Xenon as an Adjuvant to Propofol Anesthesia in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery: A Pragmatic Randomized Controlled Clinical Trial

被引:14
作者
Al Tmimi, Layth [1 ]
Devroe, Sarah [1 ]
Dewinter, Geertrui [1 ]
Van de Velde, Marc [1 ,2 ]
Poortmans, Gert [1 ]
Meyns, Bart [2 ,3 ]
Meuris, Bart [2 ,3 ]
Coburn, Mark [4 ]
Rex, Steffen [1 ,2 ]
机构
[1] Univ Leuven, KU Leuven, Dept Anesthesiol, Univ Hosp Leuven, Leuven, Belgium
[2] Univ Leuven, KU Leuven, Dept Cardiovasc Sci, Univ Hosp Leuven, Leuven, Belgium
[3] Univ Leuven, KU Leuven, Dept Cardiac Surg, Univ Hosp Leuven, Leuven, Belgium
[4] Rhein Westfal TH Aachen, Univ Hosp, Dept Anesthesiol, Aachen, Germany
关键词
TARGET-CONTROLLED INFUSION; NONCARDIAC SURGERY; INTRAOPERATIVE HYPOTENSION; SEVOFLURANE ANESTHESIA; POSTOPERATIVE DELIRIUM; HEMODYNAMIC-RESPONSES; BISPECTRAL INDEX; CARDIAC-SURGERY; BALANCED XENON; NITROUS-OXIDE;
D O I
10.1213/ANE.0000000000002179
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
BACKGROUND: Xenon was shown to cause less hemodynamic instability and reduce vasopressor needs during off-pump coronary artery bypass (OPCAB) surgery when compared with conventionally used anesthetics. As xenon exerts its organ protective properties even in subanesthetic concentrations, we hypothesized that in patients undergoing OPCAB surgery, 30% xenon added to general anesthesia with propofol results in superior hemodynamic stability when compared to anesthesia with propofol alone. METHODS: Fifty patients undergoing elective OPCAB surgery were randomized to receive general anesthesia with 30% xenon adjuvant to a target-controlled infusion of propofol or with propofol alone. The primary end point was the total intraoperative dose of norepinephrine required to maintain an intraoperative mean arterial pressure >70 mm Hg. Secondary outcomes included the perioperative cardiorespiratory profile and the incidence of adverse and serious adverse events. RESULTS: Adding xenon to propofol anesthesia resulted in a significant reduction of norepinephrine required to attain the predefined hemodynamic goals (cumulative intraoperative dose: median [interquartile range]: 370 [116-570] vs 840 [335-1710] mu g, P =.001). In the xenon-propofol group, significantly less propofol was required to obtain a similar depth of anesthesia as judged by clinical signs and the bispectral index (propofol effect site concentration [mean +/- SD]: 1.8 +/- 0.5 vs 2.8 +/- 0.3 mg, P <= .0001). Moreover, the xenon-propofol group required significantly less norepinephrine during the first 24 hours on the intensive care unit (median [interquartile range]: 1.5 [0.1-7] vs 5 [2-8] mg, P = .048). Other outcomes and safety parameters were similar in both groups. CONCLUSIONS: Thirty percent xenon added to propofol anesthesia improves hemodynamic stability by decreasing norepinephrine requirements in patients undergoing OPCAB surgery.
引用
收藏
页码:1118 / 1128
页数:11
相关论文
共 46 条
[1]   Target-Controlled Infusion: A Mature Technology [J].
Absalom, Anthony R. ;
Glen, John B. ;
Zwart, Gerrit J. C. ;
Schnider, Thomas W. ;
Struys, Michel M. R. F. .
ANESTHESIA AND ANALGESIA, 2016, 122 (01) :70-78
[2]   Xenon anaesthesia for patients undergoing off-pump coronary artery bypass graft surgery: a prospective randomized controlled pilot trial [J].
Al Tmimi, L. ;
Van Hemelrijck, J. ;
Van de Velde, M. ;
Sergeant, P. ;
Meyns, B. ;
Missant, C. ;
Jochmans, I. ;
Poesen, K. ;
Coburn, M. ;
Rex, S. .
BRITISH JOURNAL OF ANAESTHESIA, 2015, 115 (04) :550-559
[3]   Serum protein S100 as marker of postoperative delirium after off-pump coronary artery bypass surgery: secondary analysis of two prospective randomized controlled trials [J].
Al Tmimi, Layth ;
Van de Velde, Marc ;
Meyns, Bart ;
Meuris, Bart ;
Sergeant, Paul ;
Milisen, Koen ;
Pottel, Hans ;
Poesen, Koen ;
Rex, Steffen .
CLINICAL CHEMISTRY AND LABORATORY MEDICINE, 2016, 54 (10) :1671-1680
[4]  
[Anonymous], 2009, BMC ANESTHESIOL
[5]  
[Anonymous], 2007, SURVIVAL ANAL PRACTI
[6]   Intraoperative Systolic Blood Pressure Variability Predicts 30-day Mortality in Aortocoronary Bypass Surgery Patients [J].
Aronson, Solomon ;
Stafford-Smith, Mark ;
Phillips-Bute, Barbara ;
Shaw, Andrew ;
Gaca, Jeffrey ;
Newman, Mark .
ANESTHESIOLOGY, 2010, 113 (02) :305-312
[7]   The effective concentration 50 (EC50) for propofol with 70% xenon versus 70% nitrous oxide [J].
Barakat, Ahmed R. ;
Schreiber, Markus N. ;
Flaschar, Joachim ;
Georgieff, Michael ;
Schraag, Stefan .
ANESTHESIA AND ANALGESIA, 2008, 106 (03) :823-829
[8]   Administration of propofol by target-controlled infusion in patients undergoing coronary artery surgery [J].
Barvais, L ;
Rausin, I ;
Glen, JB ;
Hunter, SC ;
DHulster, D ;
Cantraine, F ;
dHollander, A .
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 1996, 10 (07) :877-883
[9]   Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group [J].
Bellomo, R ;
Ronco, C ;
Kellum, JA ;
Mehta, RL ;
Palevsky, P .
CRITICAL CARE, 2004, 8 (04) :R204-R212
[10]   Off-pump coronary artery bypass surgery: physiology and anaesthetic management [J].
Chassot, PG ;
van der Linden, P ;
Zaugg, M ;
Mueller, XM ;
Spahn, DR .
BRITISH JOURNAL OF ANAESTHESIA, 2004, 92 (03) :400-413