Sensory information from the upper airway: role in the control of breathing

Ozone-induced Nasal Hyperresponsiveness to Tachykinins in Guinea Pigs

Objective

To assess role of hydroxyl radials in the ozone-induced upper airway hyperresponsiveness to tachykinins.

Methods

A prospective, controlled, animal model (n = 96) was performed. Half of them exposed to air (A-group, placebo) and the other half exposed to 3 ppm ozone (O-group) for 2 h. Two hours post air/ozone exposure, animals were anesthetized and equally randomized to be pretreated with one of the three treatments, including saline vehicle, dimethylthiourea (DMTU; 500 mg/kg m, a hydroxyl radical scavenger), or phosphoramidon (Phos; 2 μg/kg, an inhibitor for neutral endopeptidase). Ten minutes after pretreatment, half of the animals in each group were i.v. injected with capsaicin (2 μg/kg), and the other half were i.v. injected with substance P (10 μg/kg) to produce Evans blue dye extravasation.

Results

Nasal exudative response to capsaicin or substance P in O-group was found to be significantly greater than that in A-group. This ozone-induced nasal airway hyperresponsiveness was largely prevented by DMTU. Phosphoramidon produced a similar nasal airway hyperresponsiveness in the A-group, but failed to alter ozone-induced nasal airway hyperresponsiveness in O-group. In sharp contrast, only substance P, but not capsaicin, produced a laryngeal exudative response in the A-group, which was similar to that in the O-group. The laryngeal exudative response to substance P was not significantly affected by DMTU or Phos.

Conculsion

In the guinea-pig model, hydroxyl radicals play a vital role in the development of ozone-induced nasal airway hyperresponsiveness to tachykinins. It is possibly mediated through the suppressive action of ozone on the tachykinin degradation.

Expression of Fos protein in brainstem after application of l-menthol to the rat nasal mucosa

There are two functional pathways for the nasotrigeminal reflex: the spinal nucleus of trigeminal nerve (SPV) to the Kölliker-Fuse (KF) nucleus and the nucleus of solitary tract (NTS) to the lateral parabrachial nucleus (PBl). Although stimulation of the nasal mucosa by cool temperature induces respiratory depression, it is still unknown whether these nuclei are activated. In the present study, we examined the expression of Fos protein in rat brainstem neurons after nasal application of l-menthol, which is known to activate cold-sensitive nasal receptors. Application of l-menthol, but not paraffin oil, decreased the respiratory rate from 99.7+/-15.6 to 78.5+/-7.3 min(-1). Furthermore, a significantly higher density of Fos-immunoreactive cells was observed in the SPV and KF in the l-menthol rats than in the controls. In the SPV, the density of Fos-immunoreactive cells was highest at approximately 0.5mm rostral to the obex in both the l-menthol (48.5+/-11.5 cells/section) and paraffin oil (26.0+/-9.6 cells/section) groups. In the KF, the mean density of Fos-immunoreactive cells was highest at approximately 5.0mm rostral to the obex in both groups (l-menthol: 67.8+/-14.0 cells/section, control: 41.0+/-12.7 cells/section). The present study suggests that the SPV-KF pathway is important for the cold-induced respiratory depression.

Responses to trigeminal irritants at different locations of the human nasal mucosa

BACKGROUND

Previous work suggests differences in the distribution of human intranasal trigeminal receptors. The aim of this study was to investigate these topographic differences for different concentrations of different trigeminal irritants using an electrophysiologic measure of trigeminal activation, the negative mucosa potential (NMP).

MATERIALS AND METHODS

A total of 15 healthy volunteers participated. Presented by a computer-controlled olfactometer CO2 (30% and 40% v/v), ethyl acetate (5.5% and 9.3% v/v) and acetic acid (205 and 40% v/v) were used for stimulation. NMP was recorded at the middle septum, the middle turbinate, and the floor of the nasal cavity.

RESULTS

Maximum amplitudes of the NMP were found at the middle septum and were lowest at the nasal floor. Response amplitudes were related to stimulus concentrations. There was no significant difference between responses to the three different stimuli in relation to three recording sites.

CONCLUSIONS

In agreement with previous work, the present data suggest that there are topographic differences in the responsiveness of the mucosa to chemical irritants.

Paradoxical vocal cord motion: A review focused on multiple system atrophy

OBJECTIVE

Paradoxical vocal cord motion (PVCM) is a well recognized respiratory condition in which active adduction of the vocal cords during inspiration causes functional airway obstruction. It is considered that laryngeal reflex acceleration underlies the generation of nonorganic PVCM. In various situations producing PVCM, multiple system atrophy (MSA) is a representative neurological disease causing nocturnal laryngeal stridor attributed to PVCM. The purpose of this review is to identify the underlying mechanisms associated with nonorganic and MSA-related PVCM. The following issues are addressed in this review: (1) the pathophysiology of nonorganic and MSA-related PVCM, (2) the relationships between PVCM and airway reflexes, and (3) the treatment for MSA-related PVCM.

METHODS

Review.

RESULTS AND CONCLUSIONS

An abnormality of the laryngeal output-feedback control underlies nonorganic PVCM, which is usually triggered by an excessive response to external and internal airway stimuli. Similarly, several clinical and experimental evidence suggest that MSA-related PVCM is attributed to the airway reflex as well as to paradoxical central outputs resulting from the MSA-induced damage to the pontomedullary respiratory center. Application of continuous positive airway pressure (CPAP), which suppresses the reflexive inspiratory activation of adductors, is recommended as the treatment for MSA-related PVCM.

The reflex effects on the respiratory regulation of the CO2 at the different flow rate and concentration

PURPOSE

The purpose of this study was to investigate the activation of the respiratory centers during insufflation of the larynx with CO2 at different flow rates and concentrations.

MATERIALS AND METHODS

The experiments were carried out in spontaneous air breathing rabbits, anesthetized with thiopental sodium (25 mg kg(-1) i.v.). The larynx was separated from the oropharyngeal cavity and the trachea. The tidal volume (VT) and respiratory frequency (f min(-1)) were recorded from the lower tracheal cannula. The respiratory minute volume (VE) was calculated, the action potentials from the right phrenic nerve were recorded and the inspiratory (TI) and expiratory (TE) periods and the mean inspiratory flow rate (VT/TI) were calculated. The larynx was insufflated at flow rates of 500 mL min(-1) and 750 mL min(-1), with 7 and 12% CO2-Air by means of a respiratory pump.

RESULTS

Insufflation of the larynx, with both gas mixtures, decreased the f and VT significantly. The TI and TE were found to increase significantly due to the decreasing in f. There was a significant decrease in VT/TI ratio. Following bilateral midcervical vagotomy, on the passing of both gas mixtures, significant decreases were observed in the VT, and the responses of f, TI and TE were abolished. After cutting the superior laryngeal nerve, the responses of the VT to both gas mixtures were abolished.

CONCLUSION

In conclusion, the results of this study purpose that the stimulation of the laryngeal mechanoreceptors by the effect of hypercapnia decreases the activation of the respiratory center.

Laryngeal sensitivity in the neonatal period: from bench to bedside

Laryngeal sensitivity in the newborn has been a subject of great interest for both researchers and clinicians for a number of years. From a clinical standpoint, laryngeal sensitivity is essential for both preventing foreign substances from entering into the lower airway and for finely tuning upper airway resistance. However, heightened reflexes originating from the laryngeal receptors in newborns and infants, due to neural immaturity, can lead to potentially dangerous cardiorespiratory events. The latter have been linked to apneas of prematurity, apparent life-threatening events, and sudden infant death syndrome (SIDS). From a physiological standpoint, many mechanisms pertaining to reflexes originating from laryngeal receptors are yet to be fully understood. This short review is an attempt to summarize current knowledge on laryngeal sensitivity and its potential consequences upon control of breathing abnormalities encountered within the first weeks of life.

Upper airway imaging in obstructive sleep apnea

PURPOSE OF REVIEW

Obstructive sleep apnea continues to be a significant public health problem. A variety of imaging modalities have been used recently to gain insight into the pathogenesis of this disease, as well as to identify therapeutic options.

