Xenonnarkosen – Klinische Besonderheiten, Vor- und Nachteile sowie mögliche Einsatzgebiete

Jan Höcker; Matthias Grünewald; Berthold Bein

doi:10.1055/s-0032-1316478

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Table of Contents

Anästhesiol Intensivmed Notfallmed Schmerzther 2012; 47(6): 374-380
DOI: 10.1055/s-0032-1316478

Fachwissen

Anästhesiologie

Xenonnarkosen – Klinische Besonderheiten, Vor- und Nachteile sowie mögliche Einsatzgebiete

Xenon anaesthesia – Clinical characteristics, benefits and disadvantages and fields of application

Jan Höcker

,

Matthias Grünewald

,

Berthold Bein

Abstract

Zusammenfassung

Das Edelgas Xenon kommt in der Summe seiner Eigenschaften dem „idealen Anästhetikum“ sehr nahe. Es gewährleistet eine hohe hämodynamische Stabilität und kurze Aufwachzeiten bei gleichzeitigem Fehlen relevanter Nebenwirkungen. Hauptnachteil ist sein hoher Preis. In tierexperimentellen Studien konnten zusätzlich spezifische organprotektive Effekte nachgewiesen werden, v.a. für Herz und Gehirn. Damit könnte Xenon bei Risikopatienten bzw. spezifischen Eingriffen möglicherweise Vorteile gegenüber anderen Anästhetika zeigen, die seine klinische Verwendung sinnvoll erscheinen lassen.

Abstract

The noble gas xenon provides many characteristics of the 'ideal anaesthetic agent'. Xenon offers outstanding haemodynamic stability and rapid emergence from anaesthesia without relevant side effects or toxity. The major limitation for its application in clinical routine is the high price. Recent studies demonstrated additional protective effects against ischaemic injury in particular for the heart and the brain. Therefore, xenon may be beneficial in a subset of high risk patients or operations and may become a meaningful alternative to other anaesthetics in this population.

Schlüsselwörter:

Edelgas - Xenon - Anästhesie - Organprotektion - Risikopatienten

Key words:

noble gas - xenon - anaesthesia - organ protection - perioperative risk

Full Text

References

Literatur
1 Cullen SC, Gross EG. The anesthetic properties of xenon in animals and human beings, with additional observations on krypton. Science 1951; 113: 580-582
2 Nakata Y, Goto T, Morita S. Comparison of inhalation inductions with xenon and sevoflurane. Acta anaesthesiologica Scandinavica 1997; 41: 1157-1161
3 Froeba G, Marx T, Pazhur J et al. Xenon does not trigger malignant hyperthermia in susceptible swine. Anesthesiology 1999; 91: 1047-1052
4 Franks NP, Dickinson R, de Sousa SL et al. How does xenon produce anaesthesia?. Nature 1998; 396: 324-324
5 Salmi E, Laitio RM, Aalto S et al. Xenon does not affect gamma-aminobutyric acid type A receptor binding in humans. Anesth Analg 2008; 106: 129-134
6 Banks P, Franks NP, Dickinson R. Competitive inhibition at the glycine site of the N-methyl-D-aspartate receptor mediates xenon neuroprotection against hypoxia-ischemia. Anesthesiology 2010; 112: 614-622
7 Dickinson R, Peterson BK, Banks P et al. Competitive inhibition at the glycine site of the N-methyl-D-aspartate receptor by the anesthetics xenon and isoflurane: evidence from molecular modeling and electrophysiology. Anesthesiology 2007; 107: 756-767
8 Gruss M, Bushell TJ, Bright DP et al. Two-pore-domain K+ channels are a novel target for the anesthetic gases xenon, nitrous oxide, and cyclopropane. Mol Pharmacol 2004; 65: 443-452
9 Bantel C, Maze M, Trapp S. Neuronal preconditioning by inhalational anesthetics: evidence for the role of plasmalemmal adenosine triphosphate-sensitive potassium channels. Anesthesiology 2009; 110: 986-995
10 Suzuki T, Koyama H, Sugimoto M et al. The diverse actions of volatile and gaseous anesthetics on human-cloned 5-hydroxytryptamine3 receptors expressed in Xenopus oocytes. Anesthesiology 2002; 96: 699-704
11 Suzuki T, Ueta K, Sugimoto M et al. Nitrous oxide and xenon inhibit the human (alpha 7)5 nicotinic acetylcholine receptor expressed in Xenopus oocyte. Anesth Analg 2003; 96: 443-448
12 Goto T, Nakata Y, Ishiguro Y et al. Minimum alveolar concentration-awake of Xenon alone and in combination with isoflurane or sevoflurane. Anesthesiology 2000; 93: 1188-1193
13 Nakata Y, Goto T, Ishiguro Y et al. Minimum alveolar concentration (MAC) of xenon with sevoflurane in humans. Anesthesiology 2001; 94: 611-614
14 Goto T, Nakata Y, Morita S. The minimum alveolar concentration of xenon in the elderly is sex-dependent. Anesthesiology 2002; 97: 1129-1132
15 Rossaint R, Reyle-Hahn M, Schulte Am Esch J et al. Multicenter randomized comparison of the efficacy and safety of xenon and isoflurane in patients undergoing elective surgery. Anesthesiology 2003; 98: 6-13
16 Goto T, Saito H, Shinkai M et al. Xenon provides faster emergence from anesthesia than does nitrous oxide-sevoflurane or nitrous oxide-isoflurane. Anesthesiology 1997; 86: 1273-1278
17 Coburn M, Baumert JH, Roertgen D et al. Emergence and early cognitive function in the elderly after xenon or desflurane anaesthesia: a double-blinded randomized controlled trial. Br J Anaesth 2007; 98: 756-762
18 Goto T, Saito H, Nakata Y et al. Emergence times from xenon anaesthesia are independent of the duration of anaesthesia. Br J Anaesth 1997; 79: 595-599
19 Wappler F, Rossaint R, Baumert J et al. Multicenter randomized comparison of xenon and isoflurane on left ventricular function in patients undergoing elective surgery. Anesthesiology 2007; 106: 463-471
20 Iber T, Hecker K, Vagts DA et al. Xenon anesthesia impairs hepatic oxygenation and perfusion in healthy pigs. Minerva anestesiol 2008; 74: 511-519
21 Baumert JH, Hein M, Hecker KE et al. Autonomic cardiac control with xenon anaesthesia in patients at cardiovascular risk. Br J Anaesth 2007; 98: 722-727
22 Baumert JH, Hein M, Hecker KE et al. Xenon or propofol anaesthesia for patients at cardiovascular risk in non-cardiac surgery. Br J Anaesth 2008; 100: 605-611
23 Bein B, Turowski P, Renner J et al. Comparison of xenon-based anaesthesia compared with total intravenous anaesthesia in high risk surgical patients. Anaesthesia 2005; 60: 960-967
24 Roehl AB, Steendijk P, Rossaint R et al. Xenon is not superior to isoflurane on cardiovascular function during experimental acute pulmonary hypertension. Acta anaesthesiologica Scandinavica 2012; 56: 449-458
25 Schaefer W, Meyer PT, Rossaint R et al. Myocardial blood flow during general anesthesia with xenon in humans: a positron emission tomography study. Anesthesiology 2011; 114: 1373-1379
26 Laitio RM, Kaisti KK, Laangsjo JW et al. Effects of xenon anesthesia on cerebral blood flow in humans: a positron emission tomography study. Anesthesiology 2007; 106: 1128-1133
