Clinical efficacy of xenon versus propofol: A systematic review and meta-analysis

Abstract

Background: Interest in the anesthetic use of xenon, a noble gas, has waxed and waned for decades, and the clinical effects of xenon are still debated. We performed a meta-analysis to compare the clinical efficacy of xenon with that of propofol.

Methods: Electronic searches were performed through December 2017 using various databases, including PubMed, Embase, and the Cochrane Library. We identified thirteen trials that included a total of 817 patients.

Results: Patients treated with xenon had a lower bispectral index (BIS) (weighted mean difference (WMD): -6.26, 95% confidence interval (CI): -11.33 to -1.18, P = .02), a higher mean arterial blood pressure (MAP) (WMD: 7.00, 95% CI: 2.32-11.68, P = .003) and a lower heart rate (HR) (WMD: -9.45, 95% CI: -12.28 to -6.63, P < 0.00001) than propofol-treated patients. However, there were no significant differences between the 2 treatment groups in the effects of nondepolarizing muscular relaxants, the duration spent in the postanesthesia care unit (PACU) (WMD: -0.94, 95% CI: -8.79-6.91, P = .81), or the incidence of perioperative complications [assessed using the outcomes of postoperative nausea and vomiting (PONV) (relative risk (RR): 2.01, 95% CI: 0.79-5.11, P = .14), hypotension (RR: 0.62, 95% CI: 0.27 to 1.40, P = .25), hypertension (RR: 1.27, 95% CI: 0.73-2.21, P = .39) and bradycardia (RR: 1.00, 95% CI: 0.36-2.74, P = 1.00)].

Conclusion: In this meta-analysis of randomized controlled trials, we found that xenon treatment resulted in a higher MAP, a lower HR, and a smaller BIS index than treatment with propofol.

Figure 1

The process used to perform the literature search.

Figure 2

The BIS index in the xenon group versus that in the propofol group. IV = inverse variance, random = random effect, 95% CI = 95% confidence interval.

Figure 3

PACU stay length in the xenon group versus that in the propofol groups. IV = inverse variance, fixed = fixed effect, 95% CI = 95% confidence interval.

Figure 4

The incidence of perioperative complications in the xenon group versus that in the propofol group: (A) postoperative nausea and vomiting (PONV), (B) hypertension, (C) hypotension and (D) bradycardia. PONV = postoperative nausea and vomiting.

Figure 5

Perioperative hemodynamics in the xenon group versus those in the propofol groups: (A) MAP and (B) HR. HR = heart rate, MAP = mean arterial blood pressure.