This Article Résumé de cet Article Full Text Full Text (PDF) Additional Material Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Luginbühl, M. Articles by Schnider, T. W. Search for Related Content PubMed PubMed Citation Articles by Luginbühl, M. Articles by Schnider, T. W.

Xenon does not reduce opioid requirement for orthopedic surgery

[Le xénon ne réduit pas les besoins d’opioïdes en chirurgie orthopédique]

Martin Luginbühl, MD^*, Steen Petersen-Felix, PD DR MED^*, Alex M. Zbinden^* and Thomas W. Schnider, PD DR MED

^* From the Department of Anesthesiology, University Hospital of Bern, Bern; and
the Department of Anesthesia, Kantonsspital St. Gallen, St. Gallen, Switzerland.

Address correspondence to: Dr. Martin Luginbühl, Department of Anesthesiology, University Hospital, CH-3010 Bern, Switzerland. Phone: +41-31-632-27-19; Fax: +41-31-632-05-54; E-mail: martin.luginbuehl{at}dkf.unibe.ch

Purpose: Is to test the hypothesis that 70% xenon has a relevant opioid sparing effect compared to a minimum alveolar concentration (MAC)-equivalent combination of N₂O and desflurane.

Methods: In this randomized, controlled study of 30 patients undergoing major orthopedic surgery, we determined the plasma alfentanil concentration required to suppress response to skin incision in 50% of patients (Cp₅₀) anesthetized with xenon (70%) or a combination of N₂O (70%) and desflurane (2%). A response was defined as movement, pressor response > 15 mmHg, heart rate > 90 beats·min^–1, autonomic reactions or a combination of these. At skin incision, alfentanil was administered at a randomly selected target plasma concentration thereafter the concentration was increased or decreased according to the patient’s response. After skin incision, desflurane was adjusted to maintain the bispectral index below 60 and prevent responsiveness in both groups.

Results: The Cp₅₀ (± standard error) of alfentanil was 83 ± 48ng·mL^–1 with xenon and 49 ± 26 ng·mL^–1 with N₂O/desflurane (P =0.451). During surgery five xenon and 15 N₂O/desflurane patients were given desflurane at 1.0 ± 0.5 volume % and 2.5 ± 0.7 volume %. The total age adjusted MAC was 0.97 ± 0.07 and 0.94 ± 0.07 respectively (P = 0.217). The intraoperative plasma alfentanil concentrations were 95 ± 80 and 93 ± 60 ng·mL^–1 respectively (mean ± SD; P = 0.451). Patients given xenon were slightly more bradycardic, whereas blood pressure was similar.

Conclusion: Xenon compared to a MAC-equivalent combination of N₂O and desflurane does not substantially reduce opioid requirement for orthopedic surgery. A small but clinically irrelevant difference cannot be excluded, however.

This article has been cited by other articles:

				J. F. A. Hendrickx, E. I. Eger II, J. M. Sonner, and S. L. Shafer Is Synergy the Rule? A Review of Anesthetic Interactions Producing Hypnosis and Immobility Anesth. Analg., August 1, 2008; 107(2): 494 - 506. [Abstract] [Full Text] [PDF]