Abstract
BackgroundRenal dysfunction following intraoperative arterial hypotension is mainly caused by an insufficient renal blood flow. It is associated with higher mortality and morbidity rates. We hypothesised that the intraoperative haemodynamics are more stable during xenon anaesthesia than during isoflurane anaesthesia in patients undergoing partial nephrectomy.MethodsWe performed a secondary analysis of the haemodynamic variables collected during the randomised, single-blinded, single-centre PaNeX study, which analysed the postoperative renal function in 46 patients who underwent partial nephrectomy. The patients received either xenon or isoflurane anaesthesia with 1:1 allocation ratio. We analysed the duration of the intraoperative systolic blood pressure decrease by > 40% from baseline values and the cumulative duration of a mean arterial blood pressure (MAP) of < 65 mmHg as primary outcomes. The secondary outcomes were related to other blood pressure thresholds, the amount of administered norepinephrine, and the analysis of confounding factors on the haemodynamic stability.ResultsThe periods of an MAP of < 65 mmHg were significantly shorter in the xenon group than in the isoflurane group. The medians [interquartile range] were 0 [0–10.0] and 25.0 [10.0–47.5] minutes, for the xenon and isoflurane group, respectively (P = 0.002). However, the cumulative duration of a systolic blood pressure decrease by > 40% did not significantly differ between the groups (P = 0.51). The periods with a systolic blood pressure decrease by 20% from baseline, MAP decrease to values < 60 mmHg, and the need for norepinephrine, as well as the cumulative dose of norepinephrine were significantly shorter and lower, respectively, in the xenon group. The confounding factors, such as demographic data, surgical technique, or anaesthesia data, were similar in the two groups.ConclusionThe patients undergoing xenon anaesthesia showed a better haemodynamic stability, which might be attributed to the xenon properties. The indirect effect of xenon anaesthesia might be of importance for the preservation of renal function during renal surgery and needs further elaboration.Trial registrationClinicalTrials.gov: NCT01839084. Registered 24 April 2013.
Highlights
The current “gold-standard” for curative surgery of renal cell carcinomas is partial nephrectomy [1]
We hypothesized that the patients undergoing xenon anaesthesia would exhibit significantly better haemodynamics during the surgery, as defined by the recommendation of the German Society for Anaesthesiology and Intensive Medicine (DGAI) [13]
The complete methodological details are presented elsewhere [25]. The objective of this analysis was to compare the haemodynamic stability under xenon anaesthesia with that under isoflurane anaesthesia and to explore its effects on the renal perfusion during partial nephrectomy
Summary
The current “gold-standard” for curative surgery of renal cell carcinomas is partial nephrectomy [1]. Our group recently conducted the PaNeX-study, wherein we hypothesised that the postoperative renal function after partial nephrectomy would differ between patients undergoing xenon and those undergoing isoflurane anaesthesia [25]. We hypothesized that the patients undergoing xenon anaesthesia would exhibit significantly better haemodynamics during the surgery, as defined by the recommendation of the DGAI [13]. Renal dysfunction following intraoperative arterial hypotension is mainly caused by an insufficient renal blood flow. It is associated with higher mortality and morbidity rates. We hypothesised that the intraoperative haemodynamics are more stable during xenon anaesthesia than during isoflurane anaesthesia in patients undergoing partial nephrectomy
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