BACKGROUND Older patients undergoing cardiac surgery have a 40-60% risk of developing postoperative delirium (POD), which is associated with increased morbidity and mortality. In animals, xenon has been found to be neuroprotective. Little is known about its neuroprotective effects in humans. We evaluated whether xenon anaesthesia prevents POD in patients undergoing cardiac surgery. METHODS We conducted a randomised, observer-blind, controlled trial in which 190 patients 65 yr or older undergoing on-pump cardiac surgery were randomly allocated to xenon or sevoflurane anaesthesia. During cardiopulmonary bypass, propofol infusion was used for anaesthetic maintenance. Subjects were screened for POD daily during the first 5 postoperative days using the 3-Minute Diagnostic Interview for Confusion Assessment Method (CAM) or with a CAM version for patients in ICU (CAM-ICU). Other methods to detect delirium, such as chart review, were also used. Secondary outcomes included the duration and severity of POD, and postoperative cognitive function. RESULTS The overall incidence of POD was 41% (78/190). There was no statistically significant difference in the POD incidence between the xenon and sevoflurane groups (42.7% [41/96] vs 39.4% [37/94], P=0.583). The odds ratio for POD when comparing xenon with sevoflurane was 1.18 (95% confidence interval, 0.65-2.16). CONCLUSIONS In older patients undergoing cardiac surgery, xenon anaesthesia did not result in a significant reduction in POD. Based on these results alone, use of xenon cannot be recommended for this purpose. CLINICAL TRIAL REGISTRATION EudraCT: 2014-005370-11 (May 13, 2015; https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-005370-11).

中文翻译：

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术中氙用于预防体外循环心脏手术后谵妄：一项随机、观察者盲法对照临床试验。


背景接受心脏手术的老年患者有 40-60% 的风险发生术后谵妄 (POD)，这与发病率和死亡率增加有关。在动物中，氙被发现具有神经保护作用。人们对它对人类神经保护的作用知之甚少。我们评估了氙气麻醉是否可以预防心脏手术患者的 POD。方法 我们进行了一项随机、观察者盲法对照试验，其中 190 名 65 岁或以上接受体外循环心脏手术的患者被随机分配接受氙气麻醉或七氟醚麻醉。体外循环期间，输注异丙酚用于维持麻醉。术后前 5 天，每天使用 3 分钟诊断访谈混乱评估方法 (CAM) 或针对 ICU 患者的 CAM 版本 (CAM-ICU) 对受试者进行 POD 筛查。还使用了其他检测谵妄的方法，例如图表查看。次要结局包括 POD 的持续时间和严重程度以及术后认知功能。结果POD总发生率为41%（78/190）。氙组和七氟醚组POD发生率差异无统计学意义（42.7%[41/96] vs 39.4%[37/94]，P=0.583）。比较氙气与七氟烷时，POD 的优势比为 1.18（95% 置信区间，0.65-2.16）。结论 在接受心脏手术的老年患者中，氙气麻醉并未导致 POD 显着降低。仅根据这些结果，不建议为此目的使用氙气。临床试验注册 EudraCT：2014-005370-11（2015 年 5 月 13 日；https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-005370-11）。