Inert gases “penetrated” all leading fields of science and technology and only in the last decade of the twentieth century began to be used in medicine. The first report on the narcotic properties of xenon belongs to the Russian scientist N.V. Lazarev, who predicted in 1941 and experimentally confirmed his prediction in 1946. In the same year, American scientists confirmed the results obtained by N.V. Lazarev in an experiment on mice.
After 5 years, He was used in anesthesiological practice in one of the clinics in America (S. Cullen, E, Gross, 1951). In 1962, in Russia, xenon anesthesia in humans was used by Prof. V. P. Smolnikov. However, xenon anesthesia truly became a significant event in medical science at the turn of the 21st century, when interest in xenon sharply increased not only among anesthesiologists, but also among representatives of large companies and firms involved in the production of gases and medical products. Scientific research on Xe was especially intensified in the Netherlands, then in Russia, Germany, Italy and Japan. This is evidenced by reports on xenon for the period 1994-2005. year at international Congresses on anesthesiology, the Internet is filled. And this is no coincidence. This is not a formal tribute to the latest fashionable fad in science. These studies are aimed at the serious prospect and development of environmentally friendly and safe anesthesia for the 21st century.
Anesthesiological activity is now closely connected with the industrial production of new anesthetics, many of which are potentially toxic and environmentally hazardous. The production of nitrous oxide and other nitrogenous compounds alone accounts for more than 15% of all industrial pollution in the world. According to international protocols (Kyoto, 1997), the production of anesthetics such as halothane, pentran, enflurane, isoflurane, containing carbon, chlorine and fluorine radicals should be suspended by 2030.
Thus, today anesthetic safety is becoming part of a global environmental problem and the development of environmentally friendly anesthesia using the gas anesthetic Xe, created by nature itself, is very relevant and timely. It is necessary to take into account the indisputable fact that the anesthesiological community of the world has recognized xenon as an anesthetic of the 21st century, close to ideal.
How does intravenous sedation differ from inhalational sedation?
- intravenous sedation – deeper, in which individually selected sedatives are administered intravenously, and the patient is immersed in a state of sleep (or half-asleep). Read about this type of pain relief in a separate article.
- inhalation sedation - the patient inhales a certain drug, but remains conscious, that is, reflexes are dulled, complete relaxation occurs and anxiety is relieved.
Intravenous sedation is used as an independent means of pain relief. But inhalation xenon often precedes other types of anesthesia. Since it does not have an analgesic effect, but is aimed at reducing the level of anxiety, local anesthesia (infiltration or conduction anesthesia) is additionally used, and less often, intravenous sedation. In the second case, xenon therapy is required for general stress relief before the upcoming treatment.
What does xenon therapy work with?
Xenon is part of air. It comes to us from the bowels of the earth - it comes out of the soil onto the surface of the planet and hovers in the atmosphere. Thanks to special technologies that take it out of the air or when xenon gets into mixtures of gases, it is separated and purified, and then used in medicine. Its use has no restrictions, except for legislative ones - it cannot be used during pregnancy and for children under 18 years of age. For minors, the procedure is allowed only for surgical interventions.
Photo: Valeria Barinova, “Championship”
What treatment can be done under xenon sedation?
- dental treatment: removal of caries, treatment of root canals for pulpitis or periodontitis, removal of cysts and granulomas,
- any surgical operations,
- any treatment or prosthetics in case of panic among doctors,
- periodontal treatment within the framework of Smile Recovery complexes,
- dental implantation, both single and multiple – in this case, a higher concentration of the active substance is used, which allows for a more prolonged effect of the anesthetic, and also, if necessary, to put the patient into a medicated sleep.
We know how to treat without pain!
- complete relaxation: you will have no fear of the dentist, pain or treatment,
- complete relief of pain,
- fast recovery,
- pleasant rehabilitation after, since xenon triggers metabolic processes in the body,
- you are relaxed, which means the doctor does his job without being distracted by your emotions.
With us you will stop being afraid of dentists! Individual selection of drugs, the most modern equipment and certified doctors who professionally work with all types of anesthesia.
