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.

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-treat: n = 492; per-protocol/without major protocol deviation: n = 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-protocol: P = 0.02). Postoperative cardiac troponin I release was significantly less with xenon than with total intravenous anesthesia (intention-to-treat: P = 0.05; per-protocol: P = 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.

Paracetamol versus metamizol in the treatment of postoperative pain after breast surgery: a randomized, controlled trial.

BACKGROUND AND OBJECTIVE: Intravenously administered paracetamol is an effective analgesic in postoperative pain management. However, there is a lack of data on the effect of intravenous (i.v.) paracetamol on pain following soft tissue surgery. METHODS: Eighty-seven patients undergoing elective breast surgery with total i.v. anaesthesia (propofol/remifentanil) were randomized to three groups. Group para received 1 g i.v. paracetamol 20 min before and 4, 10 and 16 h after the end of the operation. Group meta and plac received 1 g i.v. metamizol or placebo, respectively, scheduled at the same time points. All patients had access to i.v. morphine on demand to achieve adequate pain relief. RESULTS: No significant difference in total morphine consumption between groups was detectable. The proportion of patients who did not receive any morphine in the postoperative period was significantly higher in group para (42%) than in group plac (4%). Ambulation was significantly (P < 0.05) earlier in group para (4.0 +/- 0.2 h) than in groups meta (4.6 +/- 0.2 h) and plac (5.5 +/- 1.0 h). No differences were observed between groups meta and plac. There were no differences between groups with regard to incidence of postoperative nausea and vomiting or changes in vigilance. CONCLUSION: Neither i.v. paracetamol nor i.v. metamizol provided a significant reduction in total postoperative morphine consumption compared with placebo in the management of postoperative pain after elective breast surgery. Administration of paracetamol resulted in a significant reduction in the number of patients needing opioid analgesics to achieve adequate postoperative pain relief.

Laryngeal tube S II, ProSeal laryngeal mask, and EasyTube during elective surgery: a randomized controlled comparison with the endotracheal tube in nontrained professionals.

BACKGROUND AND OBJECTIVE: EasyTube (EZT), ProSeal laryngeal mask airway (PLMA), and Laryngeal tube S II (LTS II) have recently been introduced as supraglottic airway devices and have been proposed as emergency airway alternatives. The purpose of this study was to compare the performance of the three devices, if used by anaesthesiologists without extensive hands-on training, with the endotracheal tube during routine surgical procedures. METHODS: After informed consent, 88 ASA I-II patients scheduled for routine minor surgery were randomly allocated to EZT (n=22), PLMA (n=22), and LTS II (n=22) groups and the endotracheal tube (n=22) group, respectively. Overall success rates, insertion times, cuff pressures, and resulting airway leak pressures as well as subjective assessment of handling were determined. RESULTS: Overall insertion success rate of the EZT, PLMA, LTS II, and endotracheal tube was 14 out of 22 (64%), 20 out of 22 (91%), 21 out of 22 (96%), and 21 out of 22 (96%), respectively. Time to first successful ventilation with the EZT was significantly (P<0.05) longer than that with PLMA, LTS II, and endotracheal tube [median (minimum-maximum): 56 (27-150), 25 (12-70), 24 (11-150), and 20 (8-74) s, respectively]. The lowest airway leak pressure could be observed with the EZT [median (minimum-maximum), 19 (9-40) cmH2O] and the highest airway leak pressure with the LTS II [median (minimum-maximum), 40 (22-40) cmH2O]. Subjective assessment of handling was significantly (P<0.05) poorer in the EZT group compared with PLMA, LTS II, and endotracheal tube groups, respectively. CONCLUSION: In contrast to the EZT, both PLMA and LTS II proved to be suitable for routine airway management by anaesthesiologists without extensive hands-on device training.