Effect of Xenon Anesthesia Compared to Sevoflurane and Total Intravenous Anesthesia for Coronary Artery Bypass Graft Surgery on Postoperative Cardiac Troponin Release

Abstract

Background Ischemic myocardial damage accompanying coronary artery bypass graft surgery remains a clinical challenge. We investigated whether xenon anesthesia could limit myocardial damage in coronary artery bypass graft surgery patients, as has been reported for animal ischemia models. Methods In 17 university hospitals in France, Germany, Italy, and The Netherlands, low-risk elective, on-pump coronary artery bypass graft surgery patients were randomized to receive 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 postsurgery. The noninferiority margin for the mean difference in cardiac troponin I release between the xenon and sevoflurane groups was less than 0.15 ng/ml. Secondary outcomes were the safety and feasibility of xenon anesthesia. Results The first patient included at each center received xenon anesthesia for practical reasons. For all other patients, anesthesia maintenance was randomized (intention-to-treat: n = 492; per-protocol/without major protocol deviation: n = 446). Median 24-h postoperative cardiac troponin I concentrations (ng/ml [interquartile range]) were 1.14 [0.76 to 2.10] with xenon, 1.30 [0.78 to 2.67] with sevoflurane, and 1.48 [0.94 to 2.78] with total intravenous anesthesia [per-protocol]). The mean difference in cardiac troponin I release between xenon and sevoflurane was −0.09 ng/ml (95% CI, −0.30 to 0.11; per-protocol: P = 0.02). Postoperative cardiac troponin I release was significantly less with xenon than with total intravenous anesthesia (intention-to-treat: P = 0.05; per-protocol: P = 0.02). Perioperative variables and postoperative outcomes were comparable across all groups, with no safety concerns. Conclusions In postoperative cardiac troponin I release, xenon was noninferior to sevoflurane in low-risk, on-pump coronary artery bypass graft surgery patients. Only with xenon was cardiac troponin I release less than with total intravenous anesthesia. Xenon anesthesia appeared safe and feasible.

Inhaled Gases for Neuroprotection of Neonates: A Review

“…A multicenter international study showed that inhaled 65% xenon was not inferior to inhaled sevoflurane or intravenous propofol as an anesthetic agent in coronary bypass graft surgery. Furthermore, xenon administration was associated with less troponin-I release when compared to propofol (69). It is cardioand nephro-protective and is not fetotoxic (53,70,71).…”

Influence of xenon on pulmonary mechanics and lung aeration in patients with healthy lungs

“…In all patients, and in the BMI subgroups, xenon wash-in to 60% inspiratory concentrations had no significant effect on P tp (Fig 1). P max increased by 9 (6) (20) 3 (30) 1 (10) Vascular 1 (5) 0 (0) 1 (10) patients. The increase in P max was accompanied by a significant 54 (25)% increase in R AW after xenon wash-in, which was further reflected by an 8 (8)% decrease in C dyn with no alteration of C stat (Fig 2).…”

“…The noble gas xenon is an inhalation anaesthetic with cardioprotective, 9,10 neuroprotective, 11e13 and nephroprotective 14,15 properties. Moreover, xenon attenuates inflammatory stress in lung epithelial cells by activation of the hypoxia-inducible factor-1-alpha pathway and inhibition of apoptosis.…”

Getting an Early Start in Understanding Perinatal Asphyxia Impact on the Cardiovascular System

“…Its actions are mediated via KATP channels and other complex mechanisms converging toward antiapoptotic properties. In an international multicenter phase 3 study Hofland et al proved that xenon anesthesia has cardioprotective effects on patients undergoing coronary bypass (148). Although xenon was used in neonates with brain injury and proved to be very safe but not superior to mild hypothermia (149), there are no studies to date that investigate xenon cardioprotective properties in neonates with cardiac failure following PA.…”