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Advantages of xenon
- Does not harm the body;
- Helps relieve pain, because... is an anesthetic of natural origin;
- It does not cloud consciousness, however, it relieves pain;
- Not accompanied by addiction;
- Relieves pain and makes the treatment process pleasant for patients with an allergic reaction to anesthetics;
- Combined with other medications;
- Has antidepressant properties.
How does xenon sedation work?
All manifestations occur within the first five minutes after gas supply. If the patient experiences discomfort, the procedure can be interrupted immediately. This is a great advantage of inhalation sedation - the use of this method can be limited to a few minutes, which allows treatment of only 1-2 teeth.
Smile-at-Once clinics have installed specialized equipment for the inhalation supply of medical xenon “XeMed”. The procedure is carried out under the constant supervision of a doctor who has been trained to operate the appropriate equipment and has the necessary certificates and qualifications.
The doctor puts a mask on the patient and holds it on his face. Xenon is supplied for 5-6 minutes at the beginning of treatment and for 10 minutes towards the end.
How will you feel during the procedure?
At the initial stage, numbness of the skin, heaviness in the legs and throughout the body, changes in the perception of sound signals, dizziness, and loss of coordination may occur, but clarity of consciousness is maintained. Then comes a feeling of complete relaxation of the body, absence of painful irritation, and easy immersion in sleep. This entire range of sensations manifests itself in the first 5 minutes of exposure to the drug.
Xenon has an intoxicating effect and literally immerses a person in a feeling of euphoria. Therefore, some people (especially children) who are not familiar with this feeling may experience fear or even panic. But you need to understand that the effect of xenon can be stopped at any time, or the concentration can be increased so that the patient almost completely falls asleep.
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Xenon is already widely used in medicine. In addition to its well-known use as an anesthetic for surgical operations, this gas is also used in brain examinations. Xenon strongly absorbs x-rays and helps locate lesions. However, it is completely harmless. Therefore, xenon is used for fluoroscopic examinations of the brain. The radioactive isotope of element No. 54, xenon-133, is used to study the functional activity of the lungs and heart. Research is being done to use xenon as a medicine.
Xenon in the treatment of consequences of brain injuries.
Experiments have shown that the inert gas xenon helps reduce the effects of strokes, brain injuries and other lesions that cause death of nerve tissue. As biophysicists from Imperial College London discovered, xenon can block the functioning of receptors that control nerve cells and prevent their death. The specific effect of xenon was discovered during testing of new anesthetic agents. Imperial College professor Mervyn Maze, who works as an anesthesiologist at Chelsea and Westminster Hospital (London), believes that this will help create effective means to combat damage to the nervous system. Although this method does not allow the restoration of nerve cells, it will preserve them and create conditions for subsequent treatment. Professor Nick Franks, who discovered this effect of xenon, believes that this inert gas is a good candidate for the role of a drug, since it is part of our natural environment and is not toxic.
Xenon in the treatment of drug addiction
The use of xenon therapy inhalations can reduce the period of relief from withdrawal syndrome (painful condition that appears when using drugs and alcohol) by 1.5 - 2 times compared to currently used methods. The percentage of people who do not use drugs after completing a full course of xenon therapy (including rehabilitation) and under observation for one year was at least 50% (based on about 60 patients). The patient becomes a practically healthy person. The use of xenon in complex therapy of opium addiction allows one to successfully overcome the negative and painful manifestations of withdrawal syndrome, while: - reducing the manifestations of autonomic disorders; - relieves pain; — normalizes sleep in patients, even in monotherapy or with minimal pharmacological load; — reduces the time of withdrawal syndrome relief by 1.5-2 times, significantly reduces the pharmacological load. The use of this method makes it possible to effectively treat not only withdrawal syndrome, but also the post-withdrawal state of opium addiction, especially in patients with liver dysfunction and intolerance to specific pharmaceuticals used in the treatment of drug addiction.
The course of treatment includes:
— withdrawal symptoms relief 5 – 7 days; - full course of treatment with rehabilitation (repeated use of xenon using modern methods of psychotherapy, physiotherapy and pharmacotherapy) - 2 months.
