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Canadian Journal of Anesthesia

, Volume 52, Issue 1, pp 38–44 | Cite as

Xenon does not reduce opioid requirement for orthopedic surgery

  • Martin LuginbühlEmail author
  • Steen Petersen-Felix
  • Alex M. Zbinden
  • Thomas W. Schnider
General Anesthesia

Abstract

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 ± 48 ng · 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.

Keywords

Xenon Alfentanil Desflurane Bispectral Index Opioid Spare Effect 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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

Résumé

Objectif

Vérifier l’hypothèse voulant que le xénon à 70 % permette de réduire significativement les opioïdes en comparaison d’une combinaison équivalente de concentration alvéolaire minimale (CAM) de N2O et de desflurane.

Méthode

L’étude randomisée et contrôlée comptait 30 patients devant subir une intervention orthopédique majeure. La concentration plasmatique d’alfentanil nécessaire pour supprimer la réaction à une incision cutanée chez 50 % des patients (Cp50) sous anesthésie au xénon (70 %) ou une combinaison de N2O (70%) et de desflurane (2%) a été déterminée. Une réaction était un mouvement, une réponse vasopressive > 15 mmHg, une fréquence cardiaque > 90 battements · min−1, des réactions autonomes ou une des réactions combinées. Lors de l’incision cutanée, l’alfentanil était administré selon une concentration plasmatique cible choisie aléatoirement, et la concentration augmentée ou diminuée selon la réaction du patient. Après l’incision, le desflurane était ajusté pour maintenir l’index bispectral en bas de 60 et éliminer les réactions chez tous les patients.

Résultats

La Cp50 (± erreur type) de l’alfentanil a été de 83 ± 48 ng · mL−1 avec le xénon et de 49 ± 26 ng · mL−1 avec N2O/desflurane (P = 0,451). Pendant l’opération, cinq patients sous xénon et 15 sous N2O/desflurane ont reçu du desflurane à 1,0 ± 0,5 volume % et 2,5 ±0,7 volume %. L’ajustement total de la CAM en fonction de l’âge a été de 0,97 ± 0,07 et de 0,94 ± 0,07 respectivement (P = 0,217). les concentrations plasmatiques d’alfentanil ont été de 95 ± 80 et de 93 ± 60 ng · mL−1 respectivement (moyenne ± écart type; P = 0,451). Les patients qui ont reçu du xénon ont présenté un peu plus de bradycardie, mais la tension artérielle était similaire entre les groupes.

Conclusion

Le xénon, comparé à une CAM d’une combinaison équivalente de N2O et de desflurane, ne réduit pas significativement les besoins d’opioïdes en orthopédie. On ne peut toutefois exclure une petite différence, mais cliniquement non significative.

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Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  • Martin Luginbühl
    • 1
    Email author
  • Steen Petersen-Felix
    • 1
  • Alex M. Zbinden
    • 1
  • Thomas W. Schnider
    • 2
  1. 1.Department of AnesthesiologyUniversity HospitalBernSwitzerland
  2. 2.Department of AnesthesiaKantonsspital St. GallenSt. GallenSwitzerland

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