Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2020; 17 (1): 5-69 ➤ Сравнительная оценка безопасности и эффективности ксеноновой анестезии у пациентов пожилого и старческого возраста при спинальных нейрохирургических вмешательствах

Comparative evaluation of the safety and efficacy of xenon anesthesia in elderly patients with spinal neurosurgical interventions

Authors: A.V. Solenkova, A.Yu. Lubnin, N.A. Konovalov, A.S. Kulikov, O.N. Ivanova, K.A. Kozlova, M.A. Martynova, E.S. Brinyuk

Company:
N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, 125047, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2020-17-1-32-43

UDC: 616.8

Link: Clinical Physiology of Blood Circulaiton. 2020; 17 (1): 32-43

Quote as: Solenkova A.V., Lubnin A.Yu., Konovalov N.A., Kulikov A.S., Ivanova O.N., Kozlova K.A., Martynova M.A., Brinyuk E.S. Comparative evaluation of the safety and efficacy of xenon anesthesia in elderly patients with spinal neurosurgical interventions. Clinical Physiology of Circulation. 2020; 17 (1): 32–43 (in Russ.). DOI: 10.24022/1814-6910-202017-1-32-43

Keywords:  xenon anesthesia elderly patients spinal neurosurgery

Received / Accepted:  11.10.2019/21.11.2019

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Abstract

Objective. Assess the safety and efficacy of xenon anesthesia compared with total intravenous anesthesia (TIVA) with propofol in elderly patients during spinal neurosurgical operations.

Material and methods. A prospective randomized study included 60 patients (mean age 74.6±11.2 years) who underwent spinal surgery. Inclusion criteria: patients with ASA III–IV with comorbid and cardiovascular pathology. All patients before surgery MET score < 4. Predictive risk assessment of cardiac and general complications was performed in all patients before surgery. In 1st group (n=30) patients were operated with xenon anesthesia, in 2nd group (n=30) patients were operated with TIVA propofol. Fentanyl was used as an analgesic in both groups. The haemodynamics, acid-base status and arterial blood gases, bispectral monitoring of anesthesia, recovery effects, side effects and complications were compared.

Results. The results of the study showed that xenon anesthesia meets the high safety requirements of elderly patients. Hemodynamic profile with xenon anesthesia is preferable to TIVA propofol. In the 1st group, there were no episodes of intraoperative hypotension and arrhythmia, in contrast to the 2nd group where inotropic drugs and vasopressors (dopamine/noradrenaline) were used to correct hypotension in 12 patients. When using xenon anesthesia in elderly patients, the BIS index values show accordance with the clinical signs of anesthesia. The BIS-index values were identical to the recommended profile in both study groups. All patients in the 1st group were extubated in the operating room (average extubation time 3,8±0,4 min) and transferred to wake-up room. In the 2nd group, patients were extubated in the operating room/wake-up room (average extubation time 6,9±0,4 min).

Conclusion. Xenon anesthesia is an effective and safe for elderly patients during spinal neurosurgical operations. The advantages of xenon anesthesia are hemodynamic stability and good recovery effects of anesthesia. Xenon anesthesia is preferable for patients with comorbid cardiovascular pathology.

