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Excerpt
During the past 10 years, xenon has attracted increasing interest as an ideal anaesthetic. It is insoluble to human tissues, enabling rapid anaesthetic induction and emergence; is free from toxicity and cardiac depressant effects; does not trigger malignant hyperthermia; and is environmentally friendly.
Our recent clinical data have demonstrated that xenon is potent both as an analgesic and as a hypnotic. This makes xenon unique, because potent analgesics (nitrous oxide and opioids) are generally weak hypnotics, while potent hypnotics (volatile anaesthetics and propofol) are generally poor analgesics.
Xenon appears to be at least as potent an analgesic as nitrous oxide: Both suppress haemodynamic responses to skin incision to the same extent, while neither isoflurane nor sevoflurane alone can achieve this. Furthermore, the requirement of supplemental fentanyl to suppress these responses is less with xenon (49%=0.7 MAC) than with equi-MAC nitrous oxide (70%). However, unlike nitrous oxide, xenon is a potent hypnotic, because its MAC awake is 31% and, similar to other volatile anaesthetics, it almost completely suppresses the mid-latency auditory evoked potentials at clinically relevant concentrations. Interestingly, the bispectral index (BIS) monitor may not reliably indicate the depth of anaesthesia with xenon; four of 11 patients in our series opened their eyes to verbal command while their BIS values were in the range 40-49.
I expect to see further advances both in the research and in the clinical application of xenon anaesthesia, and encourage international collaboration for the greatest benefit of all humankind in this new millennium.
Acknowledgement: Xenon was generously provided by Daido-Hoxan Inc.
