Nausea and Vomiting following Balanced Xenon Anesthesia Compared to Sevoflurane: A Post-Hoc Explorative Analysis of a Randomized Controlled Trial

Abstract

ObjectiveLike other inhalational anesthetics xenon seems to be associated with post-operative nausea and vomiting (PONV). We assessed nausea incidence following balanced xenon anesthesia compared to sevoflurane, and dexamethasone for its prophylaxis in a randomized controlled trial with post-hoc explorative analysis.Methods220 subjects with elevated PONV risk (Apfel score ≥2) undergoing elective abdominal surgery were randomized to receive xenon or sevoflurane anesthesia and dexamethasone or placebo after written informed consent. 93 subjects in the xenon group and 94 subjects in the sevoflurane group completed the trial. General anesthesia was maintained with 60% xenon or 2.0% sevoflurane. Dexamethasone 4mg or placebo was administered in the first hour. Subjects were analyzed for nausea and vomiting in predefined intervals during a 24h post-anesthesia follow-up.ResultsLogistic regression, controlled for dexamethasone and anesthesia/dexamethasone interaction, showed a significant risk to develop nausea following xenon anesthesia (OR 2.30, 95% CI 1.02–5.19, p = 0.044). Early-onset nausea incidence was 46% after xenon and 35% after sevoflurane anesthesia (p = 0.138). After xenon, nausea occurred significantly earlier (p = 0.014), was more frequent and rated worse in the beginning. Dexamethasone did not markedly reduce nausea occurrence in both groups. Late-onset nausea showed no considerable difference between the groups.ConclusionIn our study setting, xenon anesthesia was associated with an elevated risk to develop nausea in sensitive subjects. Dexamethasone 4mg was not effective preventing nausea in our study. Group size or dosage might have been too small, and change of statistical analysis parameters in the post-hoc evaluation might have further contributed to a limitation of our results. Further trials will be needed to address prophylaxis of xenon-induced nausea.Trial RegistrationEU Clinical Trials EudraCT-2008-004132-20ClinicalTrials.gov NCT00793663

Effects of different sufentanil target concentrations on the MACBAR of sevoflurane in patients with carbon dioxide pneumoperitoneum stimulus

“…However, the decrease in HR did not result in a decrease of patients’ MAP, especially when a high concentration of sufentanil was administrated. It implies the hemodynamic safety range of sufentanil is large, which is consistent with the results of Fechner and his colleagues [ 31 ]. Our study did show that the use of sufentanil at a large dose results in a delay of anaesthesia recovery (Table 1 ).…”

Effects of different sufentanil target concentrations on the MACBAR of sevoflurane in patients with carbon dioxide pneumoperitoneum stimulus

“…However, the decrease in HR did not result in a decrease of patients' MAP, especially when high concentration of sufentanil was administrated. It implies the safety range of sufentanil is large, which is consistent with the results of Fechner and his colleagues [32] . Nevertheless, our study showed the use of sufentanil at a large dose results in the delay of anaesthesia recovery (table1).…”

In search of Universal Cortical Power Changes Linked to NMDA-Antagonist based Anesthetic Induced Reductions in Consciousness

“…The anomalous electrophysiology of the NMDA antagonistic anesthetics may be attributed to a number of factors. Firstly, investigations of gaseous N 2 O and Xe when compared to intravenous ketamine, are limited to a small number of studies potentially due to the unclear clinical utility of Xe as well as the widely reported association with post-operative nausea and vomiting 21-23 , and pronounced dissociative effects. In addition, dosage differences across studies ranging from subanesthetic to anesthetic levels 14,15,19,20,24 and the common practice inclusion of concomitant agents 17,25 , encumber the ability to draw conclusive findings.…”