WO2012038636A1 - Composition anesthésique gazeuse à base de xénon utilisable pendant une endartériectomie avec clampage de l'artère carotide - Google Patents
Composition anesthésique gazeuse à base de xénon utilisable pendant une endartériectomie avec clampage de l'artère carotide Download PDFInfo
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- WO2012038636A1 WO2012038636A1 PCT/FR2011/052036 FR2011052036W WO2012038636A1 WO 2012038636 A1 WO2012038636 A1 WO 2012038636A1 FR 2011052036 W FR2011052036 W FR 2011052036W WO 2012038636 A1 WO2012038636 A1 WO 2012038636A1
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- Prior art keywords
- xenon
- composition according
- clamping
- anesthetic
- endarterectomy
- Prior art date
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- 229910052724 xenon Inorganic materials 0.000 title claims abstract description 60
- FHNFHKCVQCLJFQ-UHFFFAOYSA-N xenon atom Chemical compound [Xe] FHNFHKCVQCLJFQ-UHFFFAOYSA-N 0.000 title claims abstract description 60
- 239000000203 mixture Substances 0.000 title claims abstract description 32
- 210000001715 carotid artery Anatomy 0.000 title claims abstract description 23
- 238000013171 endarterectomy Methods 0.000 title claims abstract description 22
- 239000003994 anesthetic gas Substances 0.000 title abstract 2
- 238000002695 general anesthesia Methods 0.000 claims abstract description 25
- 239000003193 general anesthetic agent Substances 0.000 claims abstract description 21
- 230000003444 anaesthetic effect Effects 0.000 claims abstract description 18
- BQJCRHHNABKAKU-KBQPJGBKSA-N morphine Chemical compound O([C@H]1[C@H](C=C[C@H]23)O)C4=C5[C@@]12CCN(C)[C@@H]3CC5=CC=C4O BQJCRHHNABKAKU-KBQPJGBKSA-N 0.000 claims abstract description 14
- 230000003788 cerebral perfusion Effects 0.000 claims abstract description 13
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 claims abstract description 12
- 239000007789 gas Substances 0.000 claims abstract description 11
- 239000001301 oxygen Substances 0.000 claims abstract description 11
- 229910052760 oxygen Inorganic materials 0.000 claims abstract description 11
- 229960005181 morphine Drugs 0.000 claims abstract description 9
- 241000124008 Mammalia Species 0.000 claims abstract description 7
- ZTVQQQVZCWLTDF-UHFFFAOYSA-N Remifentanil Chemical compound C1CN(CCC(=O)OC)CCC1(C(=O)OC)N(C(=O)CC)C1=CC=CC=C1 ZTVQQQVZCWLTDF-UHFFFAOYSA-N 0.000 claims abstract description 7
- 229960003394 remifentanil Drugs 0.000 claims abstract description 7
- IDBPHNDTYPBSNI-UHFFFAOYSA-N N-(1-(2-(4-Ethyl-5-oxo-2-tetrazolin-1-yl)ethyl)-4-(methoxymethyl)-4-piperidyl)propionanilide Chemical compound C1CN(CCN2C(N(CC)N=N2)=O)CCC1(COC)N(C(=O)CC)C1=CC=CC=C1 IDBPHNDTYPBSNI-UHFFFAOYSA-N 0.000 claims abstract description 5
- 229960001391 alfentanil Drugs 0.000 claims abstract description 5
- 229960002428 fentanyl Drugs 0.000 claims abstract description 5
- PJMPHNIQZUBGLI-UHFFFAOYSA-N fentanyl Chemical compound C=1C=CC=CC=1N(C(=O)CC)C(CC1)CCN1CCC1=CC=CC=C1 PJMPHNIQZUBGLI-UHFFFAOYSA-N 0.000 claims abstract description 5
- 229960004739 sufentanil Drugs 0.000 claims abstract description 5
- GGCSSNBKKAUURC-UHFFFAOYSA-N sufentanil Chemical compound C1CN(CCC=2SC=CC=2)CCC1(COC)N(C(=O)CC)C1=CC=CC=C1 GGCSSNBKKAUURC-UHFFFAOYSA-N 0.000 claims abstract description 5
- 238000001356 surgical procedure Methods 0.000 claims description 12
- 239000003326 hypnotic agent Substances 0.000 claims description 7
- -1 morphine compound Chemical class 0.000 claims description 5
- 229960004134 propofol Drugs 0.000 claims description 4
- OLBCVFGFOZPWHH-UHFFFAOYSA-N propofol Chemical compound CC(C)C1=CC=CC(C(C)C)=C1O OLBCVFGFOZPWHH-UHFFFAOYSA-N 0.000 claims description 4
- 230000002618 waking effect Effects 0.000 claims description 3
