Devroe Sarah, Lemiere Jurgen, Van Hese Laura, Gewillig Marc, Boshoff Derize, Poesen Koen, Van de Velde Marc, Rex Steffen
Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium.
Department of Child and Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium.
Paediatr Anaesth. 2018 Aug;28(8):726-738. doi: 10.1111/pan.13444. Epub 2018 Jul 13.
In adults, xenon has only minimal hemodynamic side effects when compared with other anesthetics. Moreover, in preclinical experiments, xenon has been demonstrated to possess cardio- and neuroprotective properties. Altogether, the favorable hemodynamic profile combined with its potential for organ-protection could render xenon an attractive option for anesthesia in children with cardiovascular compromise.
The aim of this study was to explore safety and feasibility of sevoflurane-augmented xenon anesthesia in school-aged children and to assess early postoperative neurocognitive effects of xenon-sevoflurane and sevoflurane anesthesia when compared to a control group that did not have anesthesia.
Forty children aged 4-12 years, suffering from congenital heart disease, undergoing diagnostic or interventional cardiac catheterization were randomized to either xenon-augmented sevoflurane anesthesia or sevoflurane alone. Safety was assessed by the incidence of intraprocedural hemodynamic instability and feasibility by anesthetic depth and respiratory profile. In addition, neurocognitive performance was assessed preoperatively, 2 hours after discharge from PACU and at 24 hours after anesthesia using the Amsterdam Neuropsychological Tasks system. A healthy control group of 22 age- and gender-matched children not exposed to anesthesia underwent an identical neurocognitive test battery, at comparable time intervals.
Overall hemodynamics did not differ between groups. Xenon-sevoflurane anesthesia resulted in decreased intraoperative ephedrine requirements (median [IQR]) (0.00 mg/kg [0.00-0.00] vs 0.00 mg/kg [0.00-0.01], P = 0.047). Only neurocognitive tests in the domain of alertness were significantly impaired 2 hours postoperatively in both anesthesia groups in comparison with the control group (alertness variability: P = 0.02, odds ratio 5.8), but recovered at 24 hours. For working memory, inhibition, cognitive flexibility, and motor coordination tasks, no significant interaction effects of anesthesia were found in the early postoperative period.
In this pilot trial, xenon-augmented sevoflurane anesthesia in school-aged children was feasible, and associated with decreased ephedrine requirements. All children exposed to anesthesia showed impaired neurocognitive performance in the immediate postoperative period when compared to control children; however, without significant differences between both treatment groups.
在成人中，与其他麻醉剂相比，氙气的血流动力学副作用极小。此外，在临床前实验中，已证明氙气具有心脏和神经保护特性。总体而言，氙气良好的血流动力学特征及其器官保护潜力，使其可能成为心血管功能受损儿童麻醉的一个有吸引力的选择。
本研究的目的是探讨七氟醚强化氙气麻醉在学龄儿童中的安全性和可行性，并评估与未接受麻醉的对照组相比，氙气 - 七氟醚和七氟醚麻醉术后早期的神经认知影响。
40名年龄在4至12岁、患有先天性心脏病、正在接受诊断性或介入性心导管检查的儿童被随机分为氙气强化七氟醚麻醉组或单纯七氟醚麻醉组。通过术中血流动力学不稳定的发生率评估安全性，通过麻醉深度和呼吸参数评估可行性。此外，使用阿姆斯特丹神经心理学任务系统在术前、离开麻醉后监护病房2小时以及麻醉后24小时评估神经认知表现。一组由22名年龄和性别匹配、未接触麻醉的健康儿童组成的对照组，在相似的时间间隔内接受相同的神经认知测试。
两组之间的总体血流动力学无差异。氙气 - 七氟醚麻醉导致术中麻黄碱需求量减少（中位数[四分位间距]）（0.00mg/kg[0.00 - 0.00]对0.00mg/kg[0.00 - 0.01]，P = 0.047）。与对照组相比，两个麻醉组术后2小时仅警觉性领域的神经认知测试有显著受损（警觉性变异性：P = 0.02，优势比5.8），但在24小时时恢复。对于工作记忆、抑制、认知灵活性和运动协调任务，术后早期未发现麻醉的显著交互作用。
在这项初步试验中，学龄儿童使用氙气强化七氟醚麻醉是可行的，且与麻黄碱需求量减少相关。与对照儿童相比，所有接受麻醉的儿童在术后即刻均表现出神经认知功能受损；然而，两个治疗组之间无显著差异。