Indications for the use of the method of therapeutic xenon anesthesia are:
— presence of motivation for treatment; — presence of symptoms of withdrawal syndrome in the patient; — presence of contraindications to other methods of pharmacotherapy. There are currently no contraindications for this treatment method.
Xenon in anesthesiology
Medical scientists have long been looking for the optimal anesthetic option to conduct a complete and safe anesthesia. The first report on the narcotic properties of xenon belongs to the Russian scientist N.V. Lazarev. In 1946, he experimentally confirmed the presence of narcotic properties in xenon. On November 10, 2004, 58 years after Lazarev’s message, a demonstration operation for anesthesiologists in Russia took place at the Tomsk Oncology Research Institute. The country's leading anesthesiologist Nikolai Burov and his Tomsk colleagues demonstrated how xenon gas can be used instead of conventional anesthesia. There are an unusually large number of doctors in the operating room of the Tomsk Oncology Research Institute. They came to study in Tomsk from different regions of Russia. There is a woman on the operating table. Oncologist surgeons perform breast removal. The operation, it would seem, is one of the few, only anesthesia is used using xenon. It was academician Nikolai Burov who became the founder of xenon anesthesia. It took 8 years for the gas to reach the operating rooms. The development of xenon anesthesia has long been hampered by shortages, high costs, and the lack of directive pharmacopoeial documents. But even the general anesthesia of chloroform or nitrous oxide with ether, recognized at the beginning of the 19th century, was poorly tolerated by patients. However, recently German scientists from the University of Ulm managed to create a device that allows the gas to be reused. The spent anesthetic mixture is pumped under pressure into a vessel, where it is cooled to zero degrees, explains Thomas Arzt. In this case, oxygen and nitrogen remain in the form of gases, and xenon decreases, and it is easy to separate it from the mixture and use it in a second round. In addition to being safe for the environment, doctors note that xenon as an anesthetic has almost no side effects (but only in adults) and shortens the period of time patients spend in intensive care after major operations, including heart surgery. In addition, xenon does not harm the health of medical staff as much as other gases used for anesthesia. Currently, anesthesiologists have almost abandoned explosive and toxic substances such as ether and cyclopropane. Instead, halogenated hydrocarbons are used, which nevertheless have a negative effect on the air in the operating room, and, when released into the atmosphere, cause a greenhouse effect and destroy the ozone layer. In Germany alone, 40 million liters of halogenated hydrocarbons are released into the environment every year during surgical operations. It is 105 years since the discovery of the inert gas xenon (1898) and 50 years since its first clinical use as an anesthetic (1951). Limited reserves of xenon (Xe) in the world and the high cost of gas were in past years the main reasons for its slow spread in clinical anesthesiology. An equally important task remains the task of actually reducing the cost of medical xenon, the price of which now reaches six dollars. Even with careful consumption of this gas, a two-hour anesthesia will require 15-20 liters of xenon ($75 - $120). However, the rapid growth of industrial production and the scientific and technological process of the second half of the twentieth century led to the fact that it was no longer the shortage and high cost of xenon that began to restrain the clinical use of xenon, but the lack of a regulatory framework for its widespread use. This issue has not yet been resolved in all countries, with the exception of Russia. Thus, Russia has become the first country in the world to successfully lay the regulatory framework for xenon anesthesia and create real conditions for wider clinical use of this excellent anesthetic. The annual production of xenon in the country has been increased and sufficient reserves of this gas have been created. The production of anesthesia and gas analytical equipment for xenon anesthesia is being successfully established, a curriculum and a thematic improvement program for xenon-saving anesthesia technology have been drawn up and approved at the Department of Anesthesiology and Reanimatology of the Russian Medical Academy of Postgraduate Education. The world's first monograph “Xenon in non-esthesiology” was published. M.Puls.2000. With the use of xenon in clinical practice, a new page is opening in the history of domestic anesthesiology. Xenon anesthesia has a potential reserve for cost reduction through the use of a recycling method (gas exhaled from the anesthesia machine is recycled by adsorption by a special device (adsorber unit), which, after filling, undergoes temperature desorption; purified xenon is returned to the consumer for reuse, which sharply reduces the cost and deficiency of xenon anesthesia), which is not the case with the listed anesthetics. In addition, nitrous oxides and carbon radicals when using halogen-containing liquid anesthetics are dispersed into the environment and pose an environmental hazard.
