Nausea and Vomiting following Balanced Xenon Anesthesia Compared to Sevoflurane: A Post-Hoc Explorative Analysis of a Randomized Controlled Trial.
Like other inhalational anesthetics xenon seems to be associated with post-operative nausea and vomiting (PONV). We assessed nausea incidence following balanced xenon anesthesia compared to sevoflurane, and dexamethasone for its prophylaxis in a randomized controlled trial with post-hoc explorative analysis.



220 subjects with elevated PONV risk (Apfel score ≥2) undergoing elective abdominal surgery were randomized to receive xenon or sevoflurane anesthesia and dexamethasone or placebo after written informed consent. 93 subjects in the xenon group and 94 subjects in the sevoflurane group completed the trial. General anesthesia was maintained with 60% xenon or 2.0% sevoflurane. Dexamethasone 4mg or placebo was administered in the first hour. Subjects were analyzed for nausea and vomiting in predefined intervals during a 24h post-anesthesia follow-up.



Logistic regression, controlled for dexamethasone and anesthesia/dexamethasone interaction, showed a significant risk to develop nausea following xenon anesthesia (OR 2.30, 95% CI 1.02-5.19, p = 0.044). Early-onset nausea incidence was 46% after xenon and 35% after sevoflurane anesthesia (p = 0.138). After xenon, nausea occurred significantly earlier (p = 0.014), was more frequent and rated worse in the beginning. Dexamethasone did not markedly reduce nausea occurrence in both groups. Late-onset nausea showed no considerable difference between the groups.



In our study setting, xenon anesthesia was associated with an elevated risk to develop nausea in sensitive subjects. Dexamethasone 4mg was not effective preventing nausea in our study. Group size or dosage might have been too small, and change of statistical analysis parameters in the post-hoc evaluation might have further contributed to a limitation of our results. Further trials will be needed to address prophylaxis of xenon-induced nausea.



EU Clinical Trials EudraCT-2008-004132-20 ClinicalTrials.gov NCT00793663.
Department of Anesthesiology, University Hospital Aachen, Aachen, Germany.
Astrid V
AV
Fahlenkamp
Department of Anesthesiology, University Hospital Aachen, Aachen, Germany.
Christian
C
Stoppe
Department of Anesthesiology, University Hospital Aachen, Aachen, Germany.
Jan
J
Cremer
Department of Anesthesiology, University Hospital Aachen, Aachen, Germany.
Ingeborg A
IA
Biener
Department of Anesthesiology, University Hospital Aachen, Aachen, Germany.
Dirk
D
Peters
Department of Anesthesiology, University Hospital Aachen, Aachen, Germany.
Ricarda
R
Leuchter
Hospital Pharmacy, University Hospital Aachen, Aachen, Germany.
Albrecht
A
Eisert
Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, United States of America.
Christian C
CC
Apfel
Department of Anesthesiology, University Hospital Aachen, Aachen, Germany.
Rolf
R
Rossaint
Department of Anesthesiology, University Hospital Aachen, Aachen, Germany.
Mark
M
Coburn
D000293:Adolescent; D000328:Adult; D000368:Aged; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects*; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced*; D000077149:Sevoflurane; D014839:Vomiting / Q000139:chemically induced*; D014978:Xenon / Q000009:adverse effects*; D055815:Young Adult
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D014978:Xenon