- NPUKDXXFDDZOKR-LLVKDONJSA-N etomidate Chemical compound CCOC(=O)C1=CN=CN1[C@H](C)C1=CC=CC=C1 NPUKDXXFDDZOKR-LLVKDONJSA-N 0.000 claims description 2
- 229960001690 etomidate Drugs 0.000 claims description 2
- 210000004004 carotid artery internal Anatomy 0.000 abstract description 8
- 230000000004 hemodynamic effect Effects 0.000 abstract description 8
- 239000003795 chemical substances by application Substances 0.000 abstract description 4
- 206010002091 Anaesthesia Diseases 0.000 description 13
- 230000037005 anaesthesia Effects 0.000 description 13
- 210000001367 artery Anatomy 0.000 description 9
- 210000004556 brain Anatomy 0.000 description 8
- 238000000034 method Methods 0.000 description 7
- 230000002490 cerebral effect Effects 0.000 description 6
- 230000036772 blood pressure Effects 0.000 description 5
- 238000013172 carotid endarterectomy Methods 0.000 description 5
- 230000010412 perfusion Effects 0.000 description 5
- 230000009885 systemic effect Effects 0.000 description 5
- 239000008280 blood Substances 0.000 description 4
- 210000004369 blood Anatomy 0.000 description 4
- 150000001875 compounds Chemical class 0.000 description 4
- 230000002980 postoperative effect Effects 0.000 description 4
- 208000006170 carotid stenosis Diseases 0.000 description 3
- 230000004087 circulation Effects 0.000 description 3
- 239000008246 gaseous mixture Substances 0.000 description 3
- 238000001990 intravenous administration Methods 0.000 description 3
- 208000028867 ischemia Diseases 0.000 description 3
- 239000000243 solution Substances 0.000 description 3
- 230000035488 systolic blood pressure Effects 0.000 description 3
- 230000002792 vascular Effects 0.000 description 3
- IJGRMHOSHXDMSA-UHFFFAOYSA-N Atomic nitrogen Chemical compound N#N IJGRMHOSHXDMSA-UHFFFAOYSA-N 0.000 description 2
- GQPLMRYTRLFLPF-UHFFFAOYSA-N Nitrous Oxide Chemical compound [O-][N+]#N GQPLMRYTRLFLPF-UHFFFAOYSA-N 0.000 description 2
- 230000008081 blood perfusion Effects 0.000 description 2
- 230000036770 blood supply Effects 0.000 description 2
- 230000009977 dual effect Effects 0.000 description 2
- 230000000147 hypnotic effect Effects 0.000 description 2
- 238000001802 infusion Methods 0.000 description 2
- 238000012423 maintenance Methods 0.000 description 2
- 230000000926 neurological effect Effects 0.000 description 2
- DFEYYRMXOJXZRJ-UHFFFAOYSA-N sevoflurane Chemical compound FCOC(C(F)(F)F)C(F)(F)F DFEYYRMXOJXZRJ-UHFFFAOYSA-N 0.000 description 2
- 229960002078 sevoflurane Drugs 0.000 description 2
- 238000007631 vascular surgery Methods 0.000 description 2
- 239000005526 vasoconstrictor agent Substances 0.000 description 2
- 239000003039 volatile agent Substances 0.000 description 2
- SNICXCGAKADSCV-JTQLQIEISA-N (-)-Nicotine Chemical compound CN1CCC[C@H]1C1=CC=CN=C1 SNICXCGAKADSCV-JTQLQIEISA-N 0.000 description 1
- 206010002383 Angina Pectoris Diseases 0.000 description 1
- MYMOFIZGZYHOMD-UHFFFAOYSA-N Dioxygen Chemical compound O=O MYMOFIZGZYHOMD-UHFFFAOYSA-N 0.000 description 1
- 206010020591 Hypercapnia Diseases 0.000 description 1
- 206010020772 Hypertension Diseases 0.000 description 1
- 206010020952 Hypocapnia Diseases 0.000 description 1
- 206010021143 Hypoxia Diseases 0.000 description 1
- 208000002193 Pain Diseases 0.000 description 1
- 208000007536 Thrombosis Diseases 0.000 description 1
- 230000003872 anastomosis Effects 0.000 description 1
- 229940035674 anesthetics Drugs 0.000 description 1
- 210000002551 anterior cerebral artery Anatomy 0.000 description 1
- 229940124572 antihypotensive agent Drugs 0.000 description 1
- 230000004872 arterial blood pressure Effects 0.000 description 1
- 230000015572 biosynthetic process Effects 0.000 description 1
- 230000002802 cardiorespiratory effect Effects 0.000 description 1
- 230000001413 cellular effect Effects 0.000 description 1
