The Effect of Xenon Anesthesia on the Size of Experimental Myocardial Infarction

Baumert, J.‐H.; Gesenhues, Jonas; Gerets, Christina; Baltus, Thomas; Hecker, K.; Rossaint, Rolf

doi:10.1213/01.ane.0000284697.73471.9c

Cited by 39 publications

(29 citation statements)

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“…Modulation of inflammatory responses or immune tissue damage by Xe may in the future reveal additional protective responses with respect to other organ systems, for which there is already some evidence from animal studies. [40][41][42] …”

Section: Figurementioning

confidence: 99%

Xenon Ventilation During Therapeutic Hypothermia in Neonatal Encephalopathy: A Feasibility Study

et al. 2014

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BACKGROUND AND OBJECTIVES: Therapeutic hypothermia has become standard of care in newborns with moderate and severe neonatal encephalopathy; however, additional interventions are needed. In experimental models, breathing xenon gas during cooling offers long-term additive neuroprotection. This is the first xenon feasibility study in cooled infants. Xenon is expensive, requiring a closed-circuit delivery system. METHODS: Cooled newborns with neonatal encephalopathy were eligible for this single-arm, dose-escalation study if clinically stable, under 18 hours of age and requiring less than 35% oxygen. Xenon duration increased stepwise from 3 to 18 hours in 14 subjects; 1 received 25% xenon and 13 received 50%. Respiratory, cardiovascular, neurologic (ie, amplitude-integrated EEG, seizures), and inflammatory (C-reactive protein) effects were examined. The effects of starting or stopping xenon rapidly or slowly were studied. Three matched control subjects per xenon treated subject were selected from our cooling database. Follow-up was at 18 months using mental developmental and physical developmental indexes of the Bayley Scales of Infant Development II. RESULTS: No adverse respiratory or cardiovascular effects, including post-extubation stridor, were seen. Xenon increased sedation and suppressed seizures and background electroencephalographic activity. Seizures sometimes occurred during rapid weaning of xenon but not during slow weaning. C-reactive protein levels were similar between groups. Hourly xenon consumption was 0.52 L. Three died, and 7 of 11 survivors had mental and physical developmental index scores ≥70 at follow-up. CONCLUSIONS: Breathing 50% xenon for up to 18 hours with 72 hours of cooling was feasible, with no adverse effects seen with 18 months' follow-up.

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Section: Figurementioning

confidence: 99%

Xenon Ventilation During Therapeutic Hypothermia in Neonatal Encephalopathy: A Feasibility Study

et al. 2014

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“…Different experimental in vitro and in vivo models were able to demonstrate the neuroprotective [8–12] and cardioprotective [13–16] effects induced by Xe treatment. First approaches translating these results into clinical practice showed promising neuroprotective properties of Xe in newborn infants with perinatal asphyxia [17,18] and in patients after out-of-hospital cardiac arrest [19].…”

Section: Introductionmentioning

confidence: 99%

Renal function following xenon anesthesia for partial nephrectomy—An explorative analysis of a randomized controlled study

et al. 2017

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BackgroundPerioperative preservation of renal function has a significant impact on morbidity and mortality in kidney surgery. Nephroprotective effects of the anesthetic xenon on ischemia-reperfusion injury were found in several experimental studies.ObjectiveWe aimed to explore whether xenon anesthesia can reduce renal damage in humans undergoing partial nephrectomy and to gather pilot data of possible nephroprotection in these patients.DesignA prospective randomized, single-blinded, controlled study.SettingSingle-center, University Hospital of Aachen, Germany between July 2013-October 2015.PatientsForty-six patients with regular renal function undergoing partial nephrectomy.InterventionsPatients were randomly assigned to receive xenon- (n = 23) or isoflurane (n = 23) anesthesia.Main outcome measuresPrimary outcome was the maximum postoperative glomerular filtration rate (GFR) decline within seven days after surgery. Secondary outcomes included intraoperative and tumor-related data, assessment of further kidney injury markers, adverse events and optional determination of renal function after 3–6 months.ResultsUnexpected radical nephrectomy was performed in 5 patients, thus they were excluded from the per-protocol analysis, but included in the intention-to-treat analysis. The maximum postoperative GFR decline was attenuated by 45% in the xenon-group (10.9 ml min-1 1.73 cm-2 versus 19.7 ml min-1 1.73 cm-2 in the isoflurane group), but without significance (P = 0.084). Occurrence of adverse events was reduced (P = 0.003) in the xenon group. Renal function was similar among the groups after 3–6 months.ConclusionXenon anesthesia was feasible and safe in patients undergoing partial nephrectomy with regard to postoperative renal function. We found no significant effect on early renal function but less adverse events in the xenon group. Larger randomized controlled studies in more heterogeneous collectives are required, to confirm or refute the possible clinical benefit on renal function by xenon.Trial registrationClinicalTrials.gov NCT01839084 and EudraCT 2012-005698-30

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“…Similarly, in American Society of Anesthesiologists (ASA) class 3 or 4 patients with evidenced coronary arterial disease proposed for elective noncardiac surgery, not only arterial pressure was better preserved by xenon than by propofol, but echographic indices showed better left ventricle function with xenon [14]. Conversely, xenon does not seem to possess the same preconditioning protective effect as volatile anesthetics and the size of an experimental myocardial infarction, reduced by ischemic preconditioning, was not modified by xenon administration [15 ].…”

Section: Xenonmentioning

confidence: 98%

Update on pharmacology of hypnotic drugs

Servin¹

2008

Current Opinion in Anaesthesiology

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The Effect of Xenon Anesthesia on the Size of Experimental Myocardial Infarction

Abstract: Myocardial infarct size was reduced by ischemic preconditioning but less so by xenon anesthesia. Brief, intermittent exposure to xenon before myocardial ischemia did not reduce myocardial infarct size.

Cited by 39 publications

References 30 publications

Xenon Ventilation During Therapeutic Hypothermia in Neonatal Encephalopathy: A Feasibility Study

Xenon Ventilation During Therapeutic Hypothermia in Neonatal Encephalopathy: A Feasibility Study

Renal function following xenon anesthesia for partial nephrectomy—An explorative analysis of a randomized controlled study

Update on pharmacology of hypnotic drugs

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