Xenon: one small step for anaesthesia… ?

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IntroductionOnly 4 days short of 159 years after the first public demonstration of ether anaesthesia on October 16, 1846, xenon was approved for use in anaesthesia in Germany on October 12, 2005. This may be viewed as a historic date, because although xenon was approved in Russia in 2000, it was not available for anaesthesia use in Western countries. For years, however, xenon anaesthesia has been discussed extensively within the anaesthesia community at national and international meetings, as well as in the anaesthesia literature [1]. Since its first reported use in humans in 1951, xenon has been viewed as the closest candidate for an ideal anaesthetic gas [2]. Although the anaesthetic use of xenon was not followed up rigorously throughout the subsequent years, sporadic reports continued to support the superior properties of this gas compared with the available inhalational and intravenous anaesthetics. Thus xenon was demonstrated in studies in animals and humans to be associated with superior haemodynamic stability, and was assumed to be the anaesthetic of choice for cardiovascularly compromised patients. After 1990, interest in xenon was renewed, and more studies were published examining various aspects of clinical anaesthesia with xenon. Recent reviews on xenon summarize the available knowledge for those interested in further reading. Last year's section on ‘Drugs in anaesthesia’ in this journal contained an excellent overview on xenon by Sanders and Maze [1]. The exciting new developments are the rationale for a relatively rapid follow-up since last year's review. What has occurred within the last year, and where do we stand with regard to the now approved use of xenon? The approval of xenon in Germany is only the beginning. It is likely that approval in the other European countries will be achieved by the end of 2006, and that the North American continent will soon follow.Emergence from anaesthesiaIn a large multicentre trial [3], as well as in other studies, rapid emergence from anaesthesia with xenon was demonstrated. Patients waking up after xenon anaesthesia are rapidly fully orientated. Immediately postoperatively, patients appear pain free, and feel well. When evaluated 4–12 weeks after the operation, however, no significant differences were demonstrated in two groups of 80 patients undergoing xenon or propofol anaesthesia with regard to discomfort. In contrast, postoperative pain and appetite/thirst had a significantly higher incidence in the xenon group, possibly as a consequence of the patients being fully awake earlier [4]. These results emphasize that the use of short-acting anaesthetics needs to be accompanied by an adequate strategy for postoperative care.Haemodynamic stabilityOne of the main benefits of xenon anaesthesia appears to be the haemodynamic stability compared with other anaesthetics. Xenon was demonstrated in a large multicentre trial to provide safe and efficient anaesthesia with more rapid recovery compared with isoflurane [3]. In a study performed in 160 patients with American Society of Anesthesiologists (ASA) status I and II undergoing elective surgery [5], it was shown that xenon resulted in a reduced heart rate compared with baseline and propofol values, remaining at a mean value of more than 50 beats/min. The two anaesthetic regimes with xenon and propofol were comparable between groups. Most of these data, however, were obtained in patients lacking cardiovascular risk factors.Recently, studies have become available elaborating on the haemodynamic effects of xenon in patients with pre-existing cardiovascular diseases. It was demonstrated in patients with a low cardiac ejection fraction undergoing implantation of a cardioverter/defibrillator that xenon provided greater haemodynamic stability compared with propofol [6].

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