- 230000003727 cerebral blood flow Effects 0.000 description 1
- 206010008118 cerebral infarction Diseases 0.000 description 1
- 208000026106 cerebrovascular disease Diseases 0.000 description 1
- 238000003776 cleavage reaction Methods 0.000 description 1
- 208000029078 coronary artery disease Diseases 0.000 description 1
- 230000007547 defect Effects 0.000 description 1
- 206010012601 diabetes mellitus Diseases 0.000 description 1
- 229940079593 drug Drugs 0.000 description 1
- 239000003814 drug Substances 0.000 description 1
- 230000001258 dyslipidemic effect Effects 0.000 description 1
- 230000008030 elimination Effects 0.000 description 1
- 238000003379 elimination reaction Methods 0.000 description 1
- 230000002349 favourable effect Effects 0.000 description 1
- 230000004927 fusion Effects 0.000 description 1
- 230000001631 hypertensive effect Effects 0.000 description 1
- 230000007954 hypoxia Effects 0.000 description 1
- 230000006698 induction Effects 0.000 description 1
- 230000001939 inductive effect Effects 0.000 description 1
- 239000003983 inhalation anesthetic agent Substances 0.000 description 1
- 238000002347 injection Methods 0.000 description 1
- 239000007924 injection Substances 0.000 description 1
- 238000001361 intraarterial administration Methods 0.000 description 1
- 238000007917 intracranial administration Methods 0.000 description 1
- 238000010253 intravenous injection Methods 0.000 description 1
- 238000011835 investigation Methods 0.000 description 1
- 210000004973 left posterior cerebral artery Anatomy 0.000 description 1
- 239000007788 liquid Substances 0.000 description 1
- 238000002690 local anesthesia Methods 0.000 description 1
- 238000004519 manufacturing process Methods 0.000 description 1
- 238000005259 measurement Methods 0.000 description 1
- 210000003657 middle cerebral artery Anatomy 0.000 description 1
- 238000012544 monitoring process Methods 0.000 description 1
- 208000010125 myocardial infarction Diseases 0.000 description 1
- 230000007512 neuronal protection Effects 0.000 description 1
- 230000004112 neuroprotection Effects 0.000 description 1
- 230000000324 neuroprotective effect Effects 0.000 description 1
- 229960002715 nicotine Drugs 0.000 description 1
- SNICXCGAKADSCV-UHFFFAOYSA-N nicotine Natural products CN1CCCC1C1=CC=CN=C1 SNICXCGAKADSCV-UHFFFAOYSA-N 0.000 description 1
- 229910052757 nitrogen Inorganic materials 0.000 description 1
- 239000001272 nitrous oxide Substances 0.000 description 1
- 230000000050 nutritive effect Effects 0.000 description 1
- 230000036407 pain Effects 0.000 description 1
- 230000008092 positive effect Effects 0.000 description 1
- 210000003388 posterior cerebral artery Anatomy 0.000 description 1
- 230000002035 prolonged effect Effects 0.000 description 1
- 239000000523 sample Substances 0.000 description 1
- 230000007017 scission Effects 0.000 description 1
- 230000003068 static effect Effects 0.000 description 1
- 238000006467 substitution reaction Methods 0.000 description 1
- 230000001839 systemic circulation Effects 0.000 description 1
- 238000012360 testing method Methods 0.000 description 1
- 230000024883 vasodilation Effects 0.000 description 1
- 210000002385 vertebral artery Anatomy 0.000 description 1
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 1
- 210000000707 wrist Anatomy 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K33/00—Medicinal preparations containing inorganic active ingredients
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/045—Hydroxy compounds, e.g. alcohols; Salts thereof, e.g. alcoholates
- A61K31/05—Phenols
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/045—Hydroxy compounds, e.g. alcohols; Salts thereof, e.g. alcoholates
- A61K31/05—Phenols
