Xenon anaesthesia may preserve cardiovascular function in patients with heart failure

The hypothesis that xenon anaesthesia provided haemodynamic stability was tested in patients with heart failure in a prospective, randomized, single-blind design.

Twenty-six patients scheduled for implantation of a cardioverter-defibrillator (ICD) received xenon 60-65% in oxygen (xenon group, n = 12) or propofol 3 mg/kg/h (propofol group, n = 14), both combined with remifentanil 0.2 microg/kg/min. After induction of anaesthesia with etomidate and remifentanil, heart rate (HR), mean arterial pressure (MAP) and left ventricular ejection fraction (LVEF) were recorded. After 60 min of propofol or xenon anaesthesia, the same parameters were recorded.

While HR decreased in both groups, MAP was unchanged with xenon (73 vs. 76 mmHg) and decreased with propofol (from 78 to 64 mmHg, P < 0.02). LVEF was stable in both groups [32% vs. 37%, xenon (NS), and 30% vs. 34%, propofol (NS)]. Preload, as measured by end-diastolic volume (EDV), did not change (66 vs. 63 ml with xenon; 79 vs. 81 ml with propofol, both NS). Afterload, as determined by end-systolic pressure-volume product (ESPV), decreased with propofol (6760 vs. 4920 ml mmHg) but not with xenon (4060 vs. 3780 ml mmHg, P < 0.01 between groups).

With propofol, MAP is reduced and LVEF is not increased in spite of reduced afterload. In contrast, MAP and LVEF are maintained with xenon.