title: Xenon anaesthesia for patients undergoing off-pump coronary artery bypass graft surgery: a prospective randomized controlled pilot trial.
abstract: BACKGROUND
  Off-pump coronary artery bypass (OPCAB) surgery carries a high risk for haemodynamic instability and perioperative organ injury. Favourable haemodynamic effects and organ-protective properties could render xenon an attractive anaesthetic for OPCAB surgery. The primary aim of this study was to assess whether xenon anaesthesia for OPCAB surgery is non-inferior to sevoflurane anaesthesia with regard to intraoperative vasopressor requirements.
  
  
  METHODS
  Forty-two patients undergoing elective OPCAB surgery were enrolled in this prospective, single-blind, randomized controlled pilot trial. Patients were randomized to either xenon (50-60 vol%) or sevoflurane (1.1-1.4 vol%) anaesthesia. Primary outcome was intraoperative noradrenaline requirements necessary to achieve predefined haemodynamic goals. Secondary outcomes included safety variables such as the occurrence of adverse events (intraoperatively and during a 6-month follow-up after surgery) and the perioperative cardiorespiratory and inflammatory profile.
  
  
  RESULTS
  Baseline and intraoperative data did not differ between groups. Xenon was non-inferior to sevoflurane, as xenon patients required significantly less noradrenaline intraoperatively to achieve the predefined haemodynamic goals {geometric mean 428 [95% confidence interval (CI) 312, 588] vs 1702 [1267, 2285] µg, P<0.0001}. No differences were found for safety. Significantly more sevoflurane patients developed postoperative delirium (POD) (hazard ratio 4.2, P=0.044). The average arterial pressure was lower in the sevoflurane group {median75 [interquartile range (IQR) 6] vs 72 [4] mmHg, P=0.002}. No differences were found for other haemodynamic parameters, the respiratory profile and the perioperative release of inflammatory cytokines, troponin T, serum protein S-100β and erythropoietin.
  
  
  CONCLUSIONS
  Compared with sevoflurane, xenon anaesthesia allows a significant reduction in vasopressor administration in OPCAB surgery. Moreover, xenon anaesthesia was associated with a lower risk for POD, a finding that has to be confirmed in larger studies.
  
  
  BACKGROUND
  ClinicalTrials.gov (NCT01757106) and EudraCT (2012-002316-12).
authors.affiliation: Department of Anaesthesiology, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Al Tmimi
authors.affiliation: Department of Anaesthesiology, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Van Hemelrijck
authors.affiliation: Department of Anaesthesiology, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Van de Velde
authors.affiliation: Department of Cardiac Surgery, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Sergeant
authors.affiliation: Department of Cardiac Surgery, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Meyns
authors.affiliation: Department of Anaesthesiology, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Missant
authors.affiliation: Department of Abdominal Transplant Surgery, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium Department of Microbiology and Immunology, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Jochmans
authors.affiliation: Department of Laboratory Medicines, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium Department of Neurosciences, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Poesen
authors.affiliation: Department of Anaesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Coburn
authors.affiliation: Department of Anaesthesiology, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat 49, B-3000 Leuven, Belgium steffen.rex@uzleuven.be.
authors.forename: S
authors.initials: S
authors.lastname: Rex
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage; D011446:Prospective Studies; D000077149:Sevoflurane; D016037:Single-Blind Method; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D014978:Xenon / Q000494:pharmacology*
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D014662:Vasoconstrictor Agents; D000077149:Sevoflurane; D014978:Xenon; D009638:Norepinephrine
keywords: OPCAB; noradrenaline dose; postoperative delirium; sevoflurane anaesthesia; xenon anaesthesia