Autonomic cardiac control with xenon anaesthesia in patients at cardiovascular risk.
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) ms(2) 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.
Baumert
J-H
JH
Klinik fuer Anaesthesiologie, Universitaetsklinikum Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany. jan.baumert@googlemail.com
Hein
M
M
Hecker
K E
KE
Satlow
S
S
Schnoor
J
J
Rossaint
R
R
D000368:Aged; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000494:pharmacology; D001341:Autonomic Nervous System / Q000187:drug effects* / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000009:adverse effects / Q000494:pharmacology; D011446:Prospective Studies; D014978:Xenon / Q000009:adverse effects / Q000494:pharmacology*
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D014978:Xenon; D015742:Propofol