Indications for use
Xenon can be used as an anesthetic agent for various surgical operations, painful manipulations, relieving pain attacks and treating pain syndromes. It is used in a mask or endotracheal version, both in the form of mononarcosis and in the form of combined anesthesia in combination with various intravenous sedatives, narcotic and non-narcotic analgesics, neuroplegics, tranquilizers, gangliolytics and other agents. In practice, xenon can be used as an anesthetic in the same situations as nitrous oxide: in general surgery, urology, traumatology, orthopedics, emergency surgery, especially in patients with concomitant diseases of the cardiovascular system who are at high risk. in neurosurgery of the central and peripheral nervous system, especially when using microsurgical techniques when verbal contact with the patient is necessary to differentiate sensory and motor bundles during operations on nerve trunks in pediatric surgery in mask and endotracheal options in obstetrics and operative gynecology (operative delivery, abortion, dilated operations in gynecology, diagnostic studies, pain relief during childbirth) for painful manipulations, dressings, biopsies, treatment of burn surfaces, for therapeutic purposes in relieving a painful attack (for traumatic shock, angina pectoris, myocardial infarction, renal and hepatic colic), as well as for motor aphasia, treatment of dysarthria, emotional stress relief and other functional neurological disorders. Xenon can be used both in the form of mononarcosis while maintaining spontaneous breathing, and in combination with various intravenous anesthetics. There are no contraindications to xenon; however, the use of xenon as an anesthetic is possible only with certified equipment and a specialist anesthesiologist-resuscitator who has undergone special training in “xenon-saving anesthesia technology”
Pharmacodynamics. Pharmacokinetics of xenon
Xenon is a gaseous agent for inhalation anesthesia. In the ratio with oxygen (60:40,70:30,80:20) it has a strong analgesic and anesthetic effect. After 5-6 breaths of narcotic concentration of xenon, a stage of peripheral paresthesia and hypoalgesia occurs, a feeling of numbness and heaviness in the legs, gradually rising from bottom to top, affecting the skin of the abdomen, chest, neck, and head. At 2-3 minutes, a stage of euphoria and psychomotor activity appears, which quickly gives way to the stage of complete analgesia and partial amnesia, then consciousness turns off and the anesthesia stage begins, corresponding to the first surgical stage of ether anesthesia (according to Hydel). At this stage, under conditions of mononarcosis and while maintaining spontaneous breathing, it is possible to perform surgical operations without the use of narcotic analgesics. Hemodynamic and gas exchange parameters are stable during anesthesia. Analgesia occurs when 30-40% of the mixture is inhaled. Consciousness is lost when inhaling 65-70% of the mixture with O2. Myoplegia is well expressed. Recovery from anesthesia is quick. 2-3 minutes after turning off the gas, the patient returns to full consciousness and pleasant subjective sensations. Xenon is 1.5-2 times stronger than nitrous oxide. Its MAC, according to some data, is 50-62%, according to others – 71%. Nitrous oxide has 105%. The analgesic and hypnotic effect of xenon is directly proportional to its partial pressure in the blood. Due to its low solubility, its alveolar concentration very quickly levels out with the arterial and cerebral concentrations, which leads to rapid induction of anesthesia and loss of consciousness. After turning off xenon, after 4-5 minutes it is released from the body through the lungs in a volume of 95%. Its residual concentration quickly decreases, and then Xe is gradually washed out from the body’s fluids, while maintaining longer postoperative analgesia, which indicates another important advantage of xenon over nitrous oxide and other anesthetics.