- A61K31/055—Phenols the aromatic ring being substituted by halogen
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
- A61K31/4164—1,3-Diazoles
- A61K31/4174—Arylalkylimidazoles, e.g. oxymetazolin, naphazoline, miconazole
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
- A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
- A61K31/445—Non condensed piperidines, e.g. piperocaine
- A61K31/4468—Non condensed piperidines, e.g. piperocaine having a nitrogen directly attached in position 4, e.g. clebopride, fentanyl
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
- A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P23/00—Anaesthetics
Definitions
- Gaseous anesthetic composition based on xenon that can be used during an endarterectomy with clamping of the carotid artery
- the invention relates to a gaseous drug based on xenon gas which, after inhalation, can maintain or preserve or even improve cerebral perfusion during an endarterectomy with clamping of the carotid artery under general anesthesia in the mammal, in particular in the human being.
- Carotid stenosis or carotid artery narrowing, develops in hypertensive, diabetic, dyslipidemic, and nicotine patients and frequently accompanies coronary heart disease, including angina or a history of myocardial infarction, as taught by NJ Clark. et al. ; Anesthesia in vascular surgery; In Miller RD, Eds. Anesthesia; Paris; Flammarion, 1996, 1851-1896 or by F Bonnet; Anesthesia in vascular surgery; In S amii k, Ed. Anesthesia and surgical resuscitation; Paris; Flammarion 1992: 560-577.
- Carotid stenosis therefore constitutes an obstacle to the vascularization or blood supply irrigating the tissues by the presence of an intra-arterial plaque.
- Carotid endarterectomy is the surgical procedure that removes an obstruction in the carotid artery by curettage. This is the most commonly used technique currently.
- an opening of the artery or arteriotomy is performed on the anterior surface of the carotid primitive and prolonged on the internal carotid artery. Endarterectomy is conducted in a cleavage plane located on the outer part of the media. The arteriotomy is then closed either directly or with the interposition of a prosthetic patch.
- Carotid endarterectomy is classically performed under general anesthesia.
- anesthesia raises the double problem of perioperative hemodynamic balance and neurological monitoring during the arterial clamping period, to detect ischemia (resulting from insufficient blood supply) due to clamping, resulting in the formation of a cerebral infarction.
- the polygon of Willis is actually formed, on the one hand, of two internal carotid arteries (right and left), from which are derived the two anterior cerebral arteries (right and left), the latter being joined by the communicating artery.
- anterior the continuity of the internal carotid arteries forms the middle cerebral arteries or sylvian arteries
- a basilar trunk resulting from the fusion of the two vertebral arteries, from which are born two right and left posterior cerebral arteries
- two posterior communicating arteries (right and left) which serve to connect the posterior cerebral arteries with the internal carotid arteries.
- systemic systolic (PAS) blood pressure increase is usually recommended.
- PAS systemic systolic
- the systemic PAS is not equal to the pressure in the Willis polygon, that is to say in the system of vascular substitution which allows the brain to receive nutritive blood even if one of the arteries of the neck is damaged or blocked, and a pressure gradient (GP) is described, that is to say a differential between the systemic PAS measured at the level of a radial arterial catheter (wrist artery) contralateral to surgery and arterial pressure in the carotid clamped.
