Xenon anesthesia: Safe and feasible
Ischemic myocardial damage accompanying coronary artery bypass graft surgery remains a clinical challenge. Animal ischemia models have given first indications that xenon anesthesia could limit myocardial damage in this patient group. Would it work in humans? The present multinational French-German-Italian-Dutch study investigated this question in patients treated in 17 university hospitals across Europe.
The low-risk patients undergoing on-pump coronary artery bypass graft surgery were randomized to receive either xenon, sevoflurane or propofol-based total intravenous anesthesia for anesthesia maintenance. The primary outcome was the cardiac troponin I concentration in the blood 24 h after surgery. The authors defined a value of < 0.15 ng/ml as non-inferiority margin for the mean difference in cardiac troponin I release between the xenon and sevoflurane groups.
The intention-to-treat population was 492; the per-protocol/without major protocol deviation group included 446 patients. Median 24-h postoperative cardiac troponin I concentrations were 1.14ng/ml with xenon, 1.30 with sevoflurane and 1.48 with total intravenous anesthesia (per-protocol). The mean difference in cardiac troponin I release between xenon and sevoflurane was -0.09 ng/ml. Postoperative cardiac troponin I release was significantly less with xenon than with total intravenous anesthesia. Perioperative variables and postoperative outcomes were comparable across all groups, and the authors observed no safety concerns.
In this population of on-pump coronary artery bypass graft surgery patients, xenon was non-inferior to sevoflurane in low-risk with respect to postoperative cardiac troponin I release. In addition, postoperative cardiac troponin I release was significantly less with xenon than with total intravenous anesthesia. Xenon anesthesia seems to be safe and feasible.