BJA Advance Access originally published online on April 27, 2007
British Journal of Anaesthesia 2007 98(6):722-727; doi:10.1093/bja/aem083
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Autonomic cardiac control with xenon anaesthesia in patients at cardiovascular risk
Klinik fuer Anaesthesiologie, Universitaetsklinikum Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
* Corresponding author: Department of Anesthesiology, UMC St. Radboud, Geert Grooteplein 10, Postbus 9101, Nijmegen 6500 HB, The Netherlands. E-mail: jan.baumert{at}googlemail.com
Background: The cardiovascular stability found with xenon anaesthesia may be caused by absence of circulatory depression. Xenon may also act directly on autonomic cardiovascular control.
Methods: In a prospective, randomized design, 26 patients (ASA class III and IV) with increased cardiac risk were anaesthetized for elective non-cardiac surgery with either xenon (n = 13) or propofol (n = 13), each combined with remifentanil. From intraoperative Holter ECG, 5-min intervals of stable sinus rhythm were analysed at baseline anaesthesia with etomidate/remifentanil, and after 30 and 60 min of propofol or xenon anaesthesia. Target criteria were total power and ratio of low to high frequency power of the heart rate (HR) power spectrum between 0.003 and 0.4 Hz, indicating global activity and sympatho-vagal balance of autonomic modulation of HR.
Results: When compared with baseline, total power decreased with propofol from 8.6 (1.6) to 7.1 (0.5) and to 7.8 (1.1) ms2 at 30 and 60 min, respectively, [mean (SD) of logarithmic transform] and was unchanged with xenon (P = 0.02; ANOVA). The low/high frequency power ratio changed from 3.0 (3.5) to 4.3 (4.3) and 4.1 (6.2), respectively, with xenon and from 3.9 (3.6) to 1.8 (1.5) and 1.8 (0.8) with propofol (P = 0.04; generalized linear model test). Mean arterial pressure was significantly higher with xenon throughout (P < 0.001; ANOVA).
Conclusions: Propofol caused a decrease in arterial pressure as well as autonomic HR modulation, but xenon did not. The higher arterial pressure with xenon anaesthesia may be explained by less suppression of sympatho-vagal balance.
Keywords: anaesthetic techniques, inhalation; anaesthetics gases, xenon; anaesthetics i.v., propofol; complications, hypotension; sympathetic nervous system
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  J.-H. Baumert, M. Hein, K. E. Hecker, S. Satlow, P. Neef, and R. Rossaint Xenon or propofol anaesthesia for patients at cardiovascular risk in non-cardiac surgery Br. J. Anaesth., May 1, 2008; 100(5): 605 - 611. [Abstract] [Full Text] [PDF]
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