RECENT FINDINGS

Data from more recent imaging studies have highlighted key findings regarding the anatomic sites of collapse and local tissue factors promoting upper airway compromise. The role of genetics, aging, gender and ethnicity in the development of sleep apnea and the identification of predictors for successful treatment outcomes for sleep-disordered breathing are also reviewed.

SUMMARY

As our understanding of obstructive sleep apnea evolves, newer imaging techniques and computerized models may be able to further enhance our understanding of the pathogenesis and treatment of this disease.

Possible effects on smokers of cigarette mentholation: a review of the evidence relating to key research questions

Menthol (2-isopropyl-5-methyl-cyclohexan-1-ol) is used in food, pharmaceutical, and tobacco products. Despite its long usage history and GRAS status, scientific literature on effects of cigarette mentholation is limited. Because African-American men have high lung cancer rates and predominantly smoke mentholated cigarettes, and because menthol's cooling effect might affect puffing and smoke inhalation, possible adverse effects of cigarette mentholation have been suggested. We review the evidence on the effects of mentholation on smokers, and we also identify areas for further study. Five large epidemiological studies provide no evidence that cigarette mentholation increases lung cancer risk. Mentholation cannot explain the higher risk for lung cancer in African-American male smokers, who also predominantly smoke mentholated cigarettes. Limited data on other cancers also suggest no risk from mentholation. The scientific literature suggests that cigarette mentholation does not increase puff number or puff volume of smoked cigarettes, and has little or no effect on heart rate, blood pressure, uptake of carbon monoxide, tar intake or retention, or blood cotinine concentration. Mentholation has little effect on other smoke constituents, and no apparent effect on nicotine absorption, airway patency and smoking initiation, dependency or cessation. Any toxicological effects of cigarette mentholation on adult smokers are probably quite limited.

Neural and hydroxyl radical mechanisms underlying laryngeal airway hyperreactivity induced by laryngeal acid-pepsin insult in anesthetized rats

Laryngopharyngeal or gastroesophageal reflux is associated with laryngeal airway hyperreactivity (LAH), but neither the cause-effect relationship nor the underlying mechanism has been elucidated. Here we established a rat model with enhanced laryngeal reflex reactivity induced by laryngeal acid-pepsin insult and investigated the neural and hydroxyl radical (*OH) mechanisms involved. The laryngeal segments of 103 anesthetized rats were functionally isolated while animals breathed spontaneously. Ammonia vapor was delivered into the laryngeal segment to measure laryngeal reflex reactivity. We found that the laryngeal pH 5-pepsin treatment doubled the reflex apneic response to ammonia, whereas laryngeal pH 7.4-pepsin, pH 2-pepsin, and pH 5-denatured pepsin treatment had no effect. Histological examination revealed limited laryngeal inflammation and epithelial damage after pH 5-pepsin treatment and more severe damage after pH 2-pepsin treatment. In rats that had received the laryngeal pH 5-pepsin treatment, the apneic response to ammonia was abolished by either denervation or perineural capsaicin treatment (PCT; a procedure that selectively blocks capsaicin-sensitive afferent fibers) of the superior laryngeal nerves, but was unaffected by perineural sham treatment. LAH was prevented by laryngeal application of either dimethylthiourea (DMTU; a *OH scavenger) or deferoxamine (DEF; an antioxidant for *OH), but was unaltered by the DMTU vehicle or iron-saturated DEF (ineffective DEF). LAH reappeared after recovery from PCT, DMTU, or DEF treatment. We conclude that 1) laryngeal insult by pepsin at a weakly acidic pH, but not at acidic pH, can produce LAH; and 2) LAH is probably mediated through sensitization of the capsaicin-sensitive laryngeal afferent fibers by a *OH mechanism.

Expression of ENaC subunits in sensory nerve endings in the rat larynx

We investigated the expression of three subunits of epithelial sodium channel (ENaC), alphaENaC, betaENaC and gammaENaC, in the nodose ganglion and laryngeal mucosa of rat by RT-PCR analysis and immunohistochemistry. PCR products of predicted size for alphaENaC, betaENaC and gammaENaC subunits were amplified from extract of nodose ganglion. Immunohistochemically, nodose ganglion neurons of medium to large diameter were immunoreactive for alphaENaC, betaENaC and gammaENaC. In the deep region of laryngeal submucosal layer, thick nerve fibers without varicosities were immunoreactive for alphaENaC, betaENaC and gammaENaC. In the laryngeal mucosa, terminal arborizations of the nerve endings, that immunoreacted for alphaENaC, betaENaC and gammaENaC were scattered in the lamina propria just beneath the epithelia of epiglottis and laryngeal vestibule. Double immunofluorescence with calretinin revealed that they were laminar nerve endings. Some thick nerve fibers near the laryngeal taste buds were also immunoreactive for betaENaC and gammaENaC, but negative for alphaENaC. In the larynx, ENaC channels may play important roles in mechanotransduction in the laminar endings and in the mechano- and chemotransductions in the taste bud-associated nerve fibers.

Central pathways of pulmonary and lower airway vagal afferents

Lung sensory receptors with afferent fibers coursing in the vagus nerves are broadly divided into three groups: slowly (SAR) and rapidly (RAR) adapting stretch receptors and bronchopulmonary C fibers. Central terminations of each group are found in largely nonoverlapping regions of the caudal half of the nucleus of the solitary tract (NTS). Second order neurons in the pathways from these receptors innervate neurons located in respiratory-related regions of the medulla, pons, and spinal cord. The relative ease of selective activation of SARs, and to a lesser extent RARs, has allowed for more complete physiological and morphological characterization of the second and higher order neurons in these pathways than for C fibers. A subset of NTS neurons receiving afferent input from SARs (termed pump or P-cells) mediates the Breuer-Hering reflex and inhibits neurons receiving afferent input from RARs. P-cells and second order neurons in the RAR pathway also provide inputs to regions of the ventrolateral medulla involved in control of respiratory motor pattern, i.e., regions containing a predominance of bulbospinal premotor neurons, as well as regions containing respiratory rhythm-generating neurons. Axon collaterals from both P-cells and RAR interneurons, and likely from NTS interneurons in the C-fiber pathway, project to the parabrachial pontine region where they may contribute to plasticity in respiratory control and integration of respiratory control with other systems, including those that provide for voluntary control of breathing, sleep-wake behavior, and emotions.

Function of the Laryngeal Mechanoreceptors During Vocalization

OBJECTIVES/HYPOTHESIS

The objective was to compare the activity of superior laryngeal nerve mechanoreceptors based on a respiration-based classification protocol with activities found using a vocalization-based classification protocol in adult cats.

STUDY DESIGN

Animal study.

METHODS

In the first part of the experiment, single fiber action potentials from the internal branch of the superior laryngeal nerve were recorded in decerebrated cats using a respiration-based classification protocol to identify laryngeal mechanoreceptors as pressure, flow, and drive receptors, as described in the literature. A tracheal T-tube and a laryngeal mask airway were necessary modifications to perform this protocol. In the second part of the experiment, a vocalization-based classification protocol as described in the literature was used to classify the activity of the same fiber into the following groups: peak prephonatory, frequency-following, frequency-nonfollowing, inspiratory-modulated, or mixed. Vocalization was evoked by electrical stimulation of the midbrain in the region of the periaqueductal gray.

RESULTS

In all, eight cats were used for the experiment. Data were obtained from only three cats for a total of five single fibers. Results from five cats were not obtained because of inability to phonate (in three cats) and inability to record from the superior laryngeal nerve (in two cats). We identified two flow receptors, a drive receptor, a frequency-following receptor, and a frequency-nonfollowing receptor. Both flow receptor fibers were almost silent during the phonation phase and reached the maximum activity after vocalization during the inspiratory phase. The drive receptor was active during all four airway maneuvers and was most active during tracheal occlusion. It also kept a high level of activity during the phonatory phase, suggesting a role in the modulation of vocalization and respiration. The next two receptors, a frequency-following and a frequency-nonfollowing receptor, were active only during the phonatory phase and were totally inactive during the airway maneuvers, suggesting a role only during the vocalization behavior.