- This pressure gradient indicates a lower perfusion pressure at the cerebral level during anesthesia.
- the problem is to be able to propose an anesthetic composition comprising an effective anesthetic compound, with rapid elimination, the use of which is compatible with an endarterectomy with clamping of the carotid artery under general anesthesia, that is to say having little or no hemodynamic effect to reduce the risk of post-operative cerebral involvement due to lack of intraoperative blood perfusion.
- the solution of the invention is a gaseous anesthetic composition based on xenon for use by inhalation to maintain or preserve cerebral perfusion during endarterectomy with clamping of the carotid artery under general anesthesia in the mammal.
- the solution of the invention is particularly surprising insofar as inhaled xenon makes it possible to maintain / preserve cerebral perfusion during an endarterectomy with clamping of the carotid artery under general anesthesia in a patient, whereas xenon was not known. to have this faculty in the context of such an intervention. Indeed, as underlined by the aforementioned documents of the Universiy of Kwazulu-Natal and the BAJ, xenon was deemed to have only a neuroprotective effect, or even be discouraged in such an intervention as it could have a negative impact on the infusion brain.
- xenon can be used beneficially as an inhalable volatile anesthetic agent to preserve or maintain, or even improve, cerebral perfusion during an endarterectomy with clamping of the carotid artery under general anesthesia goes to against the accepted ideas of the scientific community,
- the inhaled xenon thus used makes it possible to ensure good hemodynamics and to reduce the risk of post-operative cerebral involvement as a result of lack of perfusion of the blood stream.
- the gaseous anesthetic composition of the invention may comprise one or more of the following characteristics:
- the xenon in the gaseous composition is at a concentration of 50% to 70% by volume.
- xenon is used in combination with at least one injectable anesthetic agent.
- the injectable anesthetic agent is a morphine compound.
- the morphine compound is chosen from remifentanil, sulfentanil, fentanyl, and alfentanil.
- the dosages for these morphine compounds can be as follows: remifentanil (from 0.2 to 0.5 ⁇ g kg / min), sulfentanil (approximately 10 ⁇ g bolus), fentanyl (from 0.05 to 1 mg) and alfentanil (from 50 at 100 ⁇ g / kg).
- xenon is preferably always associated with such an injectable anesthetic agent to help fight against the pain caused by the surgical procedure in the patient.
- xenon is used as the only hypnotic agent, that is to say that xenon is generally used alone, that is to say without additional hypnotic agent.
- xenon is used with an additional hypnotic agent when the patient is "difficult.
- xenon can be used in combination with a hypnotic anesthetic agent injectable intravenously or administered by inhalation.
- the injectable hypnotic agent is chosen from propofol (dosage of 1 to 5 mg / kg or target of 1.5 ⁇ g / ml) and etomidate (dosage of 0.15 to 0.4 mg / kg), or the agent hypnotic is inhalable and is selected from sevofiurane, desfiurane and isofiurane (according to their respective minimum cellular concentrations -CAM-).
- the mammal is a human being, that is, a man or a woman, including children, adolescents, or any other group of individuals.
- the gaseous xenon is mixed with an oxygen-containing gas, in particular the xenon is mixed with pure oxygen, an air / O 2 mixture or an N 2 / O 2 mixture.
- xenon is administered before, simultaneously with and / or after administration of the injectable anesthetic agent.
- xenon is administered after administration of the injectable anesthetic agent.
- the gaseous composition contains a volume proportion of xenon of between 50 and 70% by volume, preferably of the order of at least 55% and / or at most 65% by volume xenon.
- the xenon is mixed with at least 25% by volume of oxygen, preferably with at least 30% oxygen.
- gaseous xenon begins after the patient has been anesthetized by means of the injectable anesthetic agent, preferably when the patient is asleep and intubated.
- the administration of xenon gas by inhalation is via an anesthetic respirator.
- the administration of xenon continues throughout the duration of the surgery, preferably until the awakening and the extubation of the patient.
