Multicenter randomized comparison of xenon and isoflurane on left ventricular function in patients undergoing elective surgery.
BACKGROUND
Volatile anesthetics are commonly used for general anesthesia. However, these can induce profound cardiovascular alterations. Xenon is a noble gas with potent anesthetic and analgesic properties. However, it is uncertain whether xenon alters myocardial function. The aim of this study was therefore to investigate left ventricular function during anesthesia with xenon compared with isoflurane.


METHODS
The authors performed a randomized multicenter trial to compare xenon with isoflurane with respect to cardiovascular stability and adverse effects in patients without cardiac diseases scheduled for elective surgery. Two hundred fifty-nine patients were enrolled in this trial, of which 252 completed the study according to the protocol. Patients were anesthetized with xenon or isoflurane, respectively. Before administration of the study drugs and at four time points, the effects of both anesthetics on left ventricular function were investigated using transesophageal echocardiography.


RESULTS
Global hemodynamic parameters were significantly altered using isoflurane (P < 0.05 vs. baseline), whereas xenon only decreased heart rate (P < 0.05 vs. baseline). In contrast to xenon, left ventricular end-systolic wall stress decreased significantly in the isoflurane group (P < 0.05 vs. baseline). Velocity of circumferential fiber shortening was decreased significantly in the xenon group but showed a more pronounced reduction during isoflurane administration (P < 0.05 vs. baseline). The contractile index (difference between expected and actually measured velocity of circumferential fiber shortening) as an independent parameter for left ventricular function was significantly decreased after isoflurane (P < 0.0001) but unchanged using xenon.


CONCLUSIONS
Xenon did not reduce contractility, whereas isoflurane decreased the contractile index, indicating that xenon enables favorable cardiovascular stability in patients without cardiac diseases.
Wappler
Frank
F
Department of Anesthesiology, University Hospital Hamburg-Eppendorf, and Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Germany. wapplerf@kliniken-koeln.de
Rossaint
Rolf
R
Baumert
Jan
J
Scholz
Jens
J
Tonner
Peter H
PH
van Aken
Hugo
H
Berendes
Elmar
E
Klein
Jan
J
Gommers
Diederik
D
Hammerle
Alfons
A
Franke
Andreas
A
Hofmann
Thomas
T
Schulte Esch
Jochen
J
D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D017548:Echocardiography, Transesophageal / Q000379:methods; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects*; D011183:Postoperative Complications / Q000139:chemically induced; D016037:Single-Blind Method; D013997:Time Factors; D016277:Ventricular Function, Left / Q000187:drug effects*; D014978:Xenon / Q000008:administration & dosage / Q000009:adverse effects*
D018685:Anesthetics, Inhalation; D014978:Xenon; D007530:Isoflurane