27 Laitio RM, Langsjo JW, Aalto S et al. The effects of xenon anesthesia on the relationship between cerebral glucose metabolism and blood flow in healthy subjects: a positron emission tomography study. Anesth Analg 2009; 108: 593-600
28 Rex S, Schaefer W, Meyer PH et al. Positron emission tomography study of regional cerebral metabolism during general anesthesia with xenon in humans. Anesthesiology 2006; 105: 936-943
29 Weber NC, Toma O, Wolter JI et al. The noble gas xenon induces pharmacological preconditioning in the rat heart in vivo via induction of PKC-epsilon and p38 MAPK. Br J Pharmacol 2005; 144: 123-132
30 Preckel B, Weber NC, Sanders RD et al. Molecular mechanisms transducing the anesthetic, analgesic, and organ-protective actions of xenon. Anesthesiology 2006; 105: 187-197
31 Preckel B, Mullenheim J, Moloschavij A et al. Xenon administration during early reperfusion reduces infarct size after regional ischemia in the rabbit heart in vivo. Anesth Analg 2000; 91: 1327-1332
32 Newman MF, Kirchner JL, Phillips-Bute B et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med 2001; 344: 395-402
33 De Hert SG, Turani F, Mathur S, Stowe DF. Cardioprotection with volatile anesthetics: mechanisms and clinical implications. Anesth Analg 2005; 100: 1584-1593
34 Landoni G, Biondi-Zoccai GG, Zangrillo A et al. Desflurane and sevoflurane in cardiac surgery: a meta-analysis of randomized clinical trials. J Cardiothorac Vasc Anesth 2007; 21: 502-511
35 Ma D, Yang H, Lynch J et al. Xenon attenuates cardiopulmonary bypass-induced neurologic and neurocognitive dysfunction in the rat. Anesthesiology 2003; 98: 690-698
36 Lockwood GG, Franks NP, Downie NA et al. Feasibility and safety of delivering xenon to patients undergoing coronary artery bypass graft surgery while on cardiopulmonary bypass: phase I study. Anesthesiology 2006; 104: 458-465
37 Jungwirth B, Gordan ML, Blobner M et al. Xenon impairs neurocognitive and histologic outcome after cardiopulmonary bypass combined with cerebral air embolism in rats. Anesthesiology 2006; 104: 770-776
38 Jungwirth B, Gordan ML, Kellermann K et al. Xenon administration immediately after but not before or during cardiopulmonary bypass with cerebral air embolism impairs cerebral outcome in rats. Eur J Anaesthesiol 2011; 28: 882-887
39 Choi DW, Koh JY, Peters S. Pharmacology of glutamate neurotoxicity in cortical cell culture: attenuation by NMDA antagonists. J Neurosci 1988; 8: 185-196
40 Dickinson R, Franks NP. Bench-to-bedside review: Molecular pharmacology and clinical use of inert gases in anesthesia and neuroprotection. Crit Care 2010; 14: 229-229
41 Ma D, Wilhelm S, Maze M, Franks NP. Neuroprotective and neurotoxic properties of the 'inert' gas, xenon. Br J Anaesth 2002; 89: 739-746
42 Wilhelm S, Ma D, Maze M, Franks NP. Effects of xenon on in vitro and in vivo models of neuronal injury. Anesthesiology 2002; 96: 1485-1491
43 Hobbs C, Thoresen M, Tucker A et al. Xenon and hypothermia combine additively, offering long-term functional and histopathologic neuroprotection after neonatal hypoxia/ischemia. Stroke 2008; 39: 1307-1313
44 Ma D, Hossain M, Chow A et al. Xenon and hypothermia combine to provide neuroprotection from neonatal asphyxia. Annals of neurology 2005; 58: 182-193
45 Cremer J, Stoppe C, Fahlenkamp AV et al. Early cognitive function, recovery and well-being after sevoflurane and xenon anaesthesia in the elderly: a double-blinded randomized controlled trial. Medical gas research 2011; 1: 9-9
46 Monk TG, Weldon BC, Garvan CW et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology 2008; 108: 18-30
47 Höcker J, Stapelfeldt C, Leiendecker J et al. Postoperative neurocognitive dysfunction in elderly patients after xenon versus propofol anesthesia for major noncardiac surgery: a double-blinded randomized controlled pilot study. Anesthesiology 2009; 110: 1068-1076
48 Lachmann B, Armbruster S, Schairer W et al. Safety and efficacy of xenon in routine use as an inhalational anaesthetic. Lancet 1990; 335: 1413-1415
49 Coburn M, Kunitz O, Apfel CC et al. Incidence of postoperative nausea and emetic episodes after xenon anaesthesia compared with propofol-based anaesthesia. Br J Anaesth 2008; 100: 787-791
50 Saito H, Saito M, Goto T, Morita S. Priming of anesthesia circuit with xenon for closed circuit anesthesia. Artificial organs 1997; 21: 70-72
51 Höcker J, Raitschew B, Meybohm P et al. Differences between bispectral index and spectral entropy during xenon anaesthesia: a comparison with propofol anaesthesia. Anaesthesia 2010; 65: 595-600

Supplementary Material

Literature