CONCLUSION

Because vocalization is an important stimulus for the activation of certain superior laryngeal nerve receptors, a classification protocol based on respiration alone is incomplete. Classification into pressure, flow, and drive receptors alone is not appropriate for the study of laryngeal receptors during vocalization. Some frequency-following and frequency-nonfollowing receptors may be active only during phonation and would otherwise be missed without vocalization stimuli.

Immunolocalization of VR1 and VRL1 in rat larynx

Immunoreactivity for vanilloid receptor subtype 1 (VR1) and its analogue vanilloid receptor-like protein 1 (VRL1) were examined in combination with immunoreactivity for substance P (SP) and calcitonin gene-related peptide (CGRP) in the rat larynx. VR1 and VRL1 immunoreactivity were observed in the intraepithelial free nerve endings, subepithelial nerve plexus and laryngeal epithelial cells. Most of VR1 immunoreactive nerves were also immunoreactive for SP or CGRP. VR1 immunoreactive intraepithelial nerve endings may be laryngeal nociceptors.

Laryngeal inputs in defensive airway reflexes in humans

Stimulation of laryngeal receptors is the natural starting point of defensive airway reflexes including the cough reflex, expiration reflex, spasmodic panting, and apnoea with laryngospasm. Although several different types of laryngeal receptors have been reported, the laryngeal irritant receptors are considered to play the most essential role in elicitation of defensive airway reflexes. Based on the knowledge that the laryngeal irritant receptors are stimulated by water solutions lacking chloride anions, we have developed an experimental method to elicit defensive airway reflexes with a direct instillation of distilled water onto the laryngeal mucosa in humans. Using this experimental method, we studied the characteristics of defensive airway reflexes in lightly anaesthetized patients with multiple system atrophy (MSA). The reflex responses to water stimulation observed in these patients were characterized by apnoea with laryngospasm while the cough reflex was never elicited. Endoscopic images of the larynx in these patients were also characterized by laryngeal oedema. Considering the pathological changes occurring in the central nervous system and the laryngeal mucosa, it is possible that the defensive airway reflexes may be modified by central and/or peripheral mechanisms in patients with MSA.

Upper airway afferents are sufficient to evoke the early components of respiratory-related cortical potentials in humans

Repeated inspiratory occlusions in humans elicit respiratory-related cortical potentials, the respiratory counterpart of somatosensory-evoked potentials. These potentials comprise early components (stimulus detection) and late components (cognitive processing). They are considered as the summation of several afferent activities from various part of the respiratory system. This study assesses the role of the upper airway as a determinant of the early and late components of the potentials, taking advantage of the presence of a tracheotomy in patients totally or partially deafferented. Eight patients who could breathe either through the mouth or through a tracheotomy orifice (whole upper airway bypassed) were studied (4 quadriplegic patients with phrenic pacing, 4 patients with various sources of inspiratory pump dysfunction). Respiratory-related evoked potentials were recorded in CZ-C3 and CZ-C4. They were consistently present after mouth occlusions, with a first positive P1 and a first negative N1 components of normal latencies (P1: 40.4 ± 6.1 ms in CZ-C3 and 47.6 ± 7.6 ms in CZ-C4; N1: 84.4 ± 27.1 ms in CZ-C3 and 90.2 ± 17.4 ms in CZ-C4) and amplitudes. Tracheal occlusions did not evoke any cortical activity. Therefore, in patients with inspiratory pump dysfunction, the activation of upper airway afferents is sufficient to produce the early components of the respiratory-related evoked cortical potentials. Per contra, in this setting, pulmonary afferents do not suffice to evoke these components.

Distribution of pH regulators in the rat laryngeal nerve: the spatial relationship between Na+/HCO3− cotransporters and Na+/H+ exchanger type 3

We studied the distribution of Na(+)/HCO(3)(-) cotransporters (NBC) and Na(+)/H(+) exchanger type 3 (NHE3) in the laryngeal nerve by immunohistochemistry to elucidate the spatial relationship of pH regulation system in the peripheral nerves. The nervous components, i.e., the nerve cells in the nodose and local ganglia and nerve fibers, were immunoreactive for NBC. Glial components such as Schwann cells and satellite cells surrounding nerve fibers and nerve cell bodies were also immunoreactive for NBC in most cases, while the cells comprising the perineurium and endoneurium were immunoreactive for NHE3. These results suggest that NBC-dependent pH regulation systems are present in the laryngeal nerve. Whereas, NHE3 may regulate extracellular pH rather than intracellular pH. In conclusion, spatial relationship of NBC and NHE3 in the laryngeal nerve would be important for pH regulation. Perineural lymph may have key role for acid-induced modulation of axons and Schwann cells.

Inspiratory activation of the vocal cord adductor, part II: Animal study in the cat

OBJECTIVES/HYPOTHESIS

The authors have shown previously that the vocal cord adductor is activated during inspiration in patients with vocal cord abduction impairment and that this adductor inspiratory activity is abolished by relief from inspiratory tracheal negative pressure by opening the tracheostoma. (Shiba K. Isono S, Sekita Y, Tanaka A. Inspiratory activation of the vocal cord adductor, Part I: human study in patients with restricted abduction of the vocal cords. Laryngoscope 2004;114:372-375). The authors hypothesized that insufficient opening of the glottis during inspiration generates strong negative pressure in the trachea and that this negative pressure triggers an airway reflex that activates the adductor.

STUDY DESIGN

Experimental study of the mechanism of laryngeal obstruction using an animal model of restricted abduction of the vocal cords.

METHODS

To identify such an airway reflex, the authors recorded the adductor electromyogram in anesthetized cats whose vocal cords were mechanically adducted by stitching both cords together. To determine whether this reflex modulation of adductor activity is induced through afferents from the larynx or from the lower airway, the authors applied negative pressure to the subglottic space and lower airway separately.

RESULTS

The adductor was activated during inspiration with powerful negative pressure in the trachea. Negative pressure in the subglottic space had a more marked effect on the adductor activity than did pressure in the lower airway. The adductor inspiratory activity was virtually abolished by laryngeal deafferentation.

CONCLUSION

Glottal narrowing during inspiration reflexly activates the vocal cord adductor. This paradoxical inspiratory-related adductor activation is induced by an airway reflex triggered mainly through afferents from the larynx and probably contributes to stridor and dyspnea in patients with laryngeal obstruction.

Developmental changes in upper airway dynamics

Normal children have a less collapsible upper airway in response to subatmospheric pressure administration (P(NEG)) during sleep than normal adults do, and this upper airway response appears to be modulated by the central ventilatory drive. Children have a greater ventilatory drive than adults. We, therefore, hypothesized that children have increased neuromotor activation of their pharyngeal airway during sleep compared with adults. As infants have few obstructive apneas during sleep, we hypothesized that infants would have an upper airway that was resistant to collapse. We, therefore, compared the upper airway pressure-flow (V) relationship during sleep between normal infants, prepubertal children, and adults. We evaluated the upper airway response to 1). intermittent, acute P(NEG) (infants, children, and adults), and 2). hypercapnia (children and adults). We found that adults had a more collapsible upper airway during sleep than either infants or children. The children exhibited a vigorous response to both P(NEG) and hypercapnia during sleep (P < 0.01), whereas adults had no significant change. Infants had an airway that was resistant to collapse and showed a very rapid response to P(NEG). We conclude that the upper airway is resistant to collapse during sleep in infants and children. Normal children have preservation of upper airway responses to P(NEG) and hypercapnia during sleep, whereas responses are diminished in adults. Infants appear to have a different pattern of upper airway activation than older children. We speculate that the pharyngeal airway responses present in normal children are a compensatory response for a relatively narrow upper airway.

