Highlights
- •50% inhaled Xenon rapidly depresses background aEEG voltage to a steady level in newborn pigs.
- •Stable hemodynamics are maintained during 24 h Xenon ventilation in newborn pigs.
- •The predictive value of aEEG voltage recovery will be influenced by Xenon ventilation.
Abstract
Background
Changes in electroencephalography (EEG) voltage range are used to monitor the depth
of anaesthesia, as well as predict outcome after hypoxia-ischaemia in neonates. Xenon
is being investigated as a potential neuroprotectant after hypoxic-ischaemic brain
injury, but the effect of Xenon on EEG parameters in children or neonates is not known.
This study aimed to examine the effect of 50% inhaled Xenon on background amplitude-integrated
EEG (aEEG) activity in sedated healthy newborn pigs.
Methods
Five healthy newborn pigs, receiving intravenous fentanyl sedation, were ventilated
for 24 h with 50%Xenon, 30%O2 and 20%N2 at normothermia. The upper and lower voltage-range of the aEEG was continuously monitored
together with cardiovascular parameters throughout a 1 h baseline period with fentanyl sedation only, followed by 24 h of Xenon administration.
Results
The median (IQR) upper and lower aEEG voltage during 1 h baseline was 48.0 μV (46.0–50.0) and 25.0 μV (23.0–26.0), respectively. The median (IQR) aEEG upper and lower voltage ranges
were significantly depressed to 21.5 μV (20.0–26.5) and 12.0 μV (12.0–16.5) from 10 min after the onset of 50% Xenon administration (p = 0.002). After the initial Xenon induced depression in background aEEG voltage, no
further aEEG changes were seen over the following 24 h of ventilation with 50% xenon under fentanyl sedation. Mean arterial blood pressure
and heart rate remained stable.
Conclusion
Mean arterial blood pressure and heart rate were not significantly influenced by 24 h Xenon ventilation. 50% Xenon rapidly depresses background aEEG voltage to a steady
~50% lower level in sedated healthy newborn pigs. Therefore, care must be taken when
interpreting the background voltage in neonates also receiving Xenon.
Abbreviations:
aEEG (amplitude-integrated electroencephalography), EEG (electroencephalography), HT (therapeutic hypothermia), i.v. (intravenous), MAC (minimal alveolar concentration), N2 (nitrogen), NMDA (N-methyl-d-aspartate), O2 (oxygen), Trec (Rectal temperature), Xe (Xenon)Keywords
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References
- Anesthesia and analgesia in the NICU.Clin. Perinatol. 2012; 39: 239-254
- Performance of entropy and Bispectral Index as measures of anaesthesia effect in children of different ages.Br. J. Anaesth. 2005; 95: 674-679
- Bispectral analysis during procedural sedation in the pediatric emergency department.Pediatr. Emerg. Care. 2012; 28: 1003-1008
- An observational study exploring amplitude-integrated electroencephalogram and spectral edge frequency during paediatric anaesthesia.Anaesth. Intensive Care. 2012; 40: 275-284
- Bispectral index and lower margin amplitude of the amplitude-integrated electroencephalogram in neonates.Neonatology. 2015; 107: 34-41
- Amplitude-integrated EEG and the newborn infant.Curr. Pediatr. Rev. 2014; 10: 11-15
- Acute neonatal encephalopathy and seizures recurrence: a combined aEEG/EEG study.Seizure. 2013; 22: 703-707
- Effect of hypothermia on amplitude-integrated electroencephalogram in infants with asphyxia.Pediatrics. 2010; 126: e131-e139
- Predictive value of early continuous amplitude integrated EEG recordings on outcome after severe birth asphyxia in full term infants.Arch. Dis. Child. Fetal Neonatal Ed. 1995; 72: F34-F38
- How does xenon produce anaesthesia?.Nature. 1998; 396: 324
- Neither xenon nor fentanyl induces neuroapoptosis in the newborn pig brain.Anesthesiology. 2013; 119: 345-357
