Effect of Xenon Anesthesia Compared to Sevoflurane and Total Intravenous Anesthesia for Coronary Artery Bypass Graft Surgery on Postoperative Cardiac Troponin Release: An International, Multicenter, Phase 3, Single-blinded, Randomized Noninferiority Trial.

Anesthesiology 2017 12;127(6):918-933

From the Sector Cardiothoracic Anesthesiology, Thorax Centre, Rotterdam, The Netherlands (J. Hofland, I.d.L.); Service d'Anesthésie-Réanimation II, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France (A.O.); Louis Pradel University Hospital, Lyon, France and Department of Anesthesiology and Intensive Care Medicine and Inserm U1060, Faculty of Medicine, Claude Bernard Lyon 1 University, Lyon, France (J.-L.F.); Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (M.G., B.B.); Air Liquide Santé International, Paris-Saclay Research Center, Jouy-en-Josas, France (J. Hazebroucq); Department of Anesthesia, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Rennes, France (C.E.); Department of Anesthesia and Intensive Care, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Bron, France (P.J.); Department of Anesthesiology and Intensive Care Medicine, University of Lübeck, Lübeck, Germany (M.H.); Service d'Anesthésie Réanimation Chirurgicale, Nouvel Hôpital Civil, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France (A.S.); Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany (M.C.); Department of Anesthesia and Intensive Care, Institut de Cardiologie - Chirurgie Cardiaque, Hôpital Pitié Salpetrière, Paris, France (J.A.); Service d'Anesthésie et Réanimation Chirurgicale, Hôpital G&R Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France (B.R.); Clinic of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt am Main, Frankfurt am Main, Germany (P.M.); Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (B.P.); Service d'Anesthésie et Réanimation Chirurgicale, Centre Hospitalier Universitaire de Caen, Caen, France (J.-L.H.); Department of Anesthesia and Intensive Care, Policlinico "Umberto I," "La Sapienza," University of Rome, Rome, Italy (L.T.); Department of Anesthesiology and Intensive Care, Klinikum Links der Weser gGmbH, Bremen, Germany (P.T.); Chirurgie Cardiovasculaire - Service de Réanimation, Centre Hospitalier Universitaire de Toulouse, Hospitalier de Rangueil, Toulouse, France (H.B.); and Clinic for Anesthesia and Critical Care Medicine, University Hospital Rostock, Rostock, Germany (J.P.R). Service d'Anesthésie et Réanimation Chirurgicale, Centre Hospitalier Universitaire de Caen, Caen, France Departments of Anesthesiology and Cardiothoracic Surgery, Thorax Centre, Rotterdam, The Netherlands Departments of Anesthesiology and Cardiothoracic Surgery, Thorax Centre, Rotterdam, The Netherlands Departments of Anesthesiology and Cardiothoracic Surgery, Thorax Centre, Rotterdam, The Netherlands Service d'Anesthésie-Réanimation II, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France Universitäts Klinikum Schleswig-Holstein, Klinik für Anästhesiologie und Operative Intensivmedizin, Campus Kiel, Kiel, Germany Universitäts Klinikum Schleswig-Holstein, Klinik für Anästhesiologie und Operative Intensivmedizin, Campus Kiel, Kiel, Germany Universitäts Klinikum Schleswig-Holstein, Klinik für Anästhesiologie und Operative Intensivmedizin, Campus Kiel, Kiel, Germany Universitäts Klinikum Schleswig-Holstein, Klinik für Anästhesiologie und Operative Intensivmedizin, Campus Kiel, Kiel, Germany Universitäts Klinikum Schleswig-Holstein, Klinik für Anästhesiologie und Operative Intensivmedizin, Campus Kiel, Kiel, Germany Air Liquide Santé International, Jouy-en-Josas, France Department of Anesthesia, Hôpital Pontchaillou, Rennes, France Department of Anesthesia, Hôpital Pontchaillou, Rennes, France Department of Anesthesia, Hôpital Pontchaillou, Rennes, France Department of Anesthesia, Hôpital Pontchaillou, Rennes, France Department of Anesthesia and Intensive Care, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Bron, France Department of Anesthesiology and Intensive Care Medicine, University of Lübeck, Lübeck, Germany Department of Anesthesiology and Intensive Care Medicine, University of Lübeck, Lübeck, Germany Department of Anesthesiology and Intensive Care Medicine, University of Lübeck, Lübeck, Germany Department of Anesthesiology and Intensive Care Medicine, University of Lübeck, Lübeck, Germany Department of Anesthesiology and Intensive Care Medicine, University of Lübeck, Lübeck, Germany Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany Service d'Anesthésie Réanimation Chirurgicale, Hôpitaux Universitaire de Strasbourg, Strasbourg, France Service d'Anesthésie Réanimation Chirurgicale, Hôpitaux Universitaire de Strasbourg, Strasbourg, France Service d'Anesthésie Réanimation Chirurgicale, Hôpitaux Universitaire de Strasbourg, Strasbourg, France Service d'Anesthésie Réanimation Chirurgicale, Hôpitaux Universitaire de Strasbourg, Strasbourg, France Service d'Anesthésie Réanimation Chirurgicale, Hôpitaux Universitaire de Strasbourg, Strasbourg, France Service d'Anesthésie Réanimation Chirurgicale, Hôpitaux Universitaire de Strasbourg, Strasbourg, France Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany Department of Anesthesia and Intensive Care, Institut de Cardiologie - Chirurgie Cardiaque, Hôpital Pitié Salpetrière, Paris, France Department of Anesthesia and Intensive Care, Institut de Cardiologie - Chirurgie Cardiaque, Hôpital Pitié Salpetrière, Paris, France Department of Anesthesia and Intensive Care, Institut de Cardiologie - Chirurgie Cardiaque, Hôpital Pitié Salpetrière, Paris, France Department of Anesthesia and Intensive Care, Institut de Cardiologie - Chirurgie Cardiaque, Hôpital Pitié Salpetrière, Paris, France Service d'Anesthésie et Réanimation Chirurgicale, Hôpital G&R Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France Service d'Anesthésie et Réanimation Chirurgicale, Hôpital G&R Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France Service d'Anesthésie et Réanimation Chirurgicale, Hôpital G&R Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France Service d'Anesthésie et Réanimation Chirurgicale, Hôpital G&R Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France Clinic of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt am Main, Frankfurt am Main, Germany Clinic of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt am Main, Frankfurt am Main, Germany Clinic of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt am Main, Frankfurt am Main, Germany Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Anesthesia and Intensive Care, Policlinico "Umberto I," "La Sapienza," University of Rome, Rome, Italy Department of Anesthesia and Intensive Care, Policlinico "Umberto I," "La Sapienza," University of Rome, Rome, Italy Department of Anesthesia and Intensive Care, Policlinico "Umberto I," "La Sapienza," University of Rome, Rome, Italy Chirurgie Cardiovasculaire - Service de Réanimation, Centre Hospitalier Regional Universitaire, Hospitalier de Rangueil, Toulouse, France Clinic for Anesthesia and Critical Care Medicine, University Hospital of Rostock, Rostock, Germany Clinic for Anesthesia and Critical Care Medicine, University Hospital of Rostock, Rostock, Germany.