Contribution of free nerve endings in the laryngeal epithelium to CO2 reception in rats

The superior laryngeal nerve (SLN) contains CO2-sensitive fibers. In the laryngeal epithelium, two candidates for CO2 reception have been identified, namely the intraepithelial free nerve endings and the taste buds. To elucidate the contribution of free nerve endings to CO2 reception, electrophysiological activities were recorded during various stages of regeneration of nerve endings following SLN-crush in rats. The left SLN was crushed surgically and maintained from 4 to 40 days for regeneration of nerve endings. Laryngeal sections were processed for immunohistochemical staining of protein gene product 9.5 to observe regeneration of free nerve endings and taste buds in the epithelium. By day 4 after SLN-crush, both the free nerve endings and taste buds had disappeared. Regeneration of the free nerve endings was recognized from day 8, while that of the taste buds started at day 16. On day 40, the number of taste buds on SLN-crush side was similar to that on the untreated side. Electrophysiological recording of SLN throughout the regeneration period (excluding day 4), showed response to intralaryngeal 9% CO2 (stimulation or inhibition) whether or not taste buds were present. Our results showed intralaryngeal CO2 reception without taste bud involvement, indicating that the free nerve endings in the laryngeal epithelium are receptive to intralaryngeal CO2.

Cough. 1: Chronic cough in adults

The investigation and treatment of chronic cough in adults is generally rewarding, provided there is an understanding of its aetiology, particularly when it arises from sites outside the respiratory tract.

Nasal trigeminal inputs release the A5 inhibition received by the respiratory rhythm generator of the mouse neonate

Experiments were performed on neonatal mice to analyze why, in vitro, the respiratory rhythm generator (RRG) was silent and how it could be activated. We demonstrated that in vitro the RRG in intact brain stems is silenced by a powerful inhibition arising from the pontine A5 neurons through medullary alpha(2) adrenoceptors and that in vivo nasal trigeminal inputs facilitate the RRG as nasal continuous positive airway pressure increases the breathing frequency, whereas nasal occlusion and nasal afferent anesthesia depress it. Because nasal trigeminal afferents project to the A5 nuclei, we applied single trains of negative electric shocks to the trigeminal nerve in inactive ponto-medullary preparations. They induced rhythmic phrenic bursts during the stimulation and for 2-3 min afterward, whereas repetitive trains produced on-going rhythmic activity up to the end of the experiments. Electrolytic lesion or pharmacological inactivation of the ipsilateral A5 neurons altered both the phrenic burst frequency and occurrence after the stimulation. Extracellular unitary recordings and trans-neuronal tracing experiments with the rabies virus show that the medullary lateral reticular area contains respiratory-modulated neurons, not necessary for respiratory rhythmogenesis, but that may provide an excitatory pathway from the trigeminal inputs to the RRG as their electrolytic lesion suppresses any phrenic activity induced by the trigeminal nerve stimulation. The results lead to the hypothesis that the trigeminal afferents in the mouse neonate involve at least two pathways to activate the RRG, one that may act through the medullary lateral reticular area and one that releases the A5 inhibition received by the RRG.

Intertrigeminal region attenuates reflex apnea and stabilizes respiratory pattern in rats

The goal of the present study was to determine whether the newly described anatomical pathway involving the pontine intertrigeminal region (ITR), (Chamberlin and Saper, 1998), has a physiological role in mediating or modulating vagally-induced reflex apnea. We explored the ITR impact on vagal reflex apnea elicited by intravenuously injected 5-HT in ten anesthetized rats. The animals had a catheter inserted into the femoral vein for administration of 5-HT (0.00375 mg) and respiration was recorded by piezo-electric crystal. Multibarrel pipettes were used to pressure inject glutamate (5-10 nl, 10 mM), kynurenic acid (10 nl, 50 mM, a glutamate receptor antagonist), and red dye into the ITR, unilaterally and bilaterally. Intravenous administration of 5-HT produced an immediate 3-s apnea. Microinjections of glutamate into the ITR produced apneas, while microinjections of kynurenic acid blocked the glutamate effect. Following glutamate antagonism, subsequent administration of 5-HT produced apneas of much longer duration (8 s). Acute ponto-medullary transection in two animals yielded even greater prolongation of 5-HT-induced apnea. We conclude that a physiological role for the ITR in respiration is to attenuate vagally-induced reflex apneas. This finding is in agreement with the general modulatory role of pontine structures in autonomic activities including respiration, heart rate and regulation of blood pressure. In addition, our data indicate that medullary circuits, independent of pontine structures, are sufficient to produce 5-HT induced reflex apnea.

Effects of C fiber blockade on cardiorespiratory responses to laryngeal stimulation in concious lambs

The primary aim of the study was to explore cardiorespiratory reflexes originating from laryngeal C fiber endings in the neonatal period. Seventeen lambs were instrumented for recording glottal adductor and diaphragm EMG, heart rate, systemic arterial pressure and respiratory movements. C fiber blockade was induced in eight lambs by 30 mg/kg capsaicin, the remaining nine lambs serving as controls. Cardiorespiratory reflexes were induced in non-sedated lambs by flowing air, menthol or 13% CO2, or by injecting water or 50 microg capsaicin in the laryngeal inlet through an endoscope. Responses to all stimuli but capsaicin were similar between the two groups. While cardiorespiratory responses were induced by capsaicin in control lambs, the responses were significantly inhibited in lambs with C fiber blockade. We conclude that laryngeal C fiber endings are functional and responsible for laryngeal chemoreflexes in newborn lambs.

Upper airway muscle paralysis reduces reflex upper airway motor response to negative transmural pressure in rat

The reflex upper airway (UA) motor response to UA negative pressure (UANP) is attenuated by neuromuscular blockade. We hypothesized that this is due to a reduction in the sensitivity of laryngeal mechanoreceptors to changes in UA pressure. We examined the effect of neuromuscular blockade on hypoglossal motor responses to UANP and to asphyxia in 15 anesthetized, thoracotomized, artificially ventilated rats. The activity of laryngeal mechanoreceptors is influenced by contractions of laryngeal and tongue muscles, so we studied the effect of selective denervation of these muscle groups on the UA motor response to UANP and to asphyxia, recording from the pharyngeal branch of the glossopharyngeal nerve (n = 11). We also examined the effect of tongue and laryngeal muscle denervation on superior laryngeal nerve (SLN) afferent activity at different airway transmural pressures (n = 6). Neuromuscular blockade and denervation of laryngeal and tongue muscles significantly reduced baseline UA motor nerve activity (P < 0.05), caused a small but significant attenuation of the motor response to asphyxia, and markedly attenuated the response to UANP. Motor denervation of tongue and laryngeal muscles significantly decreased SLN afferent activity and altered the response to UANP. We conclude that skeletal muscle relaxation reduces the reflex UA motor response to UANP, and this may be due to a reduction in the excitability of UA motor systems as well as a decrease of the response of SLN afferents to UANP.

Oral and pharyngeal reflexes in the mammalian nervous system: their diverse range in complexity and the pivotal role of the tongue

The oral cavity and pharynx are anatomically separate but functionally integrated regions of the head. The two regions are involved in complex motor responses that include feeding, chewing, swallowing, speech, and respiration. The multiple sensory receptors that innervate these two regions provide the first link in reflexes that control muscles of the entire head, upper gastrointestinal tract, and airway. Most of the reflexes affect the diversity of muscles that compose the tongue, which is vital to all stages of feeding and which continually affects the patency of the airway. Oral-pharyngeal reflexes are evident in the mammalian fetus and continually emerge as the animal or human matures. Some of the first reflexes in the oral region are geared toward nourishment. As the central nervous system matures and the oral and pharyngeal regions develop morphologically, new reflexes develop. Many of these reflexes are protective both of the tissue in the oral cavity, such as the tongue, and of the upper airway in preventing aspiration. While simple reflexes can be evoked in isolation, most reflexes combine with more complex oral and pharyngeal responses such as chewing and vocalization. Oral-pharyngeal reflexes demonstrate a range in complexity. Some sensory stimuli will evoke a series of responses, as is often evident in the infant, and other stimuli will evoke a complex multiple-level recruitment of muscles in a sequence, as in pharyngeal swallowing. Certain sensory inputs evoke an entire motor behavior pattern, such as taste avoidance or facial expression. The oral-pharyngeal reflexes are critical to maintaining life and ultimately serve functions that the oral and pharyngeal regions have in common, such as communication, feeding, and breathing.

