Safety, hemodynamic effects and detection of acute xenon inhalation : Rationale for banning xenon from sport / Justin Stevan Lawley, Hannes Gatterer, Katrin A. Dias, Erin J. Howden, Satyam Sarma, William K. Cornwell 3rd, Christopher M. Hearon Jr., Mitchel Samels, Braden Everding, Max Hendrix, Thomas Piper, Mario Thevis, Benjamin D. Levine. - (Journal of applied physiology (2019) 15 August)

• PMID: 31414955.
• DOI: 10.1152/japplphysiol.00290.2019

Abstract

OBJECTIVE:
This study aimed to quantify the sedative effects, detection rates and cardiovascular responses to xenon.

METHODS:
On three occasions, participants breathed xenon (FiXe 30%, for 20 min; FiXe 50% for 5 min; FiXe 70% for 2 min) in a non-blinded design. Sedation was monitored by a board certified anesthesiologist. During 70% xenon, participants were also verbally instructed to operate a manual value with time to task failure being recorded. Beat-by-beat hemodynamics were measured continuously by ECG, photoplethysmography and transcranial Doppler. Over 48 hours post administration, xenon was measured in blood and urine by gas chromatography-mass spectrometry.

RESULTS:
Xenon caused variable levels of sedation and restlessness. Task failure of the self-operating value occurred at 60 - 90 seconds in most individuals. Over the first minute, 50 and 70% xenon caused a substantial reduction in total peripheral resistance (P<0.05). All dosages caused an increase in cardiac output (P<0.05). By the end of xenon inhalation, slight hypertension was observed after all three doses (P<0.05) with an increase in middle cerebral artery velocity (P<0.05). Xenon was consistently detected, albeit in trace amounts, up to 3 hours post all three doses of xenon inhalation in blood and urine with variable results thereafter.

DISCUSSION:
Xenon inhalation caused sedation incompatible with self-operation of a breathing apparatus, thus causing a potential life threatening condition in the absence of an anesthesiologist. Yet, xenon can only be reliably detected in blood and urine up to 3 hours post acute dosing.

In November 2008 the South African Institute for Drug-Free Sport (SAIDS) has reported an anti-doping rule violation against the Athlete Lucky Maselesele after his sample tested positive for the prohibited substance cocaine. After the notification the Athlete filed a statement in his defence and was heard for the Disciplinary Committee.

The Athlete denied the use of the prohibited substance and stated that he only used his asthma medication.
He argued that he was tested 8 times before and on all occasions he tested negative in his 12 years football career. Three days prior to the competition he had a stomach problem and asked his wife to bring him medication from the pharmacy and he does not think that such medication would contain such prohibited substance. Also the Athlete disputed the validity of the A sample test result.

The Committee concludes that no departure from the ISL occurred in this case and that the Athlete failed to establish how the prohibited substance entered his body.
Therefore the SAIDS Disciplinary Committee decides to impose a 2 year period of ineligibility on the Athlete.

Related case:

SAIDS 2014 SAIDS vs Lindhikaya Mthangayi
May 12, 2014

In September 2009 Athletics South Africa (ASA) reported an anti-doping rule violation against the South African Athlete Lindhikaya Mthangayi after his A and B samples tested positive for the prohibited substance methylhexaneamine (dimethylpentylamine).

After notification a provisional suspension was ordered. The Athlete filed a statement in his defence and was heard for the ASA Disciplinary Committee.

The Athlete stated that due to the death of his brother he suffered from stress and headaches and therefore he used Adcodol tablets and also with several supplements for training. The Athlete admitted that he was careless and expressed his apologies.

The Committee concludes that the Athlete didn’t know that the supplement AMH Ultrate contained the prohibited substance and that he had no intention to enhance his sport performance.

Considering the circumstances the AS Disciplinary Committee decides on 9 April 2010 to impose a 6 month period of ineligibility on the Athlete, starting on the date of the provisional suspension, i.e. on 8 October 2009.

In September 2010 the South African Institute for Drug-Free Sport (SAIDS) has reported an anti-doping rule violation against the Athlete after his out-of-competition sample tested positive for the prohibited substance boldenone.
The Athlete already served a two year period of ineligibility since 12 July 2009 after his sample tested positive for the prohibited substance stanozolol.
Due to this is the Athlete’s second violation the SAIDS Disciplinary Committee decides to impose a 16 year period of ineligibility on the Athlete, starting on the date the current 2 year period of ineligibility is completed, i.e. on 12 July 2011.

The South African Institute for Drug-Free Sport (SAIDS) has reported an anti-doping rule violation against the Athlete after his sample tested positive for the prohibited substance salbutamol.

On review of the case, SAIDS is unable to prove beyond a mere balance of probability that the athlete knowingly took the banned substance to enhance his performance or took the banned substance with hope of not being tested.
SAIDS therefore requests the Disciplinary Committee members to evaluate the case with respect to Article 10.4 of the SA Anti-doping Rules. SAIDS will be content with a ruling of a stern warning and proviso that the athlete consult with his personal physician about the correct method of using a metered dose inhaler to treat his exercise induced asthma and for the athlete to be more conversant with substances that are banned in sport and which of these substances require him to apply for a therapeutic use exemption and which ones require a declaration of use on the doping control form.
The request is made by SAIDS in light of the fact that the boxer has been under provisional suspension since 22 January 2010 (4 months served).

Facts
The South African Institute for Drug-Free Sport (SAIDS) charges Lwandile Zino (the athlete) for a violation of the Anti-Doping Rules. The presence of a prohibited substance was detected in the Athlete’s sample. substance identified was cannabinoids metabolites, in a concentration of 66ng/ml (nanograms/millilitre), which is significantly above the permitted threshold of 15ng/ml.

