The influence of xenon on regulation of the autonomic nervous system in patients at high risk of perioperative cardiac complications.
BACKGROUND
As xenon anaesthesia (XE) does not produce haemodynamic depression its use may be of benefit in patients at high risk of intraoperative haemodynamic instability and perioperative cardiac complications. XE (n=22) was compared with total i.v. anaesthesia (TIVA, n=22) for differences in autonomic regulation, peri- and postoperative performance.


METHODS
Patients undergoing abdominal aortic surgery were studied at five events: T1: baseline awake; T2: anaesthesia induction; T3: before aortic cross-clamping; T4: after aortic cross-clamping; T5: after aortic declamping. T3-T5: end-tidal xenon concentration 60 (5)%. Intraoperative analysis: heart rate, heart rate variability, blood pressure and cardiac output. Postoperative analysis: 24 h Holter ECG, intensive care unit and hospital stay, and patient's outcome after 6 months.


RESULTS
XE in contrast to TIVA increased parasympathetic and decreased sympathetic activity. Median low to high frequency decreased significantly in the XE group after start of XE (P<0.05) and remained significantly lower during all events after start of XE as compared with TIVA (P=0.0001). After start of XE heart rate of these patients was significantly lower as compared with TIVA (P=0.04). Cardiac output increased significantly in TIVA after aortic declamping (P<0.05). Outcome parameters did not differ significantly between groups.


CONCLUSIONS
XE patients demonstrated lower sympathetic and higher parasympathetic activity as compared with TIVA patients. This was reflected by significant differences in haemodynamics but did not correlate with a better postoperative outcome. Thus, it remains controversial whether XE provides benefits in high risk patients.
Hanss
R
R
Department of Anaesthesiology and Intensive Care Medicine, University-Hospital Schleswig-Holstein, Campus Kiel, Germany. hanss@anaesthesie.uni-kiel.de
Bein
B
B
Turowski
P
P
Cavus
E
E
Bauer
M
M
Andretzke
M
M
Steinfath
M
M
Scholz
J
J
Tonner
P H
PH
D000368:Aged; D000369:Aged, 80 and over; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology; D001012:Aorta, Abdominal / Q000601:surgery*; D001341:Autonomic Nervous System / Q000187:drug effects* / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000209:etiology; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007432:Intraoperative Period; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D015742:Propofol / Q000494:pharmacology; D012307:Risk Factors; D016896:Treatment Outcome; D014978:Xenon / Q000494:pharmacology*
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D014978:Xenon; D015742:Propofol