Xenon anesthesia for awake craniotomy: safety and efficacy

Kulikov, A S; Bilotta, Federico; Borsellino, Beatrice; Sel'kov, Denis; Kobyakov, G L; Lubnin, А. Yu.

doi:10.23736/s0375-9393.18.12406-0

Cited by 17 publications

(14 citation statements)

References 49 publications

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“…Dilmen et al 38 concluded that blood pressure was higher in the MAC group during head frame fixation and incision, whereas higher in the SAS group during the intraoperative neurological assessment. Kulikov et al 36 used xenon anesthesia and found that 50% of patients experienced at least 1 hypertensive episode (systolic blood pressure > 150 mm Hg) during the incision and craniotomy phases.…”

Section: Other Outcomesmentioning

confidence: 99%

Comparison of the Asleep-Awake-Asleep Technique and Monitored Anesthesia Care During Awake Craniotomy: A Systematic Review and Meta-analysis

Natalini

Ganau

Rosenkranz

et al. 2020

Journal of Neurosurgical Anesthesiology

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Awake craniotomy (AC) is the preferred surgical option for intractable epilepsy and resection of tumors adjacent to or within eloquent cortical areas. Monitored anesthesia care (MAC) or an asleep-awake-asleep (SAS) technique is most widely used during AC. We used a random-effects modeled meta-analysis to synthesize the most recent evidence to determine whether MAC or SAS is safer and more effective for AC. We included randomized controlled trials and observational studies that explored the incidence of AC failure, duration of surgery, and hospital length of stay in adult patients undergoing AC. Eighteen studies were included in the final analysis. MAC was associated with a lower risk of AC failure when compared with SAS (global pooled proportion MAC vs. SAS 1% vs. 4%; odds ratio [ORs]: 0.28; 95% confidence interval [CI]: 0.11-0.71; P = 0.007) and shorter surgical procedure time (global pooled mean MAC vs. SAS 224.44 vs. 327.94 min; mean difference, −48.76 min; 95% CI: −61.55 to −35.97; P < 0.00001). SAS was associated with fewer intraoperative seizures (global pooled proportion MAC vs. SAS 10% vs. 4%; OR: 2.38; 95% CI: 1.05-5.39; P = 0.04). There were no differences in intraoperative nausea and vomiting between the techniques (global pooled proportion MAC vs. SAS: 4% vs. 8%; OR: 0.86; 95% CI: 0.30-2.45; P = 0.78). Length of stay was shorter in the MAC group (MAC vs. SAS 3.96 vs. 6.75 days; mean difference, −1.30; 95% CI: −2.69 to 0.10; P = 0.07). In summary, MAC was associated with lower AC failure rates and shorter procedure time compared with SAS, whereas SAS was associated with a lower incidence of intraoperative seizures. However, there was a high risk of bias and other limitations in the studies included in this review, so the superiority of 1 technique over the other needs to be confirmed in larger randomized studies.

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Section: Other Outcomesmentioning

confidence: 99%

Comparison of the Asleep-Awake-Asleep Technique and Monitored Anesthesia Care During Awake Craniotomy: A Systematic Review and Meta-analysis

Natalini

Ganau

Rosenkranz

et al. 2020

Journal of Neurosurgical Anesthesiology

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“…In her study, Myasnikova V. showed that anesthesia with xenon at concentration of 48-55 % significantly reduced BIS down to 46-56 during ophthalmic surgery, however narcotic analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) were used throughout the surgery which could have an additional effect on BIS values [5]. In a study using xenon anesthesia in neurosurgery for craniotomy to remove brain neoplasms, the BIS index level was within safe range, but 70 % of the patients had epilepsy and were on anticonvulsants, while narcotic analgesics were also used during surgical treatment along with NSAIDs, which could alter the EEG pattern and BIS level [6]. Similar data were obtained in earlier works of other authors, where various techniques of monitoring the depth of hypnosis showed convincing results in xenon anesthesia, but had limitations such as age, concomitant use of narcotic analgesics, benzodiazepines, anticonvulsants in the perioperative period, or diseases that could affect the baseline EEG [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Assessment of xenon-induced depth of hypnosis according to Kugler’s scale in elderly and senile patients undergoing knee replacement surgery: a prospective open-label cohort study

