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

• Published in: Anesthesiology (Philadelphia) 2017-12, Vol.127 (6), p.918-933
• Main Authors: Hofland, Jan, Ouattara, Alexandre, Fellahi, Jean-Luc, Gruenewald, Matthias, Hazebroucq, Jean, Ecoffey, Claude, Joseph, Pierre, Heringlake, Matthias, Steib, Annick, Coburn, Mark, Amour, Julien, Rozec, Bertrand, Liefde, Inge de, Meybohm, Patrick, Preckel, Benedikt, Hanouz, Jean-Luc, Tritapepe, Luigi, Tonner, Peter, Benhaoua, Hamina, Roesner, Jan Patrick, Bein, Berthold, Hanouz, Luc, Tenbrinck, Rob, Bogers, Ad.J.J.C, Mik, Bert G, Coiffic, Alain, Renner, Jochen, Steinfath, Markus, Francksen, Helga, Broch, Ole, Haneya, Assad, Schaller, Manuella, Guinet, Patrick, Daviet, Lauren, Brianchon, Corinne, Rosier, Sebastien, Lehot, Jean-Jacques, Paarmann, Hauke, Schön, Julika, Hanke, Thorsten, Ettel, Joachym, Olsson, Silke, Klotz, Stefan, Samet, Amir, Laurinenas, Giedrius, Thibaud, Adrien, Cristinar, Mircea, Collanges, Olivier, Levy, François, Rossaint, Rolf, Stevanovic, Ana, Schaelte, Gereon, Stoppe, Christian, Hamou, Nora Ait, Hariri, Sarah, Quessard, Astrid, Carillion, Aude, Morin, Hélène, Silleran, Jacqueline, Robert, David, Crouzet, Anne-Sophie, Zacharowski, Kai, Reyher, Christian, Iken, Sonja, Weber, Nina C, Hollmann, Marcus, Eberl, Susanne, Carriero, Giovanni, Collacchi, Daria, Di Persio, Alessandra, Fourcade, Olivier, Bergt, Stefan, Alms, Angela
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia, Intravenous; Anesthetics, Inhalation - administration & dosage; Biomarkers - blood; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - trends; Female; Humans; Internationality; Male; Methyl Ethers - administration & dosage; Middle Aged; Postoperative Complications - blood; Postoperative Complications - prevention & control; Prospective Studies; Sevoflurane; Single-Blind Method; Treatment Outcome; Troponin I - blood; Xenon - administration & dosage
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/ALN.0000000000001873

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-treatn = 492; per-protocol/without major protocol deviationn = 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-protocolP = 0.02). Postoperative cardiac troponin I release was significantly less with xenon than with total intravenous anesthesia (intention-to-treatP = 0.05; per-protocolP = 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.