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Geetha S, Prashanth NV, Durga P, Jayaram K, Farooq M, Chandra S, Sushma. Comparison of nebulisation 0.75% ropivacaine with 2% lignocaine for attenuation of haemodynamic response due to intubation: A prospective randomised study. J Perioper Pract 2024:17504589241229906. [PMID: 38600632 DOI: 10.1177/17504589241229906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Laryngoscopy and intubation are associated with the reflex response of hypertension, tachycardia and other intraoperative complications. Nebulised route drug administration and entropy-guided induction enable optimal intubating conditions. AIMS To compare pre-induction nebulisation between 0.75% ropivacaine and 2% lignocaine in blunting the nasotracheal intubation response. MATERIALS AND METHODS A total of 100 patients undergoing elective faciomaxillary surgeries were prospectively randomised to receive pre-induction nebulisation: 5mL of 2% lignocaine (100mg) (Group L) or 5mL of 0.75% ropivacaine (37.5mg) (Group R). Patients were induced and intubated (nasotracheal) with entropy monitoring. Observed parameters included systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, entropy at baseline, induction, intubation, post-intubation one, three and five minutes, propofol induction dose, electrocardiogram changes and peri-intubation cough reflex. RESULTS Ropivacaine aerosol proved significantly better than lignocaine aerosol on haemodynamics (systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate) and cough reflex (p < 0.05). Both groups experienced similar entropy changes and propofol induction dose requirements and no fresh electrocardiogram changes (compared with the baseline). CONCLUSION Pre-induction nebulised ropivacaine offers superior intubating conditions than lignocaine regarding haemodynamic response and cough reflex for faciomaxillary surgeries.
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Affiliation(s)
- Singam Geetha
- Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | - Padmaja Durga
- Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | | | | | - Sushma
- Nizam's Institute of Medical Sciences, Hyderabad, India
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Li P, Li D, Wang L, Ye F, Yang B, Yu L, Fang S, Tong Z, Yin Q, Shi Y, Li X, Zhao G. Effects of lidocaine administration via the perforated outer cuff of a dual-cuff endotracheal tube and remifentanil administration on recovery from general anaesthesia for female patients undergoing thyroidectomy: a single centre, double-blind, randomised study. BMC Anesthesiol 2022; 22:194. [PMID: 35733086 PMCID: PMC9213641 DOI: 10.1186/s12871-022-01734-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
Background Cough caused by endotracheal tube (ETT) placement is ubiquitous and correlates with adverse outcomes. Remifentanil administration via target-controlled infusion (TCI) is one of the cough prevention measures used during recovery. In a pilot study, lidocaine administered via the perforated outer cuff of a dual-cuff endotracheal tube was also found to prevent cough due to ETT placement. We therefore compared these two cough prevention approaches during recovery after thyroidectomy in a single-centre, double-blind, randomised study conducted in China during the period from 09/10/2020 to 30/04/2021. Methods Ninety-eight female patients aged 18–65 years with American Society of Anaesthesiologists Physical Status scores of I and II were scheduled to undergo thyroidectomy. The ETT contained an internal cuff covered by a perforated outer cuff to allow for lidocaine delivery. Patients were randomised to receive either 4 ml of saline solution (Group R, n = 49) or 4 ml of 2% lidocaine in the outer cuff (Group L, n = 49) at the beginning of skin suturing. Remifentanil (2 ng/ml) was maintained in Group R until extubation, while remifentanil was maintained in Group L until the end of skin suturing. The primary outcome was cough during patient transfer, at 1 min before extubation, and at extubation. The secondary outcomes were haemodynamics and other recovery parameters. Results Primary outcomes were compared between remifentanil vs. lidocaine application, namely, the incidence of cough during patient transfer (0% in Group R vs. 0% in Group L), at 1 min before extubation (22.45% in Group R vs. 4.08% in Group L; P = 0.015), and at extubation (61.22% in Group R vs. 20.41% in Group L; P < 0.001). Compared with remifentanil, lidocaine more effectively decreased heart rate elevation and hypoxemia at 5 min after extubation, the spontaneous respiration recovery time, the extubation time, the duration of post-anaesthesia care unit (PACU) stay, Richmond Agitation-Sedation Scale scores in the agitated range and Critical-Care Pain Observation Tool scores. Conclusion Lidocaine administered via the perforated outer cuff of the ETT significantly improved recovery from general anaesthesia compared to remifentanil in female patients after thyroidectomy. Trial registration Chinese Clinical Trial Registry (No. ChiCTR2000038653), registered on 27/09/2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01734-1.