- the solution of the invention is therefore based on a use of an anesthetic composition that can be administered to the patient by inhalation, which contains an effective proportion of gaseous xenon, typically between about 50 and 70% by volume, to obtain and / or maintain a anesthetized alone or in combination with another anesthetic
- an anesthetic composition that can be administered to the patient by inhalation, which contains an effective proportion of gaseous xenon, typically between about 50 and 70% by volume, to obtain and / or maintain a anesthetized alone or in combination with another anesthetic
- xenon inhaled by a patient at a concentration of between 50 and 70% by volume contributes, in combination with one or more morphine products, to maintain a general anesthesia allowing the performance of surgical procedures, in particular endarterectomy with clamping. of the carotid artery.
- Xenon gas is administered to the patient, once the patient is asleep and intubated, by inhalation via an anesthetic respirator, for example the Felix Dual TM reference respirator marketed by Air Liquide Medical Systems, in combination with a minimum of 30 % by volume of oxygen, and this throughout the duration of the surgery, that is to say until waking and extubation of the patient.
- anesthesia with xenon hemodynamic parameters were found to be stable, with higher systolic blood pressure values than with conventional inhaled or intravenous (IV) anesthetic agents. allows, during an endarterectomy with clamping of the carotid artery, to ensure a good hemodynamic and thus to reduce the risk of postoperative cerebral involvement by default of intraoperative blood perfusion.
- xenon maintains the perfusion pressure of the brain or prevents a decrease thereof by not causing a major pressure gradient between the systemic circulation and the cerebral circulation.
- the gaseous xenon according to the invention thus serves to manufacture an inhaled gaseous anesthetic composition for maintaining or preserving a cerebral perfusion during an endarterectomy with clamping of the carotid artery under general anesthesia in the mammal, in particular in this general anesthesia was induced by a conventional anesthetic agent, especially an injectable iv agent, for example propofol in combination with a morphine iv, for example remifentanil.
- a conventional anesthetic agent especially an injectable iv agent, for example propofol in combination with a morphine iv, for example remifentanil.
- the inhalable xenon-based gas anesthetic composition according to the invention can be used in a method of treating a patient undergoing endarterectomy with clamping of the carotid artery under general anesthesia comprising the steps of:
- a xenon gaseous gas composition preferably a gaseous mixture containing from 50 to 70% by volume of xenon and at least 25 at 30% by volume of oxygen.
- the administration of xenon gas by inhalation is via an anesthetic respirator, for example the Felix Dual TM respirator marketed by Air Liquide Medical System.
- the xenon or gaseous mixture based on xenon constituting the gaseous anesthetic composition of the invention is preferably packaged in a bottle of gas under pressure or in liquid form, for example in a bottle of one to several liters (containing water) and a pressure of between 2 and 300 bar.
- the xenon or gaseous mixture based on xenon constituting the gaseous anesthetic composition of the invention can be in "ready-to-use" form, for example in pre-mixing with oxygen (30% by volume or more) or, alternatively, be mixed on site during its use, in particular with oxygen and optionally another gaseous compound, for example nitrogen.
- anesthetic agent namely sevofiurane: group S of 12 patients.
- group X of 12 patients (% by volume).
- the primary endpoint is the pressure gradient (GP) between systolic blood pressure (SBP) measured at the level of a radial arterial catheter contralateral to surgery and blood pressure in the clamped carotid artery.
- SBP systolic blood pressure
- This pressure is obtained by a Fogarty probe, which also allows the clamping of the internal carotid by inflating the balloon, connected to a pressure sensor.
- the mean GP of patients in group X is significantly lower (p ⁇ 0.001) than the average GP of patients in group S, as can be seen in the attached figure which represents the average radial-carotid pressure gradient (in mm Hg) of Group S and X patients
- the combination of a more stable hemodynamics and a decrease in GP are favorable elements for the use of inhaled xenon, in combination with one or more injectable anesthetic agents, such as a morphine compound chosen from remifentanil, sulfentanil, fentanyl and alfentanil, to maintain or improve cerebral perfusion during clamping of the carotid artery during endarterectomy under general anesthesia.
