L Al Tmimi1, J Van Hemelrijck2, M Van de Velde2, P Sergeant3, B Meyns3, C Missant2, I Jochmans4, K Poesen5, M Coburn6, S Rex7. 1. Department of Anaesthesiology, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium. 2. Department of Anaesthesiology, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium. 3. Department of Cardiac Surgery, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium. 4. Department of Abdominal Transplant Surgery, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium Department of Microbiology and Immunology, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium. 5. Department of Laboratory Medicines, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium Department of Neurosciences, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium. 6. Department of Anaesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany. 7. Department of Anaesthesiology, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium steffen.rex@uzleuven.be.
Abstract
BACKGROUND:Off-pump coronary artery bypass (OPCAB) surgery carries a high risk for haemodynamic instability and perioperative organ injury. Favourable haemodynamic effects and organ-protective properties could render xenon an attractive anaesthetic for OPCAB surgery. The primary aim of this study was to assess whether xenon anaesthesia for OPCAB surgery is non-inferior to sevoflurane anaesthesia with regard to intraoperative vasopressor requirements. METHODS:Forty-two patients undergoing elective OPCAB surgery were enrolled in this prospective, single-blind, randomized controlled pilot trial. Patients were randomized to either xenon (50-60 vol%) or sevoflurane (1.1-1.4 vol%) anaesthesia. Primary outcome was intraoperative noradrenaline requirements necessary to achieve predefined haemodynamic goals. Secondary outcomes included safety variables such as the occurrence of adverse events (intraoperatively and during a 6-month follow-up after surgery) and the perioperative cardiorespiratory and inflammatory profile. RESULTS: Baseline and intraoperative data did not differ between groups. Xenon was non-inferior to sevoflurane, as xenon patients required significantly less noradrenaline intraoperatively to achieve the predefined haemodynamic goals {geometric mean 428 [95% confidence interval (CI) 312, 588] vs 1702 [1267, 2285] µg, P<0.0001}. No differences were found for safety. Significantly more sevoflurane patients developed postoperative delirium (POD) (hazard ratio 4.2, P=0.044). The average arterial pressure was lower in the sevofluranegroup {median75 [interquartile range (IQR) 6] vs 72 [4] mmHg, P=0.002}. No differences were found for other haemodynamic parameters, the respiratory profile and the perioperative release of inflammatory cytokines, troponin T, serum protein S-100β and erythropoietin. CONCLUSIONS: Compared with sevoflurane, xenon anaesthesia allows a significant reduction in vasopressor administration in OPCAB surgery. Moreover, xenon anaesthesia was associated with a lower risk for POD, a finding that has to be confirmed in larger studies. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT01757106) and EudraCT (2012-002316-12).
RCT Entities:
BACKGROUND: Off-pump coronary artery bypass (OPCAB) surgery carries a high risk for haemodynamic instability and perioperative organ injury. Favourable haemodynamic effects and organ-protective properties could render xenon an attractive anaesthetic for OPCAB surgery. The primary aim of this study was to assess whether xenon anaesthesia for OPCAB surgery is non-inferior to sevoflurane anaesthesia with regard to intraoperative vasopressor requirements. METHODS: Forty-two patients undergoing elective OPCAB surgery were enrolled in this prospective, single-blind, randomized controlled pilot trial. Patients were randomized to either xenon (50-60 vol%) or sevoflurane (1.1-1.4 vol%) anaesthesia. Primary outcome was intraoperative noradrenaline requirements necessary to achieve predefined haemodynamic goals. Secondary outcomes included safety variables such as the occurrence of adverse events (intraoperatively and during a 6-month follow-up after surgery) and the perioperative cardiorespiratory and inflammatory profile. RESULTS: Baseline and intraoperative data did not differ between groups. Xenon was non-inferior to sevoflurane, as xenonpatients required significantly less noradrenaline intraoperatively to achieve the predefined haemodynamic goals {geometric mean 428 [95% confidence interval (CI) 312, 588] vs 1702 [1267, 2285] µg, P<0.0001}. No differences were found for safety. Significantly more sevofluranepatients developed postoperative delirium (POD) (hazard ratio 4.2, P=0.044). The average arterial pressure was lower in the sevoflurane group {median75 [interquartile range (IQR) 6] vs 72 [4] mmHg, P=0.002}. No differences were found for other haemodynamic parameters, the respiratory profile and the perioperative release of inflammatory cytokines, troponin T, serum protein S-100β and erythropoietin. CONCLUSIONS: Compared with sevoflurane, xenon anaesthesia allows a significant reduction in vasopressor administration in OPCAB surgery. Moreover, xenon anaesthesia was associated with a lower risk for POD, a finding that has to be confirmed in larger studies. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT01757106) and EudraCT (2012-002316-12).
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