Universität zu Köln

Stevanoviv, Ana, Schaefer, Patrick ORCID: 0000-0001-5301-4092, Coburn, Mark, Rossaint, Rolf, Stoppe, Christian, Boor, Peter ORCID: 0000-0001-9921-4284, Pfister, David, Heidenreich, Axel, Christ, Hildegard ORCID: 0000-0003-3235-2994, Hellmich, Martin and Fahlenkamp, Astrid V. (2017). Renal function following xenon anesthesia for partial nephrectomy-An explorative analysis of a randomized controlled study. PLoS One, 12 (7). SAN FRANCISCO: PUBLIC LIBRARY SCIENCE. ISSN 1932-6203

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Abstract

Background Perioperative preservation of renal function has a significant impact on morbidity and mortality in kidney surgery. Nephroprotective effects of the anesthetic xenon on ischemia-reperfusion injury were found in several experimental studies. Objective We aimed to explore whether xenon anesthesia can reduce renal damage in humans undergoing partial nephrectomy and to gather pilot data of possible nephroprotection in these patients. Design A prospective randomized, single-blinded, controlled study. Setting Single-center, University Hospital of Aachen, Germany between July 2013-October 2015. Patients Forty-six patients with regular renal function undergoing partial nephrectomy. Interventions Patients were randomly assigned to receive xenon-(n = 23) or isoflurane (n = 23) anesthesia. Main outcome measures Primary outcome was the maximum postoperative glomerular filtration rate (GFR) decline within seven days after surgery. Secondary outcomes included intraoperative and tumor-related data, assessment of further kidney injury markers, adverse events and optional determination of renal function after 3-6 months. Results Unexpected radical nephrectomy was performed in 5 patients, thus they were excluded from the per-protocol analysis, but included in the intention-to-treat analysis. The maximum postoperative GFR decline was attenuated by 45% in the xenon-group (10.9 ml min(-1) 1.73 cm(-2) versus 19.7 ml min-1 1.73 cm(-2) in the isoflurane group), but without significance (P = 0.084). Occurrence of adverse events was reduced (P = 0.003) in the xenon group. Renal function was similar among the groups after 3-6 months. Conclusion Xenon anesthesia was feasible and safe in patients undergoing partial nephrectomy with regard to postoperative renal function. We found no significant effect on early renal function but less adverse events in the xenon group. Larger randomized controlled studies in more heterogeneous collectives are required, to confirm or refute the possible clinical benefit on renal function by xenon.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Stevanoviv, Ana UNSPECIFIED UNSPECIFIED UNSPECIFIED Schaefer, Patrick UNSPECIFIED orcid.org/0000-0001-5301-4092 UNSPECIFIED Coburn, Mark UNSPECIFIED UNSPECIFIED UNSPECIFIED Rossaint, Rolf UNSPECIFIED UNSPECIFIED UNSPECIFIED Stoppe, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Boor, Peter UNSPECIFIED orcid.org/0000-0001-9921-4284 UNSPECIFIED Pfister, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Heidenreich, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED Christ, Hildegard UNSPECIFIED orcid.org/0000-0003-3235-2994 UNSPECIFIED Hellmich, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Fahlenkamp, Astrid V. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-224895
DOI:	10.1371/journal.pone.0181022
Journal or Publication Title:	PLoS One
Volume:	12
Number:	7
Date:	2017
Publisher:	PUBLIC LIBRARY SCIENCE
Place of Publication:	SAN FRANCISCO
ISSN:	1932-6203
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ISCHEMIA-REPERFUSION INJURY; CYSTATIN-C; SEVOFLURANE ANESTHESIA; VOLATILE ANESTHETICS; NEONATAL ASPHYXIA; CLINICAL-PRACTICE; SURGICAL-PATIENTS; SERUM CREATININE; KIDNEY-FUNCTION; IN-VIVO Multiple languages Multidisciplinary Sciences Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/22489