Functional morphology and physiology of pulmonary rapidly adapting receptors (RARs)

Rapidly adapting receptors (RARs) in the airway mucosa are found from the nasopharynx to the bronchi. They have thin (Adelta) vagal afferent fibres and lie in and under the epithelium, but their morphology has not been defined. They are very sensitive to mechanical stimuli, and have a rapidly adapting irregular discharge. However, with in vitro preparations they are rather insensitive to chemical stimuli, apart from acid and nonisosmolar solutions. Their pattern of response varies with site. RARs in the nasopharynx, larynx, and trachea usually respond only during the onset of stimuli, while those in the trachea often have an off-response as well. Those in the bronchi are less rapidly adapting and more chemosensitive. Their membranes have mechanosensitive and acid-sensitive ion channels, but no vanilloid receptors. In vivo RARs are sensitive to a wide range of chemical irritants and mediators, and presumably are excited secondarily to mechanical changes in the mucosa and airway smooth muscle. In the central nervous system (CNS) they interact with other vagal afferent pathways. The reflexes they cause vary with site (inspiratory efforts from the nasopharynx, cough or expiratory efforts from the larynx and trachea, and deep breaths or tachypnoea from the bronchi). Pathways from RARs and other vagal reflexes show plasticity at the peripheral, ganglionic, and CNS levels.

Inhibitory synaptic mechanisms regulating upper airway patency

The breathing cycle of vertebrates comprises three phases (inspiration, postinspiration and expiration) that are apparent in the activities generated in the ponto-medullary respiratory network. A large body of evidence now indicates that in adult mammals generation of this three-phase pattern is based on reciprocal synaptic inhibition between distinct subsets of respiratory neurones. This review summarises our recent experiments focused on the role of glycinergic inhibition in respiratory pattern formation: e.g. in co-ordinating the activity of spinal and cranial motor outputs that drive the ventilatory pump (thoracic and abdominal muscles) and adjust airflow by regulating laryngeal resistance (laryngeal abductors and adductors). We used arterially perfused in situ preparations of neonatal and mature rat and show that specific blockade of glycine receptors within the ponto-medullary network caused a severe disruption of the co-ordination of spinal and cranial motor outputs: postinspiratory neurones lose their characteristic inspiratory inhibition revealing excitatory synaptic drive coincident with inspiratory phrenic nerve activity. The resulting simultaneous discharge of inspiratory and postinspiratory neurones caused co-activation of both glottal abductors and adductors during neural inspiration. The latter resulted in a paradoxical inspiratory adduction of the vocal fold and severe disruption of the eupneic breathing pattern. The effect of blocking glycine receptors was the same in both mature and newborn rats suggesting that glycinergic inhibition is essential for co-ordinating cranial and spinal motor outputs from birth.

Neurology of allergic inflammation and rhinitis

Afferent nerves, derived from the trigeminal ganglion, and postganglionic autonomic nerves, derived from sympathetic and parasympathetic ganglia expressing many different neurotransmitters, innervate the nose. Reflexes that serve to optimize the air-conditioning function of the nose by altering sinus blood flow, or serve to protect the nasal mucosal surface by mucus secretion, vasodilatation, and sneezing, can be initiated by a variety of stimuli, including allergen, cold air, and chemical irritation. Activation of nasal afferent nerves can also have profound effects on respiration, heart rate, blood pressure, and airway caliber (the diving response). Dysregulation of the nerves in the nose plays an integral role in the pathogenesis of allergic rhinitis. Axon reflexes can precipitate inflammatory responses in the nose, resulting in plasma extravasation and inflammatory cell recruitment, while allergic inflammation can produce neuronal hyper-responsiveness. Targeting the neuronal dysregulation in the nose may be beneficial in treating upper airway disease.

Trigeminal reflex regulation of the glottis depends on central glycinergic inhibition in the rat

In an unanesthetized decerebrate in situ arterially perfused brain stem preparation of mature rat, strychnine (0.05-0.2 microM) blockade of glycine receptors caused postinspiratory glottal constriction to occur earlier, shifting from early expiration to inspiration. This resulted in a paradoxical inspiratory-related narrowing of the upper airway. Stimulation of the trigeminal ethmoidal nerve (EN5; 20 Hz, 100 micros, 0.5-2 V) evoked a diving response, which included a reflex apnea, glottal constriction, and bradycardia. After strychnine administration, this pattern was converted to a maintained phrenic nerve discharge and a reduced glottal constriction that was interrupted intermittently by transient abductions. The onset of firing of postinspiratory neurons shifted from early expiration into neural inspiration in the presence of strychnine, but neurons maintained their tonic activation during EN5 stimulation, as observed during control. Inspiratory neurons that were hyperpolarized by EN5 stimulation in control conditions were powerfully excited after loss of glycinergic inhibition. Thus the integrity of glycinergic inhibition within the pontomedullary respiratory network is critical for the coordination of cranial and spinal motor outflows during eupnea but also for protective reflex regulation of the upper airway.

Anatomical study applied to anesthetic block technique of the superior laryngeal nerve

BACKGROUND

The topography of the internal branch of the superior laryngeal nerve (ibSLN) was prospectively studied to evaluate the greater horn of the hyoid bone (ghHB) and the incisura of the thyroid cartilage (iTC) as anatomical repairs in laryngeal anesthetic block. Factors such as gender, ethnicity and side of the neck were also analyzed concerning their influence in the ibSLN position.

METHODS

One hundred neck dissections were performed in 50 human cadavers bilaterally identifying the ibSLN, the ghHB and iTC. The distance between the ghHB and ibSLN in the cranio-caudal direction (dHB), and the distance between the iTC and the ipsilateral thyrohyoid membrane ostium (dTC) were measured. Furthermore, the results were statistically analyzed according to ethnicity, gender and side of the neck.

RESULTS

The ibSLN was juxtaposed to the apex ghBH in 31 out of 100 dissections. The mean dHB was 2.4 mm, and mean dTC was 33.4 mm. The statistical analysis did not identify any significant difference regarding those distances between the groups in terms of ethnicity, gender and side of the neck.

CONCLUSION

The ibSLN was often dissected very close to the ghHB, and this result was not influenced by any factor studied. Therefore, the ghHB can be considered a good anatomical repair to localize the ibSLN in the local block of the larynx. Furthermore, the dTC could frequently be reached by routinely used nerve block needle. However, a few anatomical variations may occur, resulting in a low failure rate of this anesthetic procedure.

Effect of upper airway negative pressure and lung inflation on laryngeal motor unit activity in rabbit

Distortion of the upper airway by negative transmural pressure (UANP) causes reflex vagal bradycardia. This requires activation of cardiac vagal preganglionic neurons, which exhibit postinspiratory (PI) discharge. We hypothesized that UANP would also stimulate cranial respiratory motoneurons with PI activity. We recorded 32 respiratory modulated motor units from the recurrent laryngeal nerve of seven decerebrate paralyzed rabbits and recorded their responses to UANP and to withholding lung inflation using a phrenic-triggered ventilator. The phasic inspiratory (n = 17) and PI (n = 5) neurons detected were stimulated by -10 cmH(2)O UANP and by withdrawal of lung inflation (P < 0.05, Friedman's ANOVA). Expiratory-inspiratory units (n = 10) were tonically active but transiently inhibited in postinspiration; this inhibition was more pronounced and prolonged during UANP stimuli and during no-inflation tests (P < 0.05). We conclude that, in addition to increasing inspiratory activity in the recurrent laryngeal nerve, UANP also stimulates units with PI activity.

Olfactory CO(2) chemoreceptors

Amphibians and reptiles possess CO(2)-sensitive olfactory receptors that cause a dose-dependent decrease in breathing when stimulated by CO(2) concentrations ranging from 0.5 to 8%. In amphibians, it has been shown that inhibition of the enzyme, carbonic anhydrase (CA), attenuates the response of CO(2)-sensitive olfactory receptors to transient changes in nasal CO(2). Histology and electrophysiology studies in frogs show that identification of sites of CA activity can serve as markers for locations of CO(2) chemosensitivity in the olfactory epithelium. There is also growing evidence that CO(2) receptors may be present in the olfactory epithelium of mammals. The objectives of this review are to, (1) summarize the current state of knowledge of olfactory CO(2) receptors in amphibians, reptiles, and mammals; (2) present results from an experiment designed to determine the distribution and density of CA activity within the rat nasal cavity; (3) show results from an experiment that recorded the olfactory receptor response to CO(2) in areas of the rat nasal cavity exhibiting the highest densities of CA activity; and (4) discuss the presumed role of the olfactory CO(2) receptors in the control of breathing and in abnormalities of breathing, such as sudden infant death syndrome (SIDS).