The effect of xenon on the body
When performing xenon monoanesthesia in a mask version in patients (hernia repairs, venectomies), 4 stages of xenon monoanesthesia were established: The first stage is paresthesia and hypoalgesia. Appears with the first 5-6 breaths of the Xe:O2 mixture (70:30) and increases over 1-2 minutes. It is characterized by the appearance of peripheral paresthesia, numbness of the skin, lethargy and weakness in the legs, a feeling of pressure and diffuse heaviness throughout the body. There is noise in the ears and a feeling of squeezing of the head. There is a feeling of intoxication, loss of coordination, swaying, like in a boat. Consciousness remains clear, breathing is uniform, the skin is warm, dry, the pulse is slightly increased, and hypoalgesia increases. The pain threshold increases 2 times from the original one. The second stage is euphoria and psychomotor activity. The stage begins at 3 minutes against the background of already reduced pain and visceral sensitivity. There is a surge of joyful emotions and a feeling of bliss. Logorrhea arises, the desire to talk about your pleasant sensations. Suggestibility remains. Stiffness, lethargy, and dysarthria gradually increase. Muscle tone increases. Breathing deepens and becomes uneven. The skin is dry, warm, pink, the pulse is rapid. The pain threshold increases 3 times. The third stage is analgesia and partial amnesia. Appears at 4 minutes. Characterized by the appearance of severe analgesia. The pain threshold is not determined. The patient does not respond to painful stimuli. Consciousness is preserved, but memory lapses occur, visual images and absurd situations arise, lethargy increases, and (according to the subjects) a premonition of an imminent loss of consciousness appears. By reducing the concentration of Xe, it is possible to prolong the stage of analgesia and maintain verbal contact with the patient, which opens up wide possibilities for using xenon for therapeutic purposes, as well as for eliminating pain and performing operations when personal contact between the operating surgeon and the patient is necessary. The fourth stage is anesthesia (complete analgesia and amnesia). Comes at the 5th minute. Corresponds to level 1 of the surgical stage of ether anesthesia (according to Gidel). Consciousness is lost, pharyngeal and corneal reflexes disappear. The pupils narrow. Breathing is rhythmic. Muscle tone decreases, the jaw sinks. The pulse returns to normal. The skin is dry, pink, warm. The patient does not respond to surgical manipulation. The patient awakens after turning off Xe within 2 minutes, and after 4-5 minutes consciousness is restored in full, maintaining hypoalgesia for 12-30 minutes. No adverse reactions from xenon anesthesia were noted. Xenon does not significantly change the morphological composition and coaguology of blood compared to nitrous oxide. There is moderate leukocytosis, an increase in monocytes and band neutrophils without a statistically significant difference between anesthetics. With xenon anesthesia, the tendency to hypercoagulation remains. With nitrous oxide - to hypocoagulation. Xenon moderately increases cerebral blood flow, improves blood flow in the liver and kidneys, and creates vasoplegia, which provides it with good prospects in critical conditions in surgery, traumatology, and neurosurgery. Xenon in the maximum permissible concentration in the clinic and experiment does not affect carbohydrate, fat and protein metabolism, blood cholesterol and blood gases, enzyme composition of blood, LPO. Xenon fully justifies the established opinion about its “nobility” and chemical indifference in the body. Xenon does not exhibit toxicity in either acute or chronic experiments on small and large animals. It does not have a teratogenic or mutagenic effect, has no embryotoxic effect, is devoid of allergenicity and carcinogenicity, and has a moderate immunostimulating effect. Xenon is environmentally friendly and safe provided that low-flow anesthesia and a special adsorber are used to capture waste xenon. It is chemically inert, does not enter into any biochemical processes and is excreted from the body through the lungs unchanged. It does not provoke malignant hyperthermia. There is quite a lot of convincing evidence to consider xenon one of the best inhalational anesthetics. It largely satisfies the requirements for an “ideal inhalational anesthetic.” In practical terms, xenon should become the anesthetic of choice, the “golden reserve” for operations in patients with high anesthetic risk, in which the use of other alternative anesthetics is associated with danger.
