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- Kulasekar Kaliappan, V Nataraj (3 June 2008)
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Kulasekar Kaliappan , V Nataraj
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Editor- We were interested to read the article by J.H. Baumert and colleagues on the effects of xenon-based anaesthetic for non-cardiac surgery for ASA III/IV patients. There are a few aspects worth mentioning. A constant infusion rate of propofol 5 (0.5) mg kg-1 h-1 was used in this study. A target controlled infusion of propofol would have been more appropriate to maintain a constant propofol concentration at the effect site. This might explain the lower MPI values at 60 minutes as observed in this study rather than at 30 minutes after the infusion, as the propofol plasma level would have been higher at 60 minutes compared to that at 30 minutes. As noted in the discussion, BIS has not been validated for use with xenon; it would be interesting to know if there were any instances of awareness in the study (xenon) group. There was no mention about the use of any further doses of muscle relaxant (cis-atracurium); it would be interesting to know if the surgical conditions were been satisfactory, as the duration of the procedures in the study was upto 180 min. Postoperative pain control was not discussed. As xenon is eliminated quicker compared to propofol, autonomic controls are established earlier than the other group; possibility of inadequate pain control contributing to higher values in observed MPI variables. Authors did not look for any difference in outcomes, like length of hospital stay or 30 day morbidity and mortality. Finally, in cost-driven health care of present age, cost of xenon would be a significant factor. Conflict of Interest:None declared |
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