- injectable anesthetic agents such as a morphine compound chosen from remifentanil, sulfentanil, fentanyl and alfentanil
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- Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Medicinal Chemistry (AREA)
- Chemical & Material Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Pharmacology & Pharmacy (AREA)
- Epidemiology (AREA)
- Inorganic Chemistry (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Anesthesiology (AREA)
- General Chemical & Material Sciences (AREA)
- Chemical Kinetics & Catalysis (AREA)
- Organic Chemistry (AREA)
- Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
- Medicinal Preparation (AREA)
- Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
Abstract
Description
Claims
Priority Applications (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
CA2808662A CA2808662A1 (fr) | 2010-09-22 | 2011-09-06 | Composition anesthesique gazeuse a base de xenon utilisable pendant une endarteriectomie avec clampage de l'artere carotide |
CN2011800456964A CN103118674A (zh) | 2010-09-22 | 2011-09-06 | 可用于涉及夹闭颈动脉的动脉内膜切除术期间的基于氙的麻醉气体组合物 |
EP11773487.1A EP2618823A1 (fr) | 2010-09-22 | 2011-09-06 | Composition anesthésique gazeuse à base de xénon utilisable pendant une endartériectomie avec clampage de l'artère carotide |
US13/820,970 US20130177654A1 (en) | 2010-09-22 | 2011-09-06 | Xenon-based anesthetic gas composition usable during an endarterectomy involving the clamping of the carotid artery |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
FR1057587A FR2964876B1 (fr) | 2010-09-22 | 2010-09-22 | Composition anesthesique gazeuse a base de xenon utilisable pendant une endarteriectomie avec clampage de l'artere carotide |
FR1057587 | 2010-09-22 |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2012038636A1 true WO2012038636A1 (fr) | 2012-03-29 |
Family
ID=43982283
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/FR2011/052036 WO2012038636A1 (fr) | 2010-09-22 | 2011-09-06 | Composition anesthésique gazeuse à base de xénon utilisable pendant une endartériectomie avec clampage de l'artère carotide |
Country Status (6)
Country | Link |
---|---|
US (1) | US20130177654A1 (fr) |
EP (1) | EP2618823A1 (fr) |
CN (1) | CN103118674A (fr) |
CA (1) | CA2808662A1 (fr) |
FR (1) | FR2964876B1 (fr) |
WO (1) | WO2012038636A1 (fr) |
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---|---|---|---|---|
US20160078189A1 (en) * | 2014-09-16 | 2016-03-17 | Scott Laboratories, Inc. | Sedation system and method providing enhanced safety |
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WO2003105871A1 (fr) * | 2002-06-12 | 2003-12-24 | Messer Griesheim Gmbh | Protection cerebrale a l'aide d'un gaz contenant du xenon |
WO2010040656A1 (fr) * | 2008-10-06 | 2010-04-15 | L'air Liquide Societe Anonyme Pour L'etude Et L'exploitation Des Procedes Georges Claude | Anesthésique gazeux à base de xénon destiné à être administré par le biais d'un cœur-poumon artificiel |
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2010
- 2010-09-22 FR FR1057587A patent/FR2964876B1/fr not_active Expired - Fee Related
-
2011
- 2011-09-06 EP EP11773487.1A patent/EP2618823A1/fr not_active Withdrawn
- 2011-09-06 US US13/820,970 patent/US20130177654A1/en not_active Abandoned
- 2011-09-06 CN CN2011800456964A patent/CN103118674A/zh active Pending
- 2011-09-06 CA CA2808662A patent/CA2808662A1/fr not_active Abandoned
- 2011-09-06 WO PCT/FR2011/052036 patent/WO2012038636A1/fr active Application Filing
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WO2010040656A1 (fr) * | 2008-10-06 | 2010-04-15 | L'air Liquide Societe Anonyme Pour L'etude Et L'exploitation Des Procedes Georges Claude | Anesthésique gazeux à base de xénon destiné à être administré par le biais d'un cœur-poumon artificiel |
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Also Published As
Publication number | Publication date |
---|---|
CN103118674A (zh) | 2013-05-22 |
FR2964876A1 (fr) | 2012-03-23 |
EP2618823A1 (fr) | 2013-07-31 |
US20130177654A1 (en) | 2013-07-11 |
CA2808662A1 (fr) | 2012-03-29 |
FR2964876B1 (fr) | 2013-04-12 |
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