized controlled trial

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