Background: Ischemic myocardial damage accompanying coronary artery bypass graft surgery remains a clinical challenge. We investigated whether xenon anesthesia could limit myocardial damage in coronary artery bypass graft surgery patients, as has been reported for animal ischemia models.

Methods: In 17 university hospitals in France, Germany, Italy, and The Netherlands, low-risk elective, on-pump coronary artery bypass graft surgery patients were randomized to receive xenon, sevoflurane, or propofol-based total intravenous anesthesia for anesthesia maintenance. The primary outcome was the cardiac troponin I concentration in the blood 24 h postsurgery. The noninferiority margin for the mean difference in cardiac troponin I release between the xenon and sevoflurane groups was less than 0.15 ng/ml. Secondary outcomes were the safety and feasibility of xenon anesthesia.

Results: The first patient included at each center received xenon anesthesia for practical reasons. For all other patients, anesthesia maintenance was randomized (intention-to-treat: n = 492; per-protocol/without major protocol deviation: n = 446). Median 24-h postoperative cardiac troponin I concentrations (ng/ml [interquartile range]) were 1.14 [0.76 to 2.10] with xenon, 1.30 [0.78 to 2.67] with sevoflurane, and 1.48 [0.94 to 2.78] with total intravenous anesthesia [per-protocol]). The mean difference in cardiac troponin I release between xenon and sevoflurane was -0.09 ng/ml (95% CI, -0.30 to 0.11; per-protocol: P = 0.02). Postoperative cardiac troponin I release was significantly less with xenon than with total intravenous anesthesia (intention-to-treat: P = 0.05; per-protocol: P = 0.02). Perioperative variables and postoperative outcomes were comparable across all groups, with no safety concerns.

Conclusions: In postoperative cardiac troponin I release, xenon was noninferior to sevoflurane in low-risk, on-pump coronary artery bypass graft surgery patients. Only with xenon was cardiac troponin I release less than with total intravenous anesthesia. Xenon anesthesia appeared safe and feasible.

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http://Insights.ovid.com/crossref?an=00000542-201712000-0000
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http://dx.doi.org/10.1097/ALN.0000000000001873DOI Listing
December 2017
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