References

  1. Starkweather A. Posterior lumbar interbody fusion: an old concept with new techniques. J. Neurosc. Nurs. 2006; 38; 13–20.
  2. Dagal A., Lam A.M. Anesthesia for neurosurgery. In: Barash P.G., Cullen B.F., Stoelting R.K., Cahalan M., Stock M.C. (Eds). Clinical anesthesia. 7th ed. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins; 2013: 996–1030.
  3. Butterworth IV J.F., Mackey D.C., Wasnick J.D. Morgan & Mikhail's clinical anesthesiology. 5th ed. New York: Lange Medical Books/McGraw-Hill; 2013: 907–19.
  4. Law L.S., Lo E.A., Gan T.J. Xenon anesthesia: a systematic review and meta-analysis of randomized controlled trials. Anesth. Analg. 2016; 122: 678–97. DOI: 10.1213/ANE.0000000000000914
  5. Xia Y., Fang H., Xu J., Jia C., Tao G., Yu B. Сlinical efficacy of xenon versus propofol. A systematic review and meta-analysis. Medicine (Baltimore). 2018; 97 (20): 1–6. DOI: 10.1097/MD.0000000000010758
  6. Baumert J.H., Hein M., Hecker K.E., Satlow S., Neef P., Rossaint R. Xenon or propofol anaesthesia for patients at cardiovascular risk in non-cardiac surgery. Br. J. Anaesth. 2008; 100: 605–11. DOI: 10.1093/bja/ aen050
  7. Rossaint R., Reyle-Hahn M., Schulte Am Esch J., Scholz J., Scherpereel P., Vallet B. et al. Multicenter randomized comparison of the efficacy and safety of xenon and isoflurane in patients undergoing elective surgery. Anesthesiology. 2003; 98: 6–13.
  8. Dingley J., Tooley J., Porter H., Thoresen M. Xenon provides short-term neuroprotection in neonatal rats when administered after hypoxia-ischemia. Stroke. 2006; 37: 501–6. DOI: 10.1161/01.str.0000198867. 31134.ac
  9. Буров Н.Е., Руденко М.И., Замятин М.Н. Опыт применения ксенона в хирургии. В кн.: Суслов Н.И., Потапов В.Н., Шписман М.Н. и др. (ред.) Применение ксенона в медицине. Томск: ТГУ; 2009: 243–53. [Burov N.E., Rudenko M.I., Zamyatin M.N. Experience in using xenon in surgery. In: Suslov N.I., Potapov V.N., Shpisman M.N et al. (Eds) Use of xenon in medicine. Tomsk; 2009: 243–53 (in Russ.).]
  10. Kristensen S.D., Knuuti J., Saraste A., Anker S., Bo/tker H.E., Hert S.D. et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur. J. Anaesthesiol. 2014; 31 (10): 517–73. DOI: 10.1097/EJA.0000000000000150
  11. Прогнозирование и профилактика кардиальных осложнений внесердечных хирургических вмешательств. Национальные рекомендации. Кардиоваскулярная терапия и профилактика. 2011; (6S3): 3–28. DOI: 10.15829/1728-8800-2011-6S3-3-28 [Prediction and prevention of cardiac complications of non-cardiac surgery. National recommendations. Cardiovascular Therapy and Prevention. 2011; (6S3): 3–28 (in Russ.) DOI: 10.15829/1728-8800-2011-6S33-28 ]
  12. Eagle K.A., Berger P.B., Calkins H., Chaitman B.R., Ewy G.A., Fleischmann K.E. et al. ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery – Executive Summary (A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)). Anesth. Analg. 2002; 94: 1052–64.
  13. Goldman L., Caldera D.L., Nussbaum S.R., Southwick F.S., Krogstad D., Murray B. et al. Cardiac risk factors and complications in noncardiac surgery. N. Engl. J. Med. 1977; 297: 845–50. DOI: 10.1056/NEJM 197710202971601
  14. Detsky A.S., Abrams H.B., Forbath N., Scott J.G., Hilliard J.R. Cardiac assessment for patients undergoing noncardiac surgery. A multifactorial clinical risk index. Arch. Intern. Med. 1986; 146: 2131–40. DOI: 10.1001/archinte.1986.00360230047007
  15. Lee T.H., Marcantonio E.R., Mangione C.M., Thomas E.J., Polanczyk C.A., Cook E.F. et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999; 100: 1043–90. DOI: 10.1161/ 01.CIR.100.10.1043
  16. Grant P.J., Greene M.T., Chopra V., Bernstein S.J., Hofer T.P., Flanders S.A. Assessing the Caprini Score for risk assessment of venous thromboembolism in hospitalized medical patients. Am. J. Med. 2016; 129 (5): 528–35. DOI:10.1016/j.amjmed.2015.10.027
  17. Bilimoria K.Y., Liu Y., Paruch J.L., Zhou L., Kmiecik T.E., Ko C.Y. et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J. Am. Coll. Surg. 2013; 217 (5): 833–42. DOI: 10.1016/j.jamcollsurg.2013.07.385
  18. Hug C., McLeskey C.H., Nahrwold M.L. Haemodynamic effects of propofol: data from over 25000 patients. Anesth. Analg. 1993; 77 (Suppl. 4): 21–9.
  19. Bein B., Turowski P., Renner J., Hanss R., SteinfathM., Scholz J. et al. Comparison of xenon-based anaesthesia compared with total intravenous anaesthesia in high risk surgical patients. Anaesthesia. 2005; 60: 960–7. DOI: 10.1111/j.1365-2044.2005.04326.x
  20. Choi Y.J., Kim M.C., Lim Y.J. Propofol infusion associated metabolic acidosis in patients undergoing neurosurgical anesthesia: a retrospective study. J. Korean. Neurosurg. Soc. 2014; 56 (2): 135–40. DOI: 10.3340/ jkns.2014.56.2.135
