氙气作为非体外循环冠状动脉旁路移植术患者异丙酚麻醉的辅助剂：一项实用随机对照临床试验。

Xenon as an Adjuvant to Propofol Anesthesia in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery: A Pragmatic Randomized Controlled Clinical Trial.

机构信息

From the Departments of *Anesthesiology, †Cardiovascular Sciences, and ‡Cardiac Surgery, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium; and §Department of Anesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany.

出版信息

Anesth Analg. 2017 Oct;125(4):1118-1128. doi: 10.1213/ANE.0000000000002179.

DOI:10.1213/ANE.0000000000002179

PMID:28598913

Abstract

BACKGROUND

Xenon was shown to cause less hemodynamic instability and reduce vasopressor needs during off-pump coronary artery bypass (OPCAB) surgery when compared with conventionally used anesthetics. As xenon exerts its organ protective properties even in subanesthetic concentrations, we hypothesized that in patients undergoing OPCAB surgery, 30% xenon added to general anesthesia with propofol results in superior hemodynamic stability when compared to anesthesia with propofol alone.

METHODS

Fifty patients undergoing elective OPCAB surgery were randomized to receive general anesthesia with 30% xenon adjuvant to a target-controlled infusion of propofol or with propofol alone. The primary end point was the total intraoperative dose of norepinephrine required to maintain an intraoperative mean arterial pressure >70 mm Hg. Secondary outcomes included the perioperative cardiorespiratory profile and the incidence of adverse and serious adverse events.

RESULTS

Adding xenon to propofol anesthesia resulted in a significant reduction of norepinephrine required to attain the predefined hemodynamic goals (cumulative intraoperative dose: median [interquartile range]: 370 [116-570] vs 840 [335-1710] µg, P = .001). In the xenon-propofol group, significantly less propofol was required to obtain a similar depth of anesthesia as judged by clinical signs and the bispectral index (propofol effect site concentration [mean ± SD]: 1.8 ± 0.5 vs 2.8 ± 0.3 mg, P≤ .0001). Moreover, the xenon-propofol group required significantly less norepinephrine during the first 24 hours on the intensive care unit (median [interquartile range]: 1.5 [0.1-7] vs 5 [2-8] mg, P = .048). Other outcomes and safety parameters were similar in both groups.

CONCLUSIONS

Thirty percent xenon added to propofol anesthesia improves hemodynamic stability by decreasing norepinephrine requirements in patients undergoing OPCAB surgery.

摘要

背景

与常规使用的麻醉剂相比，氙气在非体外循环冠状动脉旁路移植术（OPCAB）中引起的血液动力学不稳定和减少血管加压药需求较少。由于氙气即使在亚麻醉浓度下也能发挥其器官保护特性，我们假设在接受 OPCAB 手术的患者中，与单独使用丙泊酚麻醉相比，将 30%的氙气加入丙泊酚全身麻醉中会导致更好的血液动力学稳定性。

方法

50 名接受择期 OPCAB 手术的患者被随机分为接受丙泊酚全身麻醉，添加 30%的氙气作为丙泊酚靶控输注的辅助剂，或单独接受丙泊酚麻醉。主要终点是术中需要的去甲肾上腺素的总剂量，以维持术中平均动脉压>70mmHg。次要结果包括围手术期心肺功能谱和不良及严重不良事件的发生率。

结果

将氙气加入丙泊酚麻醉中可显著减少达到预设血液动力学目标所需的去甲肾上腺素剂量（累积术中剂量：中位数[四分位距]：370[116-570] vs 840[335-1710]μg，P=.001）。在氙气-丙泊酚组中，以临床体征和双谱指数判断，需要的丙泊酚量明显减少，以获得相似的麻醉深度（丙泊酚效应部位浓度[平均值±标准差]：1.8±0.5 vs 2.8±0.3mg，P≤.0001）。此外，在重症监护病房的前 24 小时，氙气-丙泊酚组需要的去甲肾上腺素明显减少（中位数[四分位距]：1.5[0.1-7] vs 5[2-8]mg，P=.048）。两组的其他结果和安全性参数相似。