History
The Athlete accepted the evidence relating to the presence and concentration level of the prohibited substance, but pleaded not guilty as it was argued that the presence of the prohibited substance cannabinoids was due to the inhalation of second hand smoke. The Athlete explained the circumstances relating to his living arrangements with his siblings who are chronic marijuana users that resulted in the inhalation of second hand smoke. The Athlete stated that he is a non-drinker and a non-smoker due to his profession. There was no intention to enhance his sport performance due to the incidental nature of the transgression.

Considerations panel
The concentration of cannabinoids metabolites in the sample is too high for being the result of passive smoking.

Decision
A) Imposition of a period of ineligibility of twelve (12) months of which six (6) months are suspended. The Panel concurred that the period of ineligibility be credited against the period for which he had been provisionally suspended. Accordingly, the Athlete would be prohibited from competing as a boxer until Saturday 25th September 2010;
B) Furthermore, that during the six (6) month suspended period (26th September 2010 until 25th March 2011) the boxer will be subject to a series of voluntary urine test at the behest of SAIDS;
C) Should the Athlete test positive again for any prohibited substance during the period 26th September 2010 until 25th March 2011 the maximum sentence of two years will automatically come into effect and the Athlete would have to be formally enrolled into a drug rehabilitation program.

The South African Institute for Drug-Free Sport (SAIDS) has reported an anti-doping rule violation against the Athlete after his sample tested positive for the prohibited substance metandienone.
After notification a provisional suspension was ordered and the Athlete was heard for the Disciplinary Committee.
Hereafter the SAIDS Disciplinary Committee decides to impose a 2 year period of ineligibility on the Athlete starting on 7 September 2010 until 7 September 2012.

The South African Institute for Drug-Free Sport (SAIDS) has reported an anti-doping rule violation against the Athlete after he refused to provide a sample for doping control.
After notification a provisional suspension was ordered and the Athlete was heard for the Disciplinary Committee.

The Athlete gave evidence under oath. He admitted to having been notified of the sample collection test, as well as being accompanied by a chaperone when watching the main bout of the evening as he was not ready to provide his urine sample. He conceded that he left the venue without providing the sample and explained that he had been put under pressure by his brother-in-law to leave with him as this was his form of transport home.

The Athlete’s evidence focussed on the fact that he is illiterate, uneducated and does not understand English. There was no evidence suggesting otherwise. He pointed out that although he had signed the Doping Control Form he does not read or write English and he did not fully understand or appreciate the seriousness of the implications of not providing the sample. He conceded however that the DCO had communicated verbally in Xhosa that he was required to provide the sample.

The panel considers that while no compelling justification for the failure to submit to the sample collection existed there nevertheless exists factors which detracted from the degree of fault or negligence on the part of the Athlete. The test relating to fault or negligence should be flexible enough to accommodate very real factors such as the illiteracy and lack of education of the Athlete. These factors did impact upon the Athletes ability to fully understand the significance and seriousness of his actions. The Committee notes that it is perhaps worth consideration by SAIDS for the future that in circumstances where an athlete clearly does not read, write or understand English that an informal script be read out to such athlete by the DCO in his home language.

The SAIDS Disciplinary Committee decides to impose a 1 year period of ineligibility on the Athlete starting on the date of the hearing. The period of the interim suspension of six weeks would be credited against this sanction.

Related case:
SAIDS 2010_07 WADA vs Vaughn van Jaarsveld & SAIDS - Appeal
September 23, 2011

The South African Institute for Drug-Free Sport (SAIDS) has reported an anti-doping rule violation against the Athlete after his sample tested positive for the prohibited substance sibutramine.
The Athlete filed a statement in his defence and was heard for the Disciplinary Committee.

The Athlete stated he had used a not sports related prescription for weight loss medication Ciplatrim by his physician that contained a specified substance unbeknownst to all concerned. The Athlete’s physician testified and confirmed that he had checked WADA’s (outdated) prohibited list 2009 and that sibutramine was not listed. The Athlete argued he indicated the medication on the Doping Control Form and he informed his coach.

Considering the circumstances and the evidence the SAIDS Disciplinary Committee decides to impose a reprimand on the Athlete.

In addition the Committee recommends that Cricket South Africa (CSA) Medical Committee look at instituting appropriate protocols for their professional athletes at a franchise level, semi professional and under 19 level.
CSA must contractually compel franchise cricketers to verify the status of all prescribed medicine and other supplements provided for by third parties with their respective franchise doctors.

Hereafter WADA appealed this decision.

Related case:
SAIDS 2010_07 SAIDS vs Vaughn van Jaarsveld
December 2, 2010

On 2 December 2010 the SAIDS Disciplinary Committee imposed a reprimand on the Athlete for committing an anti-doping rule violation after his sample tested positive for the prohibited substance sibutramine.

WADA appealed against this SAIDS decision to impose a reprimand on the Athlete as non appropriate sanction in this case. Also WADA lodged a Statement of Appeal with the Court of Arbitration for Sport (CAS) in which WADA requested at stay of the CAS proceedings pending the outcome of this Appeal.

Considering the circumstances and the factors in this case the Appeal Tribunal rules to set aside the decision of the Disciplinary Committee and to impose a 4 month period of ineligibility on the Athlete, less the 1 month period already served.

Therefore the Anti-Doping Appeal Tribunal of South Africa decides to impose a 3 month period on the Athlete starting on the date of the decision.