Reflex respiratory response to changes in upper airway pressure in the anaesthetized rat

1. We examined the upper airway (UA) motor response to upper airway negative pressure (UANP) in the rat. We hypothesized that this response is mediated by superior laryngeal nerve (SLN) afferents and is not confined to airway dilator muscles but also involves an increase in motor drive to tongue retractor and pharyngeal constrictor muscles, reflecting a role for these muscles in stabilizing the UA. 2. Experiments were performed in 49 chloralose-anaesthetized, tracheostomized rats. Subatmospheric pressure in the range 0 to -30 cmH(2)O was applied to the isolated UA. Motor activity was recorded in separate experiments from the main trunk of the hypoglossal nerve (XII, n = 8), the pharyngeal branch of the glossopharyngeal nerve (n = 8), the medial and lateral branches of the XII (n = 8) and the pharyngeal branch of the vagus (n = 8). Afferent activity was recorded from the whole SLN in six experiments. 3. All UA motor outflows exhibited phasic inspiratory activity and this was significantly (P < 0.05) increased by UANP. Tonic end-expiratory activity increased significantly in response to pressures more negative than -20 cmH(2)O. Bilateral section of the SLN also increased (P < 0.05) motor activity and abolished the responses to UANP. Electrical stimulation of the SLN inhibited inspiratory XII activity. SLN afferents were tonically active and inhibited by UANP. 4. We conclude that UANP causes a reflex increase in motor drive to pharyngeal dilator, tongue retractor and pharyngeal constrictor muscles via afferent fibres in the SLN. Tonic activity in SLN afferent fibres at zero transmural pressure exerts a marked inhibitory effect on UA motor outflow.

Negative pressure effects on mechanically opposing pharyngeal muscles in awake and sleeping goats

Our aim was to investigate the effects of the negative pressure reflex on mechanically opposing pharyngeal muscles during wakefulness, slow-wave sleep (SWS), and rapid eye movement (REM) sleep. In four goats with isolated upper airways, we measured tracheal airflow and electrical activity of the thyropharyngeus (TP; constricting), the stylopharyngeus (SP; dilating), and the diaphragm (Dia). In the wakefulness state in response to negative pressure tests, TP decreased (65%), SP increased (198%), and tidal volume (VT) (66%) and rate of rise of Dia (Dia(slope), 69%) decreased (P < 0.02). Similarly, during SWS, the negative pressure response of TP (31%), VT (61%), and Dia(slope) (60%) decreased, whereas SP (113%) increased, relative to SWS control (P < 0.02). In REM sleep, the negative pressure response by TP and SP were small, whereas both VT (38%) and Dia(slope) (24%) were greatly decreased (P < 0.02) compared with REM control. Inspiratory duration remained unchanged in response to negative pressure tests in all states. These data provide evidence that mechanically opposing inspiratory and expiratory pharyngeal muscles are reciprocally controlled and their response to negative pressure are state dependent.

Neural control of tongue movement with respect to respiration and swallowing

The tongue must move with remarkable speed and precision between multiple orofacial motor behaviors that are executed virtually simultaneously. Our present understanding of these highly integrated relationships has been limited by their complexity. Recent research indicates that the tongue s contribution to complex orofacial movements is much greater than previously thought. The purpose of this paper is to review the neural control of tongue movement and relate it to complex orofacial behaviors. Particular attention will be given to the interaction of tongue movement with respiration and swallowing, because the morbidity and mortality associated with these relationships make this a primary focus of many current investigations. This review will begin with a discussion of peripheral tongue muscle and nerve physiology that will include new data on tongue contractile properties. Other relevant peripheral oral cavity and oropharyngeal neurophysiology will also be discussed. Much of the review will focus on brainstem control of tongue movement and modulation by neurons that control swallowing and respiration, because it is in the brainstem that orofacial motor behaviors sort themselves out from their common peripheral structures. There is abundant evidence indicating that the neural control of protrusive tongue movement by motoneurons in the ventral hypoglossal nucleus is modulated by respiratory neurons that control inspiratory drive. Yet, little is known of hypoglossal motoneuron modulation by neurons controlling swallowing or other complex movements. There is evidence, however, suggesting that functional segregation of respiration and swallowing within the brainstem is reflected in somatotopy within the hypoglossal nucleus. Also, subtle changes in the neural control of tongue movement may signal the transition between respiration and swallowing. The final section of this review will focus on the cortical integration of tongue movement with complex orofacial movements. This section will conclude with a discussion of the functional and clinical significance of cortical control with respect to recent advances in our understanding of the peripheral and brainstem physiology of tongue movement.

Respiratory and metabolic effects of decreased osmolality in conscious rats

We investigated the respiratory and metabolic effects of decreased osmolality, and the potential roles of angiotensin II (ANG II) and the subfornical organ (SFO) in mediating these effects, in conscious Sprague-Dawley (SD) rats. Gastric water loading was induced either by oral gavage or an externalized indwelling stomach tube (20 mL·kg-1 distilled water at body temperature). Repeated measurements after oral gavage were obtained with and without water loading and with and without ANG II receptor block (saralasin, 1.3 µg·kg-1·min-1 iv). At 15 min after water loading by oral gavage, ventilation ([Formula: see text], 1.14 ± 0.08 L·kg-1·min-1) and tidal volume (10.7 ± 0.6 mL·kg-1) were transiently higher (P < 0.05), at a time when plasma osmolality was decreased (-8 ± 1 mOsm), compared with gavage tube alone (0.95 ± 0.08 L·kg-1·min-1 and 9.1 ± 0.7 mL·kg-1, respectively). However, water loading via stomach tube did not stimulate [Formula: see text]; only during the 60-s period of water infusion did [Formula: see text] increase briefly, but this was due to increased respiratory frequency. Dye indicators demonstrated that oral gavage exposes upper airway and esophageal afferents to water, presumably accounting for respiratory stimulation. Lesions of the SFO did not affect respiration or metabolism. A decrease in osmolality, associated with both water loading techniques, caused a sustained increase in oxygen consumption ([Formula: see text]) and a decrease in the [Formula: see text] ratio. ANG II receptor block reduced the * response and prevented the decrease in [Formula: see text] following water loading by oral gavage, but did not affect the transient stimulation of [Formula: see text]. Unlike larger mammals, decreased osmolality does not stimulate respiration in the SD rat.Key words: alphastat theory of respiratory control, circumventricular organs, gastric distension, osmoreceptors, [Formula: see text] ratio.

Laryngeal muscle response to phasic and tonic upper airway pressure and flow

The hypothesis that respiratory modulation due to upper airway (UA) pressure and flow is dependent on stimulus modality and respiratory phase-specific activation was assessed in anesthetized, tracheotomized, spontaneously breathing piglets. Negative pressure and flow applied to the isolated UA at room or body temperature during inspiration only enhanced posterior cricoarytenoid muscle activity from that present without UA pressure and flow (baseline) by 15--20%. Time shifting the onset of UA flow relative to tracheal flow decreased this enhancement. The same enhancement was observed with oscillatory or constant airflow. UA positive pressure and flow at room or body temperature applied during expiration only enhanced thyroarytenoid muscle activity from baseline by 50--160%. The same enhancement was observed with oscillatory or constant airflow at body temperature. Constant positive pressure and flow enhanced thyroarytenoid muscle activity more than oscillatory pressure and flow at room temperature. We conclude that the respiratory modulation of UA afferents is processed in a phase-specific fashion and is dependent on stimulus modality (tonic vs. phasic).