Negative aspects of xenon anesthesia
1. One of the important negatives of xenon anesthesia remains its high cost compared to nitrous oxide. The use of a mask or endotracheal version of xenon anesthesia with conventional gas flow greatly simplifies the method of anesthesia, but is a “wasteful” technique. Xe consumption of more than 2 l/min leads to a sharp increase in the cost of anesthesia and this technique becomes economically unprofitable, since Xe consumption increases to 120 l/hour, which increases the cost of anesthesia ($600).
2. The use of xenon, like nitrous oxide, may be limited during operations on the heart, lungs, trachea and bronchi associated with pneumothorax, in which there is a need to use hyperoxic mixtures. It is also inappropriate to use xenon in conditions of a leaky breathing circuit (in dentistry, with reconstructive operations on the trachea and bronchi, with a mask version of anesthesia)
3..Xenon, like nitrous oxide, has a high diffusion ability and, according to the law of partial pressure differences, can fill closed cavities with an undesirable increase in their volume (intestinal cavity, abdominal cavity, air cysts, closed pneumothorax, intravascular air emboli, etc.)
4.. Due to the rapid elimination of xenon from the body after the end of anesthesia, it quickly fills the alveolar space and creates the phenomenon of “diffusion” hypoxia, similar in mechanism to the diffusion hypoxia that develops after anesthesia with nitrous oxide. To prevent this phenomenon, it is necessary to use auxiliary ventilation or stimulate the patient’s volitional efforts within 4-5 minutes after stopping the supply of Xe. This is especially necessary after the mask version of anesthesia. 5 Xenon anesthesia is economically and environmentally inappropriate to use when using semi-open or semi-closed circuits without the use of capture units. The accumulation of exhaled xenon in the air should not exceed the maximum permissible concentration = 0.005% as it can cause lethargy, drowsiness, and incoordination among the medical personnel of the operating unit.
The effectiveness of the technique used
According to summary statistics, more than 300 operations were performed under xenon anesthesia in general surgery, gynecology, and vascular surgery in Russia. Xenon anesthesia has been successfully used for heart surgery under artificial circulation. No complications were recorded. Xenon provides sufficient anesthetic protection and is easily controlled. Calculations have shown that after 2 years, with 3-fold recycling with an efficiency of 85%, the amount of xenon anesthesia can be increased by 8.7 times. Since more than 3 recycling cycles of the same batch of xenon can be carried out per year, the total number of operations under anesthesia using Xe can increase 10 times or more. Thus, minimal-flow xenon anesthesia in combination with recycling successfully solves the problem of reducing the cost of xenon and its scarcity. Under this condition, the total xenon reserves in Russia will increase. Xenon is the best alternative to nitrous oxide and will take its rightful place in modern anesthesiology. The introduction of xenon-saving anesthesia technology and the active modernization of the existing fleet of anesthesia equipment in Russia will create all the prerequisites for the introduction of xenon anesthesia into widespread clinical practice. With the development of xenon anesthesia, a new and most interesting page in modern anesthesiology opens.
Will there be pain during and after the procedure?
No, during the operation you will not feel any discomfort, because you are relaxed, and we additionally applied local anesthesia, which numbs the surgical area.
After the operation there will be slight discomfort - you will feel weak, perhaps slightly dizzy. But there will be no severe pain, even after removing all the teeth and installing a large number of implants. After the anesthesia wears off, the pain may increase, but your doctor will prescribe pain medications for you to take if necessary. These sensations will not be associated with the use of xenon, but with tissue injury in general.
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Who needs these procedures?
• office workers who are always under stress and do not move much; • athletes during the inter-training period after heavy physical exertion; • people after a long flight; • people with migraine; • people who have undergone surgery or are preparing for it.
First of all, xenon works with tension, as it is a strong relaxant, but it also affects some hormones. For example, cortisol and adrenaline. The procedure does not reduce them to critical levels. The doctor strictly monitors that the indicators are at the level of a healthy person.
However, therapy cannot be used in the short term before surgery, since a sharp jump in adrenaline is possible during anesthesia. As a result, you will need a little more anesthesia in order to feel the effects of pain relief and numbness. An experienced doctor will advise you to attend a xenon therapy procedure after or the day before surgery.
