Protecting the Brain With Xenon Anesthesia for Neurosurgical Procedures

Xenon possesses some, but not all, of the clinical features of an ideal anesthetic agent. Besides well-known advantages of rapid awakening, stable hemodynamics and lack of biotransformation, preclinical data lead to the expectation of xenon's advantageous use for settings of acute ongoing brain injury; a single randomized clinical trial using an imaging biomarker for assessing brain injury corroborated xenon's preclinical efficacy in protecting the brain from further injury. In this review, we discuss the mechanisms and hence the putative applications of xenon for brain protection in neurosurgery. Although the expense of this rare monoatomic gas will likely prevent its widespread penetration into routine clinical neurosurgical practice, we draw attention to the theoretical benefits of xenon anesthesia over other anesthetic regimens for awake craniotomy and for neurosurgery in older, high-risk, and sicker patients. M.M. is a cofounder and Board Member of NeuroproteXeon, a spinout company formed by Imperial College, London on the basis of patents that were filed when he was employed at that institution. NeuroproteXeon's mission is to develop xenon for clinical use to prevent acute ongoing neurological injury. M.M. has an equity stake in NeuroproteXeon through (i) founder status, (ii) exercised stock options, and (iii) personal investment. M.M is neither an employee of NeuroproteXeon nor does he have an executive role in the company. A.R. declares no funding or conflict of interest to disclose. Address correspondence to: Mervyn Maze, MB, ChB, Department of Anesthesia and Perioperative Care University of California San Francisco, 1001 Potrero Avenue, P.O. Box 1363, San Francisco, CA 94143 (e-mail: mervyn.maze@ucsf.edu). Received June 2, 2017 Accepted December 31, 2017 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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