Modulation of laryngeal and respiratory pump muscle activities with upper airway pressure and flow

The hypothesis that upper airway (UA) pressure and flow modulate respiratory muscle activity in a respiratory phase-specific fashion was assessed in anesthetized, tracheotomized, spontaneously breathing piglets. We generated negative pressure and inspiratory flow in phase with tracheal inspiration or positive pressure and expiratory flow in phase with tracheal expiration in the isolated UA. Stimulation of UA negative pressure receptors with body temperature air resulted in a 10--15% enhancement of phasic moving-time-averaged posterior cricoarytenoid electromyographic (EMG) activity above tonic levels obtained without pressure and flow in the UA (baseline). Stimulation of UA positive pressure receptors increased phasic moving-time-averaged thyroarytenoid EMG activity above tonic levels by 45% from baseline. The same enhancement of posterior cricoarytenoid or thyroarytenoid EMG activity was observed with the addition of flow receptor stimulation with room temperature air. Tidal volume and diaphragmatic and abdominal muscle activity were unaffected by UA flow and/or pressure, whereas respiratory timing was minimally affected. We conclude that laryngeal afferents, mainly from pressure receptors, are important in modulating the respiratory activity of laryngeal muscles.

Upper airway sensation in snoring and obstructive sleep apnea

Previous studies indicate that upper airway (UA) sensory receptors play a role in the maintenance of UA patency and contribute to arousal in response to airway occlusion. An impairment of UA sensory function could therefore predispose to UA obstruction during sleep. We hypothesized that UA sensation is impaired in obstructive sleep apnea (OSA), and that sensation improves after treatment with nasal continuous positive airway pressure (CPAP). We measured two-point discrimination (2PD) and vibratory sensation thresholds (VT) in 37 patients with OSA (mean [+/- SE] apnea- hypopnea index [AHI] = 39 +/- 5 events/h), 12 nonapneic snorers (SN), and 15 control subjects (CL). Sensory thresholds were determined in the UA and on the lip and hand as control sites. Both 2PD and VT were similar among the three groups at the lip and hand sites but were significantly reduced in the UA of OSA and SN subjects versus CL (p < 0.05). Values for 2PD and VT in the UA of OSA versus SN were not significantly different. Sensory measures were repeated after 6 mo in 23 OSA patients treated with CPAP as well as in 18 untreated patients. Thresholds for 2PD and VT at control sites remained identical in both groups, as did 2PD for the UA. However, VT in the UA showed a significant improvement in treated (4.4 +/- 0.2 pre-CPAP versus 3.8 +/- 0.2 mm post-CPAP, p < 0.05) but not untreated patients. These findings indicate the presence of a selective impairment in the detection of mechanical stimuli in the UA of patients with OSA and SN, which is partially reversible after treatment with nasal CPAP in patients with OSA.

Effect of recurrent laryngeal nerve paralysis on superior laryngeal nerve afferents during evoked vocalization

We tested the hypothesis that vocal fold paresis leads to a substantial reduction in activity from the internal branch of the superior laryngeal nerve (iSLN) during respiration and evoked vocalization. The iSLN afferent activity was measured before and after recurrent laryngeal nerve paresis by cold block in decerebrate cats during spontaneous respiration and electrically evoked vocalization. Response rate patterns of 33 iSLN single units from 11 cats were categorized into 5 groups based on responses to vocalization. Only 24% of single units during spontaneous respiration and 18% during evoked phonation displayed activity pattern changes as a result of paresis. Those fibers affected were heterogeneous in discharge pattern, but none of the units that followed voice frequency lost this characteristic when the motor nerve was cooled. The relative insensitivity of iSLN activity to motor paralysis suggests that the receptors studied are coupled to tissue such that passive interaction rather than active muscular contraction is the major stimulus.

Morphology of the glomerular nerve endings in the dorsal nasal ligament of the dog

The nasal atrium appears to be an important sensory site in the dog, yet no literature is available concerning its nerve supply. The present paper demonstrates the occurrence of glomerular nerve endings in the canine nasal atrium, using immunohistochemistry for neurofilament protein (NFP) and for glial fibrillary acidic protein (GFAP). Glomerular nerve endings occurred on the perichondrium of the septal and the dorsal lateral nasal cartilages, and their terminal portions were attached with dense collagen fibril strands of the dorsal nasal ligament. The glomerular endings were derived from a thick parent axon which branched repeatedly. Complicated winding nerve fibers gave rise to numerous thin filamentous terminals. Accumulations of GFAP immunoreactive glial cells were also observed. Immunoelectron microscopy for NFP revealed several axon terminals in the glomerular endings which contained numerous neurofilaments and mitochondria and were incompletely covered by Schwann cell sheaths. The glomerular endings in the dog nasal vestibule are suggested to perceive tensional changes in the nasal dorsal ligament caused by the opening of the nostrils and to be involved in the reflex regulating the activity of the nasal muscles.

Respiratory and cardiovascular reflexes elicited by nasal instillation of capsaicin to anesthetized, spontaneously breathing dogs

Cardiopulmonary reflexes elicited by capsaicin (CAPS) instilled into the nasal passages were determined in 6 anesthetized dogs breathing spontaneously. Nasal instillation of CAPS (10 microg/ml, 10 ml) induced: 1) apneic response characterized by an increase in expiration time; 2) bronchoconstrictor response characterized by an increase in lung resistance and a decrease in dynamic compliance; and 3) cardiovascular response characterized by a decrease in heart rate and an increase in arterial blood pressure. These reflex responses to CAPS were attenuated by pretreatment with a higher dose of CAPS (100 microg/ml, 10 ml), suggesting desensitization of CAPS-sensitive endings. These results suggest that marked cardiopulmonary reflexes are produced by nasal CAPS instillation, which may result, at least in part, from stimulation of nasal CAPS-sensitive sensory afferents.

Respiratory reflexes in spontaneously breathing anesthetized dogs in response to nasal administration of sevoflurane, isoflurane, or halothane

OBJECTIVE

To characterize respiratory reflexes elicited by nasal administration of sevoflurane (Sevo), isoflurane (Iso), or halothane (Hal) in anesthetized dogs.

ANIMALS

8 healthy Beagles.

PROCEDURE

A permanent tracheostomy was created in each dog. Two to 3 weeks later, dogs were anesthetized by IV administration of thiopental and alpha-chloralose. Nasal passages were isolated such that inhalant anesthetics could be administered to the nasal passages while the dogs were breathing 100% O2 via the tracheostomy. Respiratory reflexes in response to administration of each anesthetic at 1.2 and 2.4 times the minimum alveolar concentration (MAC) and the full vaporizer setting (5%) were recorded. Reflexes in response to administration of 5% of each anesthetic also were recorded following administration of lidocaine to the nasal passages.

RESULTS

Nasal administration of Sevo, Iso, and Hal induced an immediate ventilatory response characterized by a dose-dependent increase in expiratory time and a resulting decrease in expired volume per unit of time. All anesthetics had a significant effect, but for Sevo, the changes were smaller in magnitude. Responses to administration of each anesthetic were attenuated by administration of lidocaine to the nasal passages.

CONCLUSIONS AND CLINICAL RELEVANCE

Nasal administration of Sevo at concentrations generally used for mask induction of anesthesia induced milder reflex inhibition of breathing, presumably via afferent neurons in the nasal passages, than that of Iso or Hal. Respiratory reflexes attributable to stimulation of the nasal passages may contribute to speed of onset and could promote a smoother induction with Sevo, compared with Iso or Hal.

Airway receptors

There are many types of afferent receptor in the airways; at least five in the larynx: pressure, drive, cold, irritant and C-fibre; and at least four in the trachea and bronchi: slowly and rapidly adapting stretch receptors (SARs and RARs), C-fibre receptors, and those in neuroepithelial bodies (NEBs). Histologically enough sensory structures have been identified to account for the various patterns of afferent activity, but most correlations are poor. For the larynx, four or more sensory structures have not definitively been identified with afferent discharges and reflex responses. For the trachea and bronchi, only SARs have been clearly identified morphologically and physiologically. The reflexes and afferent discharges from RARs and C-fibre receptors are fairly clear, some at least of the sensory terminals lie in the epithelium, but receptor complexes have not been mapped out. Nerves in NEBs have been identified, but not their local and central reflex actions.