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Affiliation(s)
- Ping Li
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine: Guangdong Provincial Hospital of Chinese Medicine, Guangzhou City, Guangdong Province, 510120, People's Republic of China
| | - Dewei Li
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine: Guangdong Provincial Hospital of Chinese Medicine, Guangzhou City, Guangdong Province, 510120, People's Republic of China
| | - Linan Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine: Guangdong Provincial Hospital of Chinese Medicine, Guangzhou City, Guangdong Province, 510120, People's Republic of China
| | - Fei Ye
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine: Guangdong Provincial Hospital of Chinese Medicine, Guangzhou City, Guangdong Province, 510120, People's Republic of China
| | - Bo Yang
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine: Guangdong Provincial Hospital of Chinese Medicine, Guangzhou City, Guangdong Province, 510120, People's Republic of China
| | - Lina Yu
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine: Guangdong Provincial Hospital of Chinese Medicine, Guangzhou City, Guangdong Province, 510120, People's Republic of China
| | - Sujuan Fang
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine: Guangdong Provincial Hospital of Chinese Medicine, Guangzhou City, Guangdong Province, 510120, People's Republic of China
| | - Zhilan Tong
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine: Guangdong Provincial Hospital of Chinese Medicine, Guangzhou City, Guangdong Province, 510120, People's Republic of China
| | - Qing Yin
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine: Guangdong Provincial Hospital of Chinese Medicine, Guangzhou City, Guangdong Province, 510120, People's Republic of China
| | - Yongyong Shi
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine: Guangdong Provincial Hospital of Chinese Medicine, Guangzhou City, Guangdong Province, 510120, People's Republic of China
| | - Xiangyu Li
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine: Guangdong Provincial Hospital of Chinese Medicine, Guangzhou City, Guangdong Province, 510120, People's Republic of China
| | - Gaofeng Zhao
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine: Guangdong Provincial Hospital of Chinese Medicine, Guangzhou City, Guangdong Province, 510120, People's Republic of China.
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Al-Kandery ASA, Rao MS, El-Hashim AZ. Prostaglandin E 2 sensitizes the cough reflex centrally via EP3 receptor-dependent activation of NaV 1.8 channels. Respir Res 2021; 22:296. [PMID: 34794450 PMCID: PMC8603488 DOI: 10.1186/s12931-021-01889-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022] Open
Abstract
Background Cough hypersensitivity is a major characteristic feature associated with several types of cough, including chronic cough, but its underlying mechanisms remain to be fully understood. Inflammatory mediators, such as prostaglandin E2 (PGE2), have been implicated in both peripheral induction and sensitization of the cough reflex. In this study, using a conscious guinea pig model of cough, we investigated whether PGE2 can sensitize the cough reflex via central actions and, if so, via which mechanisms. Methods All drugs were administered by intracerebroventricular (i.c.v.) route and whole-body plethysmograph set-up was used for both induction, using aerosolized citric acid (0.2 M), and recording of cough. Immunohistochemistry was performed to confirm the expression of NaV 1.8 channels in the nucleus tractus solitarius (nTS). Results We show that both PGE2 and the non-selective EP1/EP3 agonist, sulprostone, dose-dependently enhanced the citric acid-induced cough (P ≤ 0.001, P ≤ 0.01, respectively). Pretreatment with the EP1 antagonist, ONO-8130, did not affect the sulprostone-induced cough sensitization, whilst the EP3 antagonist, L-798,106, dose-dependently inhibited this effect (P ≤ 0.05). Furthermore, treatment with either the EP2 agonist, butaprost or the EP4 agonist, L-902,688, had no effect on cough sensitization. Additionally, pretreatment with either the TRPV1 antagonist, JNJ-17203212 or the TRPA1 antagonist, HC-030031, alone or in combination, nor with the NaV 1.1, 1.2, 1.3, 1.4, 1.6 and 1.7 channel blocker, tetrodotoxin, had any effect on the cough. In contrast, pretreatment with the NaV 1.8 antagonist, A-803467, dose-dependently inhibited this effect (P ≤ 0.05). Furthermore, NaV 1.8 channels were shown to be expressed in the nTS. Conclusion Collectively, our findings show that PGE2 sensitizes the cough reflex centrally via EP3 receptor-dependent activation of NaV 1.8 but independently of TRPV1,TRPA1 and TTX-sensitive sodium channel activation. These results indicate that PGE2 plays an important role in central sensitization of the cough reflex and suggest that central EP3 receptors and/or NaVv 1.8 channels may represent novel antitussive molecular targets. Graphical Abstract ![]()
