Effective and safe anesthesia is the especially important problem in pediatric anesthesiology. The authors present data on the relatively new drug xenon. Results of the investigations of both foreign and Russian scientists are cited. The mechanism of action of xenon and its effect on systemic and cerebral circulation and central nervous system, hemostasis, and other systems are demonstrated. The authors pay special attention to the factors responsible for the restricted use of the gas in general practice, indicate the peculiarities of its use in pediatric practice.

Effective and safe anesthesia is the especially important problem in pediatric anesthesiology. The authors present data on the relatively new drug — xenon. Results of the investigations of both foreign and Russian scientists are cited. The mechanism of action of xenon and its effect on systemic and cerebral circulation and central nervous system, hemostasis, and other systems are demonstrated. The authors pay special attention to the factors responsible for the restricted use of the gas in general practice, indicate the peculiarities of its use in pediatric practice.Key words: xenon, the mechanism of action, anesthesia, advantages, disadvantages, impact on the body, children.

Xenon have been used as an anesthetic in the Russian Federation for 11 years in anesthesia in adult patients. In April 2010, the permission of the Ministry of Health and Social Development for the clinical studies evaluating the efficacy and safety of medical xenon anesthesia in children based on the Institute of Emergency Children’s Surgery and Traumatology had been received. Xenon in pediatric anesthesiology is of a special interest because it has properties equivalent to an «ideal anesthetic». To assess its effectiveness in anesthesia in children 42 patients aged 1 to 18 years were included in the study. A comparative assessment of the adequacy of anesthesia with xenon and sevoflurane has been conducted. At different stages of the research in addition to clinical parameters the level of growth hormone and cortisol were measured. The study showed that anesthesia with xenon was different from sevoflurane by hemodynamic stability, and both have a high level of anesthetic anti-stress activity. Key words: anesthesia with xenon, stress hormones, anesthesia in children. (Pediatric pharmacology. — 2011; 8 (6): 77–81).

Xenon have been used as an anesthetic in the Russian Federation for 11 years in anesthesia in adult patients. In April 2010, the permission of the Ministry of Health and Social Development for the clinical studies evaluating the efficacy and safety of medical xenon anesthesia in children based on the Institute of Emergency Children’s Surgery and Traumatology had been received. Xenon in pediatric anesthesiology is of a special interest because it has properties equivalent to an «ideal anesthetic». To assess its effectiveness in anesthesia in children 42 patients aged 1 to 18 years were included in the study. A comparative assessment of the adequacy of anesthesia with xenon and sevoflurane has been conducted. At different stages of the research in addition to clinical parameters the level of growth hormone and cortisol were measured. The study showed that anesthesia with xenon was different from sevoflurane by hemodynamic stability, and both have a high level of anesthetic anti-stress activity.

Severe brain traumatic damage is very important problem because of frequent invalidization and high mortality. Among people died after brain trauma only 10-15% had life threatening brain damage. In other cases death was caused by secondary brain damage of common ischemic origin. We review current guidelines and prove administration of neuroprotector citicoline, which had been assessed in evidence based studies on both acute and chronic cerebral ischemia.

The paper presents the results of cerebral circulation (CC) in 17 ventilated patients with severe brain injury in its acute phase. All the patients developed traumatic subarachnoidal hemorrhage, which was accompanied with angiospasm in the majority of cases. Doppler transcranial study (DTCS) was performed, by using the carotid compression test; the findings correlated with paCO2 and CV parameters. A dynamic study was performed every two days starting from their admission to an intensive care unit to the recovery from coma or normalization of CC parameters. The dilation and constriction components of the CC reserve were assessed from the results of this test and continued to be controlled during therapy. Thus, this paper shows the possibility of goal-oriented correction of CC autoregulation and optimization by selecting the parameters of assisted ventilation and by changing paCO2 under the guidance of Doppler transcranial study.

Seventeen patients with severe brain injury (Glasgow-8 Coma Scale 3-8 scores) complicated by traumatic subarachnoidal hemorrhage and severe cerebral hemodynamic disorders (hyperemia, vasospasm) were examined. Hyperventilation was performed in different phases of cerebral circulation under multiparametrical monitoring (intracranial pressure, cerebral perfusion pressure, jugular oximetry, Doppler study using the carotid compression test). The use of hyperventilation to eliminate intracranial hypertension in victims with brain hyperemia was shown to make cerebral circulation consistent with brain tissue oxygen demands and to improve the autoregulatory reserve of cerebral vessels. The application of hyperventilation to eliminate intracranial hypertension in vasospasm leads to a temporary reduction in intracranial pressure, but simultaneously causes cerebral circulatory changes that do not correspond to cerebral oxygen demands, as well as lowered cerebral perfusion pressure, which increases a risk for ischemic brain tissue lesion. This requires a strict rationale for the use of hyperventilation and for multiparametrical monitoring of cerebral functions, which includes jugular oximetry, Doppler transcranial study, and measurement of intracranial pressure throughout the hyperventilation period in order to prevent secondary brain lesion.

The authors studied the time course of changes in the parameters of the cerebral thyronergic system (total and free triiodthyronine (T3) and thyroxin (T4), thyroxine-binding globulin (TBG), thyroid-stimulating hormone (TSH) by radioimmunoassay (Immunotech, Czechia; CIS, France), proinflammatory cytokine of TNF-alpha by enzyme immunoassay (Innogenetic, Belgium) in the blood and cerebrospinal fluid (CSF) in 59 patients (37 males and 22 females whose age ranged from 21 to 64 years) in acute subarachnoidal hemorrhage due to arterial aneurysmal rupture. On admission, the condition of 47 (79.7%) was rated as grades III-VI according to the Hunt-Hess scale, which was responsible for high mortality rates (33.89% in the assessment of outcomes according to the Glasgow outcome scale). The causes of death were ischemic and hemorrhagic insults, edema of the brain, cerebral stem wedging. Laboratory findings were analyzed in relation to the clinical condition of patients, outcomes, and the degree of secondary vasospasm assessed by Doppler transcranial study by the average blood flow velocity in the middle cerebral artery. They revealed a significant depression of thyroidal metabolism with developed the total low T3 syndrome just before surgical treatment in patients with deterioration in the early postoperative period. The significant correlations found by the authors between the decreased blood T3 and TSH levels and 1) the severity of neurological disorders; 2) the degree of vasospasm, and 3) the outcome of disease, as well as negative correlations of elevated TNF-alpha levels not only in the blood, but also in CSF with the content of CT3, CT4 and with the severity of neurological symptomatology are indicative of the development of isolated syndrome in the brain, which is characterized by specific thyroidal metabolic disorders, which the author propose to call the cerebral low T3 syndrome (by taking into account the presence of the autonomic systems of thyroidal homeostatic provision).