Panic attacks are always accompanied by a very violent vegetative reaction - sweaty palms, increased heart rate, a feeling of lack of air, panic. Xenon allows you to minimize all these changes. The next time a person has such an attack, only the psychological factor remains, and it is much easier to deal with it. Therefore, xenon works very well in complex therapy with psychiatrists.
Photo: Valeria Barinova, “Championship”
Is it somewhat safe?
- This procedure is completely safe for the body: xenon is inert, non-toxic and is completely eliminated through the lungs within 4 hours,
- there is a rapid restoration of consciousness - within 2-3 minutes after the end of the drug administration,
- pronounced analgesic effect, while the patient is conscious and can communicate with the doctor,
- There is practically no drug load on the heart, blood pressure remains normal,
- compatibility with any medications and anesthetics,
- ideal for both time-limited procedures (for example, treatment of one tooth) and long-term manipulations (for example, installation of a large number of dental implants).
In our clinics, treatment using xenon is carried out by professional doctors who have undergone appropriate training and are accredited. In addition, modern equipment is used for safe sedation. It is mandatory to diagnose the patient’s health condition and his individual characteristics in order to select the permissible dose of the drug. The operating rooms are equipped with a ventilator and a resuscitation kit, which are mandatory when carrying out such manipulations.
Physicochemical properties of xenon.
The inertness of Xe is due to the saturation of the outer electron shell, which is extremely closed and extremely strong. Xenon consists of monatomic molecules, has no odor or color, does not burn and does not support combustion, is not explosive, is slightly soluble in water and is very quickly excreted from the body through the lungs. As an inert gas, it is noble, does not undergo any biotransformation in the body, and does not enter into any chemical reactions. Slightly soluble in water, better soluble in fats. It is 4 times heavier than air and therefore requires non-standard rotameters. Its MAC is about 60% and it is almost 2 times stronger than nitrous oxide. High molecular weight and oil/water solubility coefficient of 20.0 and a number of other characteristics allowed prof. N.V. Lazarev to predict the narcotic properties of Xe.
The distribution coefficient of Xe (0.12) is the highest compared to other volatile anesthetics, therefore it has no equal in the controllability of anesthesia. He's induction is fast. (3–6 min). Recovery from anesthesia is much faster and awakening occurs within 2 minutes with a wonderful subjective feeling, like after a pleasant sleep.
The mechanism of anesthesia remains unclear. Of theoretical interest is the ability of Xe to form Xe(H2O)6 crystal hydrates with endogenous water molecules. The latter belong to clathrate compounds, where Xe atoms (guests) are held by water molecules by van der Waals forces. This provided a theoretical basis for the creation of the molecular theory of anesthesia, expressed by Pauling and Miller in 1961, that the hydrophobic part of the protein molecule that is part of neuroglia under the influence of Xe can change the electrical potential of the neuron membrane. However, the chemistry of clathrates in biology is making only tentative steps.
However, the Mayer-Overton lipoid theory has not lost its significance, since in relation to He. Indeed, xenon, dissolving in fats, is capable of changing the state of aggregation of phospholipids, as the main component of the cell membrane and synaptic link, and reversibly disrupts the process of nerve impulse transmission. The first exposure to xenon, even in low concentrations, occurs, judging by the anesthesia clinic, in the first relay station - the gelatinous substance in the Rexed plates of the lateral horns of the spinal cord (cotton legs), then sequentially in other parts of the ascending pain conduction system.
According to recent studies, Xe primarily inhibits NMDA receptors (N-methylD-aspartat) of the central and peripheral nervous structures of the conduction system and, to a lesser extent, acts on GABA receptors, which significantly reduces the diagnostic value of the BIS spectral index as a tool for monitoring the adequacy of the depth of anesthesia. Thus, the inert gas xenon acts as a kind of key to unlocking the secrets of anesthesia.
What patients say about xenon treatment
According to our patients, surgery under sedation is completely unnoticed. I fell asleep and woke up, and the doctor had already finished all the manipulations. If the procedure takes place without medicinal sleep, then the patient remains conscious, sometimes “falls” into sleep, but responds to the doctor’s commands, answers questions and at the same time is in a relaxed state, not feeling anything that is happening in the oral cavity.
