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BJA Advance Access originally published online on March 15, 2008
British Journal of Anaesthesia 2008 100(5):605-611; doi:10.1093/bja/aen050
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Xenon or propofol anaesthesia for patients at cardiovascular risk in non-cardiac surgery

J.-H. Baumert1,2,*, M. Hein1, K. E. Hecker1, S. Satlow1, P. Neef1 and R. Rossaint1

1 Klinik für Anaesthesiologie, Universitaetsklinikum Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
2 CAIO Anesthesiologie, UMC St Radboud, Geert Grooteplein 10, Postbus 9101, Nijmegen 6500 HB, The Netherlands

* Corresponding author: CAIO Anesthesiologie, UMC St Radboud, Geert Grooteplein 10, Postbus 9101, Nijmegen 6500 HB, The Netherlands. E mail: jan.baumert{at}googlemail.com

Background: The results of two European multi-centre trials on xenon anaesthesia led to the hypothesis that a xenon-based anaesthetic would keep left ventricular (LV) and circulatory function more stable than a propofol-based anaesthetic, in patients with coronary artery disease (CAD).

Methods: In a prospective, randomized design, 40 patients of ASA classes III and IV with known CAD were anaesthetized for elective non-cardiac surgery with either xenon (n=20) or propofol (n=20), each combined with remifentanil. Target criteria were intraoperative LV function as evaluated by transoesophageal echocardiography (TOE: Tei index, circumferential fibre shortening), arterial pressure, and heart rate (HR).

Results: Mean arterial pressure was decreased with propofol but was stable at pre-anaesthetic level with xenon (P<0.02) and HR was lower with xenon (P<0.01). The Tei index (also known as myocardial performance index) improved from 0.53 (0.14) to 0.45 (0.10) after 1 h with xenon and changed from 0.50 (0.14) to 0.55 (0.20) with propofol anaesthesia [means (SD); P=0.01 between the groups]. Deviation of circumferential fibre shortening from expected value after 1 h was –2 (14)% with xenon and –14 (18)% with propofol [means (SD); P=0.03]. There were no perioperative signs of acute myocardial ischaemia (TOE, ECG, and troponin T release).

Conclusions: Xenon anaesthesia provided a higher arterial pressure level than propofol, with no signs of cardiovascular compromise, in patients with CAD. Echocardiographic indices showed better LV function with xenon.

Keywords: anaesthetics gases; cardiovascular system, effects; heart, myocardial function


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