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Xenon Anesthesia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Law, Lawrence Siu-Chun MD; Lo, Elaine Ah-Gi PharmD, BCPS; Gan, Tong Joo MD, FRCA, MHS, LiAc

doi: 10.1213/ANE.0000000000000914
Anesthetic Pharmacology: Research Report

BACKGROUND: Xenon anesthesia has been studied for decades. However, no meta-analysis of randomized controlled trials (RCTs) on xenon anesthesia has been conducted. The aim of this study was to systematically review all available evidence from RCTs comparing xenon and other inhaled and IV anesthetics on anesthetic outcomes. Our meta-analysis attempted to quantify the effects of xenon anesthesia on clinical outcomes in relation to other anesthetics.

METHODS: We found 43 RCTs from PubMed, MEDLINE, CENTRAL, EMBASE, and CINAHL (until January 2015). A total of 31 studies comparing xenon (841 patients) with other inhaled agents (836 patients) and 12 studies comparing xenon (373 patients) with propofol (360 patients) were found. We evaluated clinical outcomes, such as intraoperative hemodynamics, emergence, and postoperative nausea and vomiting (PONV).

RESULTS: Patients undergoing xenon anesthesia had a lower heart rate and higher mean arterial pressure (MAP) intraoperatively than those receiving volatile anesthesia (mean difference = −6 min−1 [99% confidence interval {99% CI} −10.0 to −2.3]; mean difference = 9 mm Hg [99% CI 3.1–14.4]) and propofol anesthesia (mean difference = −10 min−1 [99% CI −12.4 to −6.6]; mean difference = 7 mm Hg [99% CI 0.85–13.2]). Compared with baseline, intraoperative MAP remained relatively stable (change < 5.5%, 99% CI within ±20% of the baseline) under xenon anesthesia, but MAP decreased by ≥15% under volatile (mean difference = −17 mm Hg [99% CI −29.5 to − 4.9], percentage change = −17.5%) and propofol (mean difference = −14 mm Hg [99% CI −26.1 to −2.5], percentage change = −15.0%) anesthesia. Patients had faster emergence from xenon than from volatile anesthesia: eyes opening (versus all volatile agents: mean 4 vs 7 minutes, percentage change = −49.8% [99% CI −55.1% to −44.0%]), tracheal extubation (versus all volatile agents: mean 4 vs 8 minutes percentage change = −44.6% [99% CI −57.3% to −28.1%]), orientation (versus sevoflurane: mean 5 vs 10 minutes, percentage change = −45.1% [99% CI −58.5% to −28.1%]), countdown (versus sevoflurane: mean 6 vs 10 minutes, percentage change = −41.7% [99% CI −50.3% to −31.6%]; versus isoflurane: mean 6 vs 14 minutes, percentage change = −57.7% [99% CI −65.7% to −48.3%]), and reaction on demand (versus sevoflurane: mean 4 vs 8 minutes, percentage change = −53.2% [99% CI −65.7% to −35.6%]). However, xenon anesthesia increased the risks of PONV (incidence 34.4% vs 19.9%; risk ratio = 1.72 [99% CI 1.10–2.69], risk difference = 0.19 [99% CI 0.04–0.33]).

CONCLUSIONS: Xenon anesthesia provides relatively more stable intraoperative blood pressure, lower heart rate, and faster emergence from anesthesia than volatile and propofol anesthesia. However, xenon is associated with a higher incidence of PONV.

Published ahead of print August 13, 2015

From the *Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; and Faculty of Pharmaceutical Sciences, the University of British Columbia, Vancouver, British Columbia, Canada.

Lawrence Siu-Chun Law, MD, is currently affiliated with Center for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore.

Tong Joo Gan, MD, FRCA, MHS, LiAc, is currently affiliated with the Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York.

Accepted for publication May 8, 2015.

Published ahead of print August 13, 2015

Funding: None.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Tong Joo Gan, MD, FRCA, MHS, LiAc, Department of Anesthesiology, Stony Brook Medicine, HSC Level 4, Rm 060, Stony Brook, NY 11794. Address e-mail to tong.gan@stonybrookmedicine.edu.

© 2016 International Anesthesia Research Society