Morphology of the nerve endings in laryngeal mucosa of the horse

To discuss the significance of laryngeal sensation on various disorders of the horse, we studied the morphological and topographical characteristics of sensory structures in the laryngeal mucosa using immunohistochemistry and immunoelectron microscopy. Various sensory structures, i.e. glomerular endings, taste buds and intraepithelial free nerve endings, were found in the laryngeal mucosa by immunohistochemistry for protein gene product 9.5 (PGP 9.5) and neurofilament 200kD (NF200). Glomerular nerve endings were distributed mainly in the epiglottic mucosa; some endings were also found in the arytenoid region arising from thick nerve fibres running through the subepithelial connective tissue. Some terminals directly contacted the epithelial cells. Taste buds were distributed in the epithelium of the epiglottis and aryepiglottic fold. In the whole mount preparation, the taste buds were supplied by the terminal branching of the thick nerve fibres. In some cases, the taste buds were arranged around the opening of the duct of the epiglottic glands. The intraepithelial free nerve endings were found to be immunoreactive for substance P (SP) and calcitonin gene-related peptide (CGRP). These nerve endings were surrounded by the polygonal stratified epithelial cells in the supraglottic region, and by the ciliated cells in the subglottic region. The density of the intraepithelial free nerve endings was highest in the corniculate process of the arytenoid region and lowest in the vocal cord mucosa. The densities of CGRP- and SP-immunoreactive nerve endings in the arytenoid region were (mean +/- s.d.) 30.6+/-12.0 and 10.0+/-4.9 per unit epithelial length (1 mm), respectively and in the vocal fold mucosa, 1.1+/-0.9 and 0.8+/-0.7, respectively. Approximately one half of the CGRP immunoreactive nerve endings were immunoreactive for SP, and most SP-immunoreactive nerve endings were also immunoreactive for CGRP. Well-developed subepithelial plexus with numerous intraepithelial fibres were observed in flat or round mucosal projections that existed on the corniculate process of the arytenoid region. In conclusion, the laryngeal mucosa of the horse seems to have morphology- and/or location-dependent sensory mechanisms against various endo-and exogenious stimuli.

Respiratory reflexes in response to upper-airway administration of sevoflurane and isoflurane in anesthetized, spontaneously breathing dogs

OBJECTIVE

To evaluate the respiratory effects occurring during administration of sevoflurane or isoflurane to the upper airway in dogs.

STUDY DESIGN

A prospective, randomized study.

ANIMALS

Twelve healthy adult beagles (6 males, 6 females).

METHODS

At least 2 weeks after undergoing permanent tracheostomy, dogs were premedicated with acepromazine-buprenorphine, and anesthesia was induced with thiopental and maintained with alpha-chloralose. The upper airway was functionally isolated so that the inhalant could be administered to the upper airway while dogs were breathing 100% O2 via the tracheostomy. Respiratory reflexes in response to the administration of sevoflurane or isoflurane at concentrations of 1.2, 1.8, and 2.4 times the minimal alveolar concentration (MAC) (administered in 100% O2 at a flow rate of 5 L/min) were recorded. Reflexes in response to administration of each anesthetic were also recorded following upper-airway administration of lidocaine.

RESULTS

Respiratory reflexes elicited by upper-airway administration of each anesthetic were characterized by a dose-dependent increase in expiration time, with a resultant decrease in respiratory minute ventilation and increase in end-tidal PCO2. The magnitude of these responses was greater with isoflurane than with sevoflurane at 1.8 and 2.4 MAC. These reflexes were abolished after lidocaine nebulization into the upper airway.

CONCLUSION

Isoflurane induces greater reflex inhibition of breathing than does sevoflurane when the anesthetic is inhaled into the upper airway at concentrations used for mask induction.

Calbindin D28k-immunoreactive afferent nerve endings in the laryngeal mucosa

The distribution of the calbindin D28k in the laryngeal sensory structures was studied by immunohistochemistry, immunoelectronmicroscopy, and double immunofluorescence with calretinin-immunoreactivity. Moreover, origin of the nerve endings were observed using retrograde tracer, fast blue. Immunoreactivity for calbindin D28k was found in the various types of nerve endings in the larynx, namely, laminar nerve endings, nerve endings associated with the taste buds, intraepithelial nerve endings, and endocrine cells. The laminar endings with calbindin D28k-immunoreactivity were observed in the subepithelial connective tissue. In some endings, terminals were expanded. The laminar endings were also observed in the perichondrium of the epiglottic cartilage. In the epiglottic and arytenoid epithelia, thick nerve fibers with calbindin D28k-immunoreactivity ascending to taste buds and intragemmal nerve fibers were also observed. Within the epithelial layer, intraepithelial free nerve endings with calbindin D28k-immunoreactivity were observed. Furthermore, diffuse endocrine cells were observed within the laryngeal epithelium. By immunoelectron microscopy, immunoreaction products in the endings mentioned above were localized in the cytoplasm of the axon terminals and nerve fibers which contained with numerous mitochondria. Out of the 100 laminar endings, 18 endings were immunopositive for both calbindin D28k and calretinin, 33 were positive for calbindin D28k but negative for calretinin, and 49 were positive for only calretinin in the double immunofluorescence microscopy. The nerve fibers associated with the taste buds and the free nerve endings, which immunostained for calbindin D28k, were not stained with antibody against calretinin. After injection of the fast blue in the laryngeal mucosa, fast blue-labeled cells were mainly observed in the nodose ganglia. Of the total number of labeled cell in the nodose and dorsal root ganglia at the level C1 to Th2, 65.1% occurred in nodose ganglia (572/879, n = 6). In the nodose ganglia, 79.7% of labeled cells (456/572) were immunoreacted for calbindin D28k. The distribution of calbindin D28k-immunoreactivity may be differnt from that of calretinin. It is suggested that calbindin D28k have regulatory role on intracellular calcium concentration in the laryngeal sensory corpuscles.

Effects of perineural capsaicin treatment on cardiopulmonary reflexes elicited by laryngeal instillations of capsaicin and distilled water in sevoflurane-anesthetized dogs

The aim of this study was to determine the effect of perineural capsaicin (CAPS) treatment on cardiopulmonary reflexes elicited by topical laryngeal instillation of CAPS and distilled water (DW) in sevoflurane-anesthetized dogs. Cardiopulmonary reflexes elicited by CAPS (10 microg/ml, 10 ml) were attenuated by perineural CAPS treatment to the superior laryngeal nerves (SLNs) (P<0.05), whereas those by DW (10 ml) remained unaffected (P>0.05). The reflex responses to DW that remained even after the perineural CAPS treatment were eliminated by laryngeal anesthesia with lidocaine. These results suggest that cardiopulmonary reflexes from the laryngeal mucosa elicited by CAPS instillation can be blocked by perineural CAPS treatment to the SLNs, which may result from inhibition of the laryngeal CAPS-sensitive C-fiber afferents.

Laryngeal C-fiber afferents are not involved in the apneic response to laryngeal wood smoke in anesthetized rats

Laryngeal exposure to wood smoke in rats evokes a reflex apnea which is mediated through superior laryngeal afferents (J. Appl. Physiol. 83: 723-730, 1997). To study the role of laryngeal C-fiber afferents in eliciting this response, capsaicin aerosol (0.05 - 0.2 microg/ml) and 5 ml of wood smoke were delivered separately into a functionally isolated larynx of anesthetized Sprague-Dawley rats at a constant flow rate of 1.4 ml/s, while animals breathed spontaneously. Studies were repeated after either an intravenous injection of ruthenium red (2 mg/kg; n = 8), a perineural capsaicin treatment (200 microg/ml for 5 min; n = 8) of the superior laryngeal nerves, or a perineural sham treatment (n = 8); Ruthenium red inhibits the stimulation of afferent C-fiber nerve endings by capsaicin, whereas perineural capsaicin treatment selective blocks the conduction of C-fiber afferents. Either ruthenium red or perineural capsaicin treatment abolished the apneic response to laryngeal capsaicin, but did not significantly affect the apneic response to laryngeal wood smoke. Furthermore, the apneic responses to both types of irritants were not significantly altered by perineural sham treatment, yet were completely eliminated by a subsequent denervation of superior laryngeal nerves. Our results suggest that superior laryngeal C-fiber afferents are not involved in eliciting the reflex apneic response to laryngeal wood smoke in anesthetized rats. It is speculated that this response may result mainly from the stimulation of myelinated afferents, possibly laryngeal irritant receptors.