Effect of Xenon on elevated intracranial pressure as compared with nitrous oxide and total intravenous anesthesia in pigs.
BACKGROUND
Xenon in low concentrations has been investigated in neuroradiology to measure cerebral blood flow (CBF). Several reports have suggested that inhalation of Xenon might increase intracranial pressure (ICP) by increasing the cerebral blood flow and blood volume, raising concerns about using Xenon as an anesthetic in higher concentrations for head-injured patients. A porcine study is presented in which the effects of inhaled 75% Xenon on elevated ICP, cerebral perfusion pressure and the efficacy of hyperventilation for ICP treatment were compared with nitrous oxide anesthesia and total intravenous anesthesia (TIVA).


METHODS
Twenty-one pentobarbital-anesthetized pigs (age: 12-16 weeks) were randomly assigned to three groups to receive either 4 h of Xenon-oxygen ventilation, nitrous oxide-oxygen ventilation or air-oxygen (75%/25%) ventilation, respectively. After instrumentation for parenchymal ICP measurement and ICP manipulation, an epidurally placed 6-F balloon catheter was inflated until a target ICP of 20 mmHg was achieved. After 4 h of anesthesia hyper- and hypoventilation maneuvers were performed and consecutive ICP and CBF changes were investigated.


RESULTS
Intracranial pressure and CBF increased significantly in the nitrous oxide group as compared with the controls. There was no increase of ICP or CBF in the Xenon or control group. Intracranial pressure changed in all three groups corresponding to hyper- and hypoventilation.


CONCLUSIONS
During Xenon anesthesia, elevated ICP is not increased further and is partially reversible by hyperventilation. Our study suggests that inhalation of 75% Xenon seems not to be contraindicated in patients with elevated ICP.
Schmidt
M
M
Department Cardiac Anesthesia, University of Ulm, Ulm, Germany. michael.schmidt@medizin.uni-ulm.de
Marx
T
T
Armbruster
S
S
Reinelt
H
H
Schirmer
U
U
D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D000818:Animals; D002302:Cardiac Output / Q000187:drug effects; D004569:Electroencephalography / Q000187:drug effects; D006993:Hypnotics and Sedatives / Q000494:pharmacology; D007427:Intracranial Pressure / Q000187:drug effects*; D009609:Nitrous Oxide / Q000494:pharmacology*; D010424:Pentobarbital / Q000494:pharmacology; D009418:S100 Proteins / Q000378:metabolism; D013552:Swine; D014978:Xenon / Q000494:pharmacology*
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D009418:S100 Proteins; D014978:Xenon; D010424:Pentobarbital; D009609:Nitrous Oxide