1. Recent advances – 1 – MGMC
Dr. S. Parthasarathy
MD., DA., DNB, MD (Acu), Dip. Diab. DCA,
Dip. Software statistics,
PhD(physiology)

2. Xenon
Xenon derives its name from the Greek for `stranger' because of its rarity, representing ppm.
It is odorless, nonpungent, nontoxic, nonexplosive, environmentally friendly

3. A bit history
Discovered in 1898, it is manufactured by fractional distillation of air and is used commercially for lasers, high intensity lamps, ash bulbs, jet propellant in the aerospace industry, X-ray tubes, and in medicine.
Anesthetic practice for fifty years …

4. Xenon potently inhibits N-methyl-D-aspartate (NMDA) receptors non-competitively,
with little effect on GABA A receptors or non-NMDA glutamatergic receptors
Xenon has been reported to competitively inhibit 5HT3 A receptor
MAC value of 63 % %

5. Blood gas partition coefficient of 0.15 %
Fast in and out
Better than nitrous and desflurane
Ideal in opd procedures

6. CVS Hemodynamic stable No change in HR –
-decreased cortisol and catecholamines
Less need for fentanyl
Normal LV function assessed by TEE

7. CNS xenon increases CBF;
despite changes in CBF, reactivity to carbon dioxide is maintained , changes in blood flow can be reversed with hyperventilation
CMRO2 may not change
Analgesic
in contrast to other anaesthetics that require anaesthetic or supra‐anaesthetic doses to act as a neuroprotectant, xenon may be effective at more clinically acceptable concentrations

8. Greatness xenon has no mutagenic or carcinogenic properties.
No embryotoxic or teratogenic changes were found in pregnant women
No malignant hyperthermia
No damage to liver and kidney profiles
No damage to coagulation and platelet profiles

9. Then what's the problem The cost will work out 350 US $ for a case
Recycling may decrease
xenon appears to be environmentally safe.

10. Go next

11. Summary Stranger B/G 0.15 MAC - 71% Fastest recovery Cardiostable
Neuroprotective
Analgesia
Cost
Recycling

12. Sugammadex

13. Sugammadex
Anton Bom working for a cyclodextrin to solubilize rocuronium
Found it engulfing
Possibly tested in vivo
Reversal agent for future ??
Su – sugar gammadex – gamma cyclodextrin

14. Cyclodextrin molecule with water solubility and lipid engulfment

15. Sugammadex exerts its action by forming very tight complexes in 1:1 ratio with steroidal neuromuscular blocking drugs (rocuronium > vecuronium >> pancuronium) and functions as an irreversible chelating agent.
Bound suggamadex eliminated via the kidney

16. Aminosteroid only Sugammadex has no effect on acetylcholinesterase.
This eliminates the need for anticholinergic drugs, thus avoiding their undesirable side effects.
It is ineffective against succinylcholine and benzylisoquinolinium neuromuscular blockers, such as mivacurium, atracurium and cisatracurium

17. Sugammadex at doses of 2. 0- 4
Sugammadex at doses of mg /kg has been shown to safely reverse moderate NMB induced by rocuronium in a dose dependent manner in surgical patient
0.5 Vs 7.5 minutes
Even after rocuronium infusions
16 mg /kg – CICV situations with rocuronium

18. Formulation
The drug is available in IV formulation only; vials of 200 mg (2 ml) or 500 mg (5 ml) and is for non-refrigerated storage
Old age pediatrics – ok
But less than 2 years – ??

19. Side effects
hypotension, coughing, movement, vomiting, dry mouth, parosmia, a sensation of changed temperature
Paresthesia of the arm of intravenous administration
Endogenous steroidal hormones and steroidal drugs lack the quaternary nitrogen which rocuronium and vecuronium possess- no clinical impact

20. should be avoided in pregnant and lactating patients till studies are conducted and its safety is proven.
Kidney failure – go for cis atracurium rather than sugammadex
Around 4000 rupees

21. After reversal, surgeon tells , I have forgotten to keep drainage tube
Yes we can give back rocuronium
But better use nonsteroidal drugs

22. Tips Relaxant use during skin closure – ok CICV – best
No recurarization, but ---
Knowledge of TOF count and dosage adjustment of sugammadex needed
Rocuronium-sugammadex complex can be displaced by fusidic acid or high doses of flucloxacillin

23. Summary Gamma cyclo dextrin Water and fat soluble
Encapsulation of amino steroids –
but endo steroids
Rapid reversal without anticholinesterase side effects , CICV !!
2 – 16 mg / kg --Recurarization ?? side effects ?
Re injection ? Kidney failure , pregnancy ,
less than 2 years ?