Cardiovascular effects of xenon and nitrous oxide in patients during fentanyl‐midazolam anaesthesia*

Abstract

SummaryXenon anaesthesia appears to have minimal haemodynamic effects. The purpose of this randomised prospective study was to compare the cardiovascular effects of xenon and nitrous oxide in patients with known ischaemic heart disease. In 20 patients who were due to undergo coronary artery bypass graft surgery, 30 min following induction of anaesthesia with fentanyl 30 lg.kg )1 and midazolam 0.1 mg.kg )1 but prior to the start of surgery, xenon or nitrous oxide 60% was administered for 15 min. The results showed that xenon caused a minimal decrease in the mean arterial pressure (from 81 (7) to 75 (8) mmHg, mean (SD)), but did not affect the systolic function of the left ventricle, as demonstrated by unchanged left ventricular stroke work index (LVSWI) and the fractional area change of the left ventricle (FAC) derived from transoesophageal echocardiography (TOE). However, in contrast, nitrous oxide was found to decrease the mean arterial pressure (from 81 (8) to 69 (7) mmHg), the LVSWI, and the FAC. The cardiac index, central venous and pulmonary artery occlusion pressures, systemic and pulmonary vascular resistances, and the TOE-derived E ⁄ A ratio through the mitral valve were unchanged by xenon or nitrous oxide. We conclude that xenon provides improved haemodynamic stability compared with nitrous oxide, conserving the left ventricular systolic function.

Xenon offers stable haemodynamics independent of induced hypothermia after hypoxia–ischaemia in newborn pigs

“…Xe 60% has been associated with better left ventricular performance [26] and systolic function [27] in patients with moderate cardiovascular risk [26] and ischaemic heart disease [27], respectively. Other possible mechanisms for maintaining stable MABP may be due to the preservation of the systemic vascular resistance and myocardial contractility following inhalation of Xe 50-70% in pigs [25], Xe 63% in dogs [28], and Xe 15-53% in humans who underwent coronary artery bypass grafts [29].…”

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

“…However, the impact of these findings on morbidity and mortality in high risk surgical patients is unknown. To date, only two investigations have studied the effects of xenon administration in high risk surgical patients [2,26]. In a study comparing the effects of xenon-and propofolbased sedation regimens following coronary artery bypass grafting (CABG), xenon performed comparably to propofol with respect to cardiovascular stability [26].…”

“…Recently, Goto and coworkers compared the effect of xenon and nitrous oxide on left ventricular performance and haemodynamics in patients prior to CABG and found that contractility was preserved with xenon (as assessed with FAC and left ventricular stroke work index), whereas after nitrous oxide administration, mean arterial blood pressure and contractility deteriorated [2]. However, nitrous oxide administration in patients with a limited cardiovascular reserve is not common, and therefore xenon should be compared with total intravenous or balanced anaesthesia regimens [27].…”

“…low blood ⁄ gas partition coefficient) give the gas pharmacokinetics which lead to rapid emergence from anaesthesia [1]. More importantly, animal studies and data from humans suggest a high degree of cardiovascular stability during xenon anaesthesia [2,3], mainly attributable to the lack of effects of xenon on cardiac ion channels [4]. In animal experiments, xenon has been shown to produce minimal haemodynamic effects during chronically compromised left ventricular function [5] and to mitigate reperfusion injury during cardiopulmonary bypass [6].…”

Xenon as a Neuroprotectant in Traumatic Brain Injury

“…Among 142 surgical patients xenon anesthesia was well tolerated except for more nausea and vomiting compared to those randomized to propofol (30). Several other studies in surgical patients reported xenon was well tolerated as an anesthetic (31)(32)(33)(34). In a pilot study of critical care sedation for 8 hours, 21 patients randomized to either propofol or inhaled xenon (9-62 %) had comparable sedation.…”