- Xenon ventilation during therapeutic hypothermia in neonatal encephalopathy: a feasibility study.Pediatrics. 2014; 133: 809-818
- Xenon and hypothermia combine additively, offering long-term functional and histopathologic neuroprotection after neonatal hypoxia/ischemia.Stroke. 2008; 39: 1307-1313
- Xenon enhances hypothermic neuroprotection in asphyxiated newborn pigs.Ann. Neurol. 2010; 68: 330-341
- Xenon augmented hypothermia reduces early lactate/N-acetylaspartate and cell death in perinatal asphyxia.Ann. Neurol. 2011; 70: 133-150
- Effect of stable xenon on regional cerebral blood flow and the electroencephalogram in normal volunteers.Stroke. 1991; 22: 182-189
- aepEX monitor for the measurement of hypnotic depth in patients undergoing balanced xenon anaesthesia.Br. J. Anaesth. 2012; 108: 80-88
- Assessing the depth of hypnosis of xenon anaesthesia with the EEG.Biomed. Tech. (Berl). 2010; 55: 77-82
- Bispectral index monitoring during balanced xenon or sevoflurane anaesthesia in elderly patients.Eur. J. Anaesthesiol. 2010; 27: 906-911
- Evaluation of bispectral index and auditory evoked potentials for hypnotic depth monitoring during balanced xenon anaesthesia compared with sevoflurane.Br. J. Anaesth. 2010; 105: 334-341
- Minimum alveolar concentration-awake of Xenon alone and in combination with isoflurane or sevoflurane.Anesthesiology. 2000; 93: 1188-1193
- Minimum alveolar concentration (MAC) for sevoflurane and xenon at normothermia and hypothermia in newborn pigs.Acta Anaesthesiol. Scand. 2013; 57: 646-653
- Observations on the anesthetic effect of the combination of xenon and halothane.Anesthesiology. 1969; 31: 305-309
- Anticonvulsant effect of xenon on neonatal asphyxial seizures.Arch. Dis. Child. Fetal Neonatal Ed. 2013; 98: F437-F439
- Moderate hypothermia within 6 h of birth plus inhaled xenon versus moderate hypothermia alone after birth asphyxia (TOBY-Xe): a proof-of-concept, open-label, randomised controlled trial.Lancet Neurol. 2015;
- A closed-circuit neonatal xenon delivery system: a technical and practical neuroprotection feasibility study in newborn pigs.Anesth. Analg. 2009; 109: 451-460
- Assessment of neonatal encephalopathy by amplitude-integrated electroencephalography.Pediatrics. 1999; 103: 1263-1271
- Rang & Dale's pharmacology.sixth ed. 2007: 503 (Chapter 41)
- An assessment of the effects of general anesthetics on developing brain structure and neurocognitive function.Anesth. Analg. 2008; 106: 1681-1707
- The young: neuroapoptosis induced by anesthetics and what to do about it.Anesth. Analg. 2010; 110: 442-448
- Toxic and protective effects of inhaled anaesthetics on the developing animal brain: systematic review and update of recent experimental work.Eur. J. Anaesthesiol. 2014; 31: 669-677
- Xenon offers stable haemodynamics independent of induced hypothermia after hypoxia-ischaemia in newborn pigs.Intensive Care Med. 2012; 38: 316-323
- Electro-encephalographic and blood gas observations in human surgical patients during xenon anesthesia.Anesthesiology. 1955; 16: 312-319
- Sleep drives metabolite clearance from the adult brain.Science. 2013; 342: 373-377
- Tolerance and dependence in neonates sedated with fentanyl during extracorporeal membrane oxygenation.Anesthesiology. 1990; 73: 1136-1140
- Effect of sedation and analgesia on postoperative amplitude-integrated EEG in newborn cardiac patients.Pediatr. Res. 2010; 67: 650-655
Article Info
Publication History
Published online: February 21, 2016
Accepted:
February 19,
2016
Received in revised form:
January 25,
2016
Received:
November 27,
2015
Footnotes
☆Sources of funding: This study was supported by Sport Aiding Medical Research for Kids (SPARKS (UK)), the Laerdal Foundation for Acute Medicine (Norway) and the Norwegian Research Council .
Identification
Copyright
© 2016 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