  21. Cravens G.T., Packer D.L., Johnson M.E. Incidence of propofol infusion syndrome during noninvasive radiofrequency ablation for atrial flutter or fibrillation. Anesthesiology. 2007; 106: 1134–8. DOI: 10.1097/01. anes.0000265421.40477.a3
  22. Cremer O.L., Moons K.G., Bouman E.A., Kruijswijk J.E., de Smet A.M., Kalkman C.J. Long-term propofol infusion and cardiac failure in adult head injured patients. Lancet. 2001; 357: 117–8. DOI: 10.1016/S0140-6736(00)03547-9
  23. Мороз В.В., Добрушина О.Р., Стрельникова Е.П., Корниенко А.Н., Зинина Е.П. Предикторы кардиальных осложнений операций на органах брюшной полости и малого таза у больных пожилого истарческого возраста. Общая реаниматология. 2011; 7 (5): 28–33. DOI: 10.15360/1813-9779-2011-5-26 [Moroz V.V., Dobrushina O.R., Strel'nikova E.P., Kornienko A.N., Zinina E.P. Predictors of cardiac complications of abdominal and small pelvic surgery in elderly and senile patients. General Reanimatology. 2011; 7 (5): 28–33 (in Russ.). DOI: 10.15360/18139779-2011-5-26 ]
  24. Azevedo P.S., Gumieiro D.N., Polegato B.F., Pereira G.J., Silva I.A., Pio S.M. et al. Goldman score, but not Detsky or Lee indices, predicts mortality 6 months after hip fracture. BMC Musculoskelet Disord. 2017; 18: 134. DOI: org/10.1186/s12891-017-1480-x
  25. Мощев Д.А., Лубнин А.Ю., Мошкин А.В., Моченова Н.Н., Мадорский С.В., Лукьянов В.И. Анализ прогностической значимости исследования уровня Д-димера фибрина у плановых нейрохирургических больных до госпитализации. Анестезиология и реаниматология. 2013. 4: 59–63. [Moshchev D.A., Lubnin A.Yu., Moshkin A.V., Mochenova N.N., Madorskiy S.V., Luk'yanov V.I. Analysis of the prognostic significance of the study of the level of fibrin D-dimer in planned neurosurgical patients before hospitalization. Russian Journal of Anaesthesiology and Reanimatology. 2013; 4: 59–63 (in Russ.).]
  26. Coburn M., Kunitz O., Baumert J.H., Hecker K., Haaf S., Zu ¨hlsdorff A. et al. Randomized controlled trial of the haemodynamic and recovery effects of xenon or propofol anaesthesia. Br. J. Anaesth. 2005; 94: 198–202. DOI: 10.1093/bja/aei023
  27. Fahlenkamp A.V., Krebber F., Rex S., Grottke O., Fries M., Rossaint R. et al. Bispectral index monitoring during balanced xenon or sevoflurane anaesthesia in elderly patients. Eur. J. Anaesthesiol. 2010; 27: 906–11. DOI: 10.1097/EJA.0b013e32833d1289
  28. Glass P.S., Bloom M., Kearse L., Rosow C., Sebel P., Manberg P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology. 1997; 86: 836–47.
  29.  Ho ¨cker J., Raitschew B., Meybohm P., Broch O., Stapelfeldt C., Gruenewald M. et al. Differences between bispectral index and spectral entropy during xenon anaesthesia: a comparison with propofol anaesthesia. Anaesthesia. 2010; 65: 595–600. DOI: 10.1111/j.1365-2044.2010.06344.x
  30. Bronco A., Ingelmo P.M., Aprigliano M., Turella M., Sahilliog ˇlu E., Bucciero M. et al. Xenon anaesthesia produces better early postoperative cognitive recovery than sevoflurane anaesthesia. Eur. J. Anaesthesiol. 2010; 27: 912–6. DOI: 10.1097/EJA.0b013e32833b652d
  31. Ho ¨cker J., Stapelfeldt C., Leiendecker J., Meybohm P., Hanss R., Scholz J. et al. Postoperative neurocognitive dysfunction in elderly patients after xenon versus propofol anesthesia for major noncardiac surgery: a double-blinded randomized controlled pilot study. Anesthesiology. 2009; 110: 1068–76. DOI: 10.1097/ ALN.0b013e31819dad92
  32. Coburn M., Kunitz O., Apfel C.C., Hein M., Fries M., Rossaint R. et al. Incidence of postoperative nausea and emetic episodes after xenon anaesthesia compared with propofol-based anaesthesia. Br. J. Anaesth. 2008; 100: 787–91. DOI: 10.1093/bja/aen077

About Authors

  • Alla V. Solenkova, Cand. Med. Sc., Anesthesiologist; orcid.org/0000-0001-7081-2950
  • Andrey Yu. Lubnin, Dr. Med. Sc., Professor, Head of Department of Anesthesiology and Intensive Care; orcid.org/0000-0003-2595-5877
  • Nikolay A. Konovalov, Dr. Med. Sc., Professor, Corresponding Member of RAS, Head of Department of Spinal Surgery; orcid.org/0000-0002-9976-948X
  • Aleksandr S. Kulikov, Cand. Med. Sc., Senior Researcher; orcid.org/0000-0002-2852-6544
  • Ol’ga N. Ivanova, Anesthesiologist; orcid.org/0000-0003-1253-8337
  • Kseniya A. Kozlova, Anesthesiologist; orcid.org/0000-0002-7142-229X
  • Mariya A. Martynova, Cand. Med. Sc., Neurosurgeon; orcid.org/0000-0002-1727-5102
  • Evgeniy S. Brinyuk, Postgraduate; orcid.org/0000-0001-6184-7481


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