Randomized controlled trial of the haemodynamic and recovery effects of xenon or propofol anaesthesia

Coburn, Mark; Kunitz, Oliver; Baumert, J.‐H.; Hecker, K.; Haaf, Samuel; Zühlsdorff, André; Beeker, Thorben; Rossaint, Rolf

doi:10.1093/bja/aei023

Cited by 87 publications

(48 citation statements)

References 17 publications

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“…It therefore seems reasonable to conclude that in xenon/ remifentanil anesthetized dogs bradycardia cannot be attributed to remifentanil alone. Indeed, a certain degree of bradycardia has also been described during xenon anaesthesia in pigs (Vagts et al 2004) and humans (Rossaint et al 2003, Coburn et al 2005. CO decreased during all anaesthesia regimens tested in our study.…”

Section: Haemodynamicssupporting

confidence: 76%

The haemodynamic and catecholamine response to xenon/remifentanil anaesthesia in Beagle dogs

et al. 2008

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SummaryThe noble gas xenon seems to have minimal cardiovascular side-effects and so may be an ideal anaesthetic agent when investigating cardiovascular physiology. In comparison with standard modern anaesthetics, we investigated the haemodynamic and hormonal effects of xenon in Beagle dogs. After a 30 min baseline period, anaesthesia was induced with propofol and maintained with either (1) 1.2% isoflurane/70% nitrous oxide (N 2 O), (2) 0.8% isoflurane/ 0.5 mg/kg/min remifentanil or (3) 63% xenon/0.5 mg/kg/min remifentanil (n ¼ 6 per group).Haemodynamics were recorded and blood samples taken before and 60 min after induction. Mean arterial blood pressure (MAP) was higher in conscious dogs than during isoflurane/N 2 O (86 + 2 vs. 65 + 2 mmHg, mean + SEM) and isoflurane/remifentanil anaesthesia (95 + 2 vs. 67 + 3 mmHg), whereas MAP did not decrease significantly in response to xenon/ remifentanil anaesthesia (96 + 4 vs. 85 + 6 mmHg). Bradycardia was present during isoflurane/remifentanil (54 + 2/min) and xenon/remifentanil (40 + 3/min), but not during isoflurane/N 2 O anaesthesia (98 + 3/min, P , 0.05). Xenon/remifentanil anaesthesia induced the highest reduction in cardiac output (CO) ( -61%), and the highest increase in systemic vascular resistance (þ120%) among all treatment groups (P , 0.05). A simultaneous increase in endogenous adrenaline and noradrenaline concentrations could only be observed in the xenon/remifentanil group, whereas angiotensin II and vasopressin concentrations increased in all groups. In conclusion, xenon/remifentanil anaesthesia maintains MAP but reduces heart rate and CO and is associated with a considerable stimulation of vasopressor hormones in Beagle dogs. Therefore, xenon/remifentanil exerts a new quality of adverse haemodynamic effects different from volatile anaesthetics and may not perform better during studies of cardiovascular physiology.

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Section: Haemodynamicssupporting

confidence: 76%

The haemodynamic and catecholamine response to xenon/remifentanil anaesthesia in Beagle dogs

et al. 2008

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“…The only ................................................................................................................................................................................................................... study currently available comparing xenon-based anaesthesia with total intravenous anaesthesia using propofol is in ASA I-II patients (therefore not high risk patients) undergoing elective surgery. This study did not demonstrate any differences in haemodynamic stability between xenon and propofol, and even the speed of recovery from anaesthesia was comparable between the two groups [28].…”

Section: Discussioncontrasting

confidence: 65%

Comparison of xenon‐based anaesthesia compared with total intravenous anaesthesia in high risk surgical patients*

et al. 2005

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SummaryXenon, a noble gas with anaesthetic and analgesic properties, has gained renewed interest due to its favourable physical properties which allow a rapid emergence from anaesthesia. However, high costs limit its use to a subset of patients who may benefit from xenon, thereby offsetting its costs. To date, there are only limited data available on the performance of xenon in high risk patients. We studied 39 patients with ASA physical status III undergoing aortic surgery. The patients were randomly assigned to either a xenon (Xe, n = 20) or a TIVA (T, n = 19) group. Global cardiac performance and myocardial contractility were assessed using transoesophageal echocardiography, and myocardial cell damage with troponin T and CK-MB. Echocardiographic measurements were made prior to xenon administration, following xenon administration, and after clamping of the abdominal aorta, after declamping and at corresponding time points in the TIVA group. Laboratory values were determined repeatedly for up to 72 h. Data were analysed using two-way ANOVA factoring for time and anaesthetic agent or with ANCOVA comparing linear regression lines. No significant differences were found in global myocardial performance, myocardial contractility or laboratory values at any time during the study period. Mean (SEM) duration of stay on the ICU (xenon: 38 ± 46 vs. TIVA 25 ± 15 h) or in hospital (xenon: 14 ± 12 vs. TIVA 10 ± 6 days) did not differ significantly between the groups. Although xenon has previously been shown to exert superior haemodynamic stability, we were unable to demonstrate an advantage of xenon-based anaesthesia compared to TIVA in high risk surgical patients.

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“…Die erste prospektivkontrollierte Studie zur Sicherheit und Effektivität des Xenons als Anästhetikum wurde Anfang der 90er Jahre von Lachmann et al [34] So konnten in einer weiteren mono zentrischen Studie von Coburn et al [9], die in Anlehnung an die klinische Routine durchgeführt wurde, die oben beschrie benen positiven Effekte des Xenons im Vergleich mit einer totalen intravenösen Anästhesie (TIVA) mit Propofol an einem Kollektiv von 160 chirurgischen Elektiv patienten nicht bestätigt werden. Erfasst wurden intra und postoperative hämo dynamische Parameter sowie die post operative Erholungszeit.…”

Section: Xenonanästhesieunclassified

Aktuelle Entwicklungen in der Xenonforschung

et al. 2010

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The noble gas xenon exerts favorable anesthetic properties along with remarkable hemodynamic stability in healthy patients undergoing elective surgery. It represents the nearly ideal anesthetic and provides safe and well controllable anesthesia although the exact mechanism by which xenon produces anesthesia remains to be elucidated. In addition xenon offers organ protective properties for vital organs including the brain, heart and kidneys which seem to be synergistic when used in combination with therapeutic hypothermia. As the high cost of xenon will probably preclude its wider use as a routine anesthetic, data from extensive tests in large numbers of high risk patients is needed to confirm its possible superiority in this setting.

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Randomized controlled trial of the haemodynamic and recovery effects of xenon or propofol anaesthesia

Abstract: After induction the xenon/opioid regimen maintains systolic blood pressure at baseline levels and a low heart rate. No differences between groups were found in haemodynamic stability during anaesthesia. Recovery from xenon anaesthesia was similar to that observed in the propofol group.

Cited by 87 publications

References 17 publications

The haemodynamic and catecholamine response to xenon/remifentanil anaesthesia in Beagle dogs

The haemodynamic and catecholamine response to xenon/remifentanil anaesthesia in Beagle dogs

Comparison of xenon‐based anaesthesia compared with total intravenous anaesthesia in high risk surgical patients*

Aktuelle Entwicklungen in der Xenonforschung

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