Lisichenko

Gusarov

Teplykh

et al. 2022

Annals of Critical Care

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АКТУАЛЬНОСТЬ. Анестезия ксеноном характеризуется стабильностью гемодинамических показателей, кардиопротективными, нейропротективными свойствами, что предпочтительно у пациентов пожилого и старческого возраста. Нерешенной проблемой остается оценка глубины угнетения сознания. Есть данные о возможности ее оценки по шкале Kugler на основании анализа электроэнцефалограммы (ЭЭГ). ЦЕЛЬ ИССЛЕДОВАНИЯ. Оценить возможность применения шкалы Kugler на основании ЭЭГ как алгоритма объективной оценки глубины угнетения сознания ксеноном в комбинации с наркотическими анальгетиками или без них, в сочетании с регионарной блокадой во время операции эндопротезирования коленного сустава у пациентов пожилого и старческого возраста. МАТЕРИАЛЫ И МЕТОДЫ. Включено 57 пациентов. Пациенты разделены на 2 группы, в 1-й проводили общую анестезию ксеноном, для обезболивания использовали фентанил и блокаду бедренного нерва, во 2-й анестезию проводили в сочетании с блокадой бедренного и седалищного нервов. Глубину угнетения сознания мониторировали ЭЭГ с расшифровкой и сопоставлением со шкалой Kugler, регистрировали биспектральный индекс (BIS). РЕЗУЛЬТАТЫ. При концентрации 40 % в группе 1 уровень глубины угнетения сознания — D2, в группе 2 — D1, при 55 % и выше в обеих группах — D2. Фентанил в дозе 0,39 ± 0,07 мг увеличивал дельта-ритм (δ) на 19,08 %, что соответствовало снижению эффективной концентрации ксенона ≈20 %. Анализ снижения δ-ритма и BIS при помощи ранговой корреляции Спирмена определил сильную связь в группе 1 (r = –0,78; R² = 60 %), среднего уровня в группе 2 (r = –0,61; R² = 37 %), различия связаны с фентанилом в группе 1. Снижение BIS при сравнении групп не достигло достоверно значимого уровня (р > 0,05). ВЫВОДЫ. У пациентов пожилого и старческого возраста при эндопротезировании коленного сустава в условиях сочетанной анестезии ксеноном и блокады периферических нервов стадия D2 по шкале Kugler (доля δ-ритма более 50 %) достигается при концентрации ксенона 55 % в группе без использования наркотических анальгетиков и при концентрации 40 % в случае болюсного введения фентанила. Ослабление силы связи δ-ритма и BIS в группе 2 и отсутствие достоверной разницы снижения BIS говорит о возможности менее точного определения уровня угнетения сознания BIS при моноанестезии ксеноном.

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“…Xenon is an inert gas that has been used in clinical practice as an anesthetic for more than 70 years ( Maze and Laitio, 2020 ). Moreover, the safety of xenon has been verified through long-term clinical applications ( Kulikov et al, 2019 ). In recent years, studies have demonstrated the excellent neuroprotective effects of xenon at sub-anesthetic doses ( Metaxa et al, 2014 ; Yang et al, 2014 ; Lavaur et al, 2016a ).…”

Section: Introductionmentioning

confidence: 99%

Attenuated iron stress and oxidative stress may participate in anti-seizure and neuroprotective roles of xenon in pentylenetetrazole-induced epileptogenesis

Zhang

Cheng

Zhai

et al. 2022

Front. Cell. Neurosci.

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The previous studies have demonstrated the excellent neuroprotective effects of xenon. In this study, we verified the anti-seizure and neuroprotective roles of xenon in epileptogenesis and evaluated the involvement of oxidative stress and iron accumulation in the protective roles of xenon. Epileptogenesis was induced by pentylenetetrazole (PTZ) treatment in Sprague-Dawley rats. During epileptogenesis, we found increased levels of iron and oxidative stress accompanied by elevated levels of divalent metal transporter protein 1 and iron regulatory protein 1, which are closely associated with iron accumulation. Meanwhile, the levels of autophagy and mitophagy increased, alongside significant neuronal damage and cognitive deficits. Xenon treatment reversed these effects: oxidative stress and iron stress were reduced, neuronal injury and seizure severity were attenuated, and learning and memory deficits were improved. Thus, our results confirmed the neuroprotective and anti-seizure effects of xenon treatment in PTZ-induced epileptogenesis. The reduction in oxidative and iron stress may be the main mechanisms underlying xenon treatment. Thus, this study provides a potential intervention strategy for epileptogenesis.

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Xenon anesthesia for awake craniotomy: safety and efficacy

Cited by 17 publications

References 49 publications

Comparison of the Asleep-Awake-Asleep Technique and Monitored Anesthesia Care During Awake Craniotomy: A Systematic Review and Meta-analysis

Comparison of the Asleep-Awake-Asleep Technique and Monitored Anesthesia Care During Awake Craniotomy: A Systematic Review and Meta-analysis

Assessment of xenon-induced depth of hypnosis according to Kugler’s scale in elderly and senile patients undergoing knee replacement surgery: a prospective open-label cohort study

Attenuated iron stress and oxidative stress may participate in anti-seizure and neuroprotective roles of xenon in pentylenetetrazole-induced epileptogenesis

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