Priming of anesthesia circuit with xenon for closed circuit anesthesia

Xenon is an inert gas with a practical anesthetic potency (1 MAC = 71%). Because it is very expensive, the use of closed circuit anesthesia technique is ideal for the conduction of xenon anesthesia. Here we describe our methods of starting closed circuit anesthesia without excessive waste of xenon gas. We induce anesthesia with intravenous agents, and after endotracheal intubation, denitrogenate the patient for approximately 30 min with a high flow of oxygen. This is done to minimize accumulation of nitrogen in the anesthesia circuit during the subsequent closed-circuit anesthesia with xenon. Anesthesia is maintained with an inhalational anesthetic during this period. Then, we discontinue the inhalation agent and start xenon. For this transition, we feel it is unacceptable to simply administer xenon at a high flow until the desired end-tidal concentration is reached because it is too costly. Instead we set up another machine with its circuit filled in advance (i.e., primed) with at least 60% xenon in oxygen and switch the patient to this machine. To prime the circuit, we push xenon using a large syringe into a circuit, which was prefilled with oxygen. Oxygen inside the circuit is pushed out before it is mixed with xenon, and xenon waste will thus be minimized. In this way, we can achieve close to 1 MAC from the beginning of xenon anesthesia, and thereby minimize the risk of light anesthesia and awareness during transition from denitrogenation to closed-circuit xenon anesthesia.