ABSTRACT NO: 022
Xenon has been used on a study protocol basis in our hospital since 1997. This is a continuation of the study performed in 1990 . The principal difference is that we now use the Physioflex® (Dräger, Germany) closed-circuit anaesthesia machine. More than 55 patients have now been treated with xenon and the Physioflex system. Because xenon as an anaesthetic demonstrated an ability to maintain perioperative haemodynamic stability, we decided to use it in ASA III patients with cardiac and or pulmonary problems. We present one such case.
The patient was an obese (105 kg, 160 cm) 72-year-old Jehovah's Witness admitted for total hip replacement. She had a history of myocardial infarctions (lateral and anterior wall) and three episodes of cardiac decompensation, the last episode having been 2 months prior to the operation. The echocardiogram showed moderate left ventricular function and the ejection fraction was estimated at 28%. A small dysfunction of the mitral, aortic and tricuspid valves was noted. The surgeon judged the procedure as difficult with a possible blood loss of 2.5 L. The Physioflex delivered a mixture of xenon 60% and oxygen 28%. The procedure lasted 4 h 22 min and, during this time, 19.4 L of xenon were used. Haemodynamic and ventilatory parameters remained very stable during the procedure. Blood pressure remained around 90% of the preoperative value without inotropic agents. Pulmonary pressure reduced 20% compared with the preoperative value. During the whole procedure, blood loss was 1800 mL. The patient was extubated (alert and awake).
During 1999, we have treated 17 haemodynamically compromised patients without any adverse clinical events. We conclude that the use of xenon as an anaesthetic with the Physioflex® system can offer new ways to treat compromised patients. It has certain advantages compared with the currently used volatile or intravenous anaesthetics. However, a coordinated multicentre study needs to establish the real value of xenon in clinical practice.
1 Lachmann B, Armbruster S, Schairer W et al. Lancet
The publication of this supplement has been supported by the sponsors of the Third ISMG Meeting: Abbott, AGA, AstraZeneca, Dräger, Janssen, Medex Medical, Messer Austria, Ohmeda, Pharmacia & Upjohn, Scott Medical Products, Siemens