Margarita Borisovna, 65 years old
“I was very worried how everything would go, whether it would hurt. I was offered sedation - I slept for 2 hours without feeling anything and tolerated everything very easily. After 3 days I already had new teeth, which turned out to be more beautiful than my own. And I still admire how you can do everything so quickly, so well and live a completely new life!”
- without fear and without pain
- peace of mind throughout the entire operation
- as safe as possible and even beneficial for the body
- under the full control of specialists
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2. Reasons for the slow introduction of xenon into medicine.
There are three main factors that have held back the development of xenon anesthesia. These are scarcity, high cost and lack of a regulatory framework.
Xenon deficiency
World production of pure xenon is relatively small. In total, about 6,000 m³ are produced worldwide. Even by medical standards, this is not much. With this amount of Xe, no more than 300,000 operations of 2 hours duration can be performed. If we move away from universal calculations and return to our Russian conditions, then in Russia and the CIS countries the average level of annual industrial production of pure xenon is about 1235 m³. The only source of industrial production of xenon today is ambient air. IN
1000 m³ of air contains 86 ml of Xe.
The main suppliers of raw materials (krypton-xenon concentrate) are large industrial centers of the metallurgical industry of Russia and Ukraine. Inert gases are by-products of air separation. However, “dirty” sources of their production may become depleted. Due to the increased demand for Xe, the world must think about alternative sources of its production. High cost of xenon
The second limiting factor of xenon anesthesia is the relatively high cost of Xe. Today the price has increased to $10. Prices change, as in any market. Our calculations showed that even with careful consumption of Xe (closed circuit conditions), 10–12 liters of gas will be required for 2 hours of anesthesia. ($100-120). This is a bit expensive for our Russian conditions and its cost does not delight the consumer. For this reason, there has already been a decline in the practical use of xenon in our country.
Regulatory framework
However, until recently, in economically developed Western countries, it was not the shortage and high cost of xenon that were the main obstacle to the introduction of xenon anesthesia, but the lack of regulations on the use of xenon as a new anesthetic agent. This issue was not resolved until 2007 in all countries except Russia.
In 1997-98, we carried out the entire complex of preclinical and clinical tests of xenon and by order of the Minister of Health of the Russian Federation dated October 8, 1999 No. 363, this inert gas was approved for medical use as an anesthetic. At the same time, instructions for the use of xenon, a Pharmacopoeial monograph and a Registration Certificate were approved, which Akela-N LLC received for the right to produce and sell medical Xe at the request of health care facilities.
Thus, until recently, the official manufacturer of xenon in Russia remained Akela-N LLC, which has a license to produce and sell medical xenon. The production base of this institution is located in Skhodnya, where unique equipment for the production of high-purity xenon is located
99.999% from krypton-xenon concentrate. Thus, thanks to our research, a regulatory framework was already created 10 years ago and Russia took a priority position in the world in the practical use of xenon. This is a huge achievement for our country.
How to prepare for treatment under inhalational sedation
Before implantation or dental treatment using sedation, unlike general anesthesia, no special preparation is required. The only restriction concerns food - 2-3 hours before the procedure you need to avoid consuming any foods, otherwise you may experience vomiting.
Possible contraindications are necessarily excluded. These include individual intolerance to the drug, bronchial asthma or epilepsy, acute diseases of the cardiovascular system, neuropsychiatric disorders, high intracranial pressure and acute immune disorders. The next stage is the obligatory informing of the patient about how the procedure is carried out and what sensations will arise.
Sedation in dentistry: cost of treatment
Complex dental implantation under xenon will cost from 15,000 rubles, dental treatment – from 5,000 rubles. Compared to general anesthesia, which will also help cope with fear and panic, xenon sedation is a more economical option. At the same time, the quality and safety of the drug have been time-tested and do not require lengthy preparation for the procedure and the presence of a professional team of anesthesiologists and resuscitators next to the patient. Only one accredited specialist is enough. And within 5 minutes after turning off the inhalation unit, the patient gains clarity of thinking and immediately enjoys a new smile.
