Xenon in Off-pump Coronary Artery Bypass Graft Surgery

The Safety and Feasibility of Administering Xenon to Patients Undergoing Off-pump Coronary Artery Bypass Graft Surgery: a Pilot Study

Purpose of this study is to test whether xenon application during off-pump-coronary artery bypass (OPCAB)-surgery is safe and feasible.

The investigators hypothesize that xenon application during OPCAB-surgery performs non-inferiorly to the administration of the established anaesthetic sevoflurane with regard to haemodynamic stability, respiratory function, and depth of anesthesia. The evaluation of the outcome will include several secondary parameters such as the incidence of post-operative cardiovascular and neurovascular events, the incidence of organ dysfunction and further adverse events. This study will further function as a pilot study for the evaluation of the incidence of postoperative delirium (POD) following OPCAB-surgery and xenon treatment. POD is a common complication of cardiac surgery/anaesthesia and may significantly affect the patients' mortality and outcome. Xenon possesses neuroprotective and anti-inflammatory qualities that may directly interfere with the pathogenesis of POD, as well as reducing other factors of perioperative organ injury including cardiac complications. Xenon´s favourable pharmacokinetic properties further result in rapid clearance from the brain, reducing any residual anaesthetic effects that may predispose to POD.

inhalative anesthetic, dosage: 1.4% (v/v) in 50% oxygen/medical air , continuous application during surgery

assessed by: depth of anesthesia, perioperative hemodynamic profile, peripheral and arterial oxygen saturation

Severity of postoperative critical illness as indicated by the sequential organ failure assessment (SOFA) score

Severity of postoperative critical illness as indicated by the new simplified acute physiology score (SAPS II)

Inclusion Criteria: Patients with coronary artery disease scheduled for elective OPCAB- surgery Patients willing and able to complete the requirements of this study Ejection Fraction > 30% Exclusion Criteria: Lack of informed consent Age < 18 years Pregnancy chronic obstructive pulmonary disease (COPD) GOLD > II Renal dysfunction defined as serum-creatinine > 1.5 mg/dl Acute coronary syndrome during the last 24 hours; haemodynamic instability, requirement of inotropic support Single vessel grafting Disabling neuropsychiatric disorders (severe dementia, Alzheimer's disease, schizophrenia, depression), history of stroke with residuals, significant stenosis of carotid arteries, increased intracranial pressure Hypersensitivity to the study medication Presumed uncooperativeness or legal incapacity

Al Tmimi L, Van Hemelrijck J, Van de Velde M, Sergeant P, Meyns B, Missant C, Jochmans I, Poesen K, Coburn M, Rex S. Xenon anaesthesia for patients undergoing off-pump coronary artery bypass graft surgery: a prospective randomized controlled pilot trial. Br J Anaesth. 2015 Oct;115(4):550-9. doi: 10.1093/bja/aev303.