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Affiliation(s)
- Al-Shaimaa A Al-Kandery
- Department of Pharmacology & Therapeutics, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Muddanna S Rao
- Department of Anatomy, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ahmed Z El-Hashim
- Department of Pharmacology & Therapeutics, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait.
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Brozmanova M, Pavelkova N. The Prospect for Potent Sodium Voltage-Gated Channel Blockers to Relieve an Excessive Cough. Physiol Res 2021; 69:S7-S18. [PMID: 32228007 DOI: 10.33549/physiolres.934395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
An excessive, irritable, productive or non-productive coughing associated with airway inflammation belongs to pathological cough. Increased activation of airway vagal nociceptors in pathological conditions results from dysregulation of the neural pathway that controls cough. A variety of mediators associated with airway inflammation overstimulate these vagal airway fibers including C-fibers leading to hypersensitivity and hyperreactivity. Because current antitussives have limited efficacy and unwanted side effects there is a continual demand for the development of a novel more effective antitussives for a new efficacious and safe cough treatment. Therefore, inhibiting the activity of these vagal C-fibers represents a rational approach to the development of effective antitussive drugs. This may be achieved by blocking inflammatory mediator receptors or by blocking the generator potential associated with the specific ion channels. Because voltage-gated sodium channels (NaVs) are absolutely required for action potentials initiation and conduction irrespective of the stimulus, NaVs become a promising neural target. There is evidence that NaV1.7, 1.8 and 1.9 subtypes are predominantly expressed in airway cough-triggering nerves. The advantage of blocking these NaVs is suppressing C-fiber irrespective to stimuli, but the disadvantage is that by suppressing the nerves is may also block beneficial sensations and neuronal reflex behavior. The concept is that new antitussive drugs would have the benefit of targeting peripheral airway nociceptors without inhibiting the protective cough reflex.
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Affiliation(s)
- M Brozmanova
- Department of Pathophysiology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia.
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Demoulin B, Coutier-Marie L, Ioan I, Schweitzer CE, Foucauld L, Demoulin-Alexikova S. In Vivo Documentation of Stimulus Velocity Tuning of Mechanically Induced Reflex Cough. Physiol Res 2020; 69:S139-S145. [PMID: 32228019 DOI: 10.33549/physiolres.934397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
In order to clear airways and lungs defensive reflexes are provoked rather by the dynamic phase of mechanical stimulus. It is speculated that provocation of defensive response depends not only on stimulus duration but also on stimulus velocity. Fourteen adult rabbits were anaesthetized and tracheotomized. Mechanical stimulus was provoked by a mechanical probe introduced through the tracheotomy and rotated by a small electrical motor using a rotational velocity of 40 rpm/s and 20 rpm/s. Threshold, incidence and intensity of cough reflex (CR) were analyzed for each animal. Statistical comparisons between two velocities were performed using Friedman nonparametric test for repeated measurements. Results are median (25-75 %). The threshold of CR was significantly increased (p=0.005) from 350 ms (300-500 ms) to 550 ms (350-1150 ms) and the incidence of cough reflex was significantly reduced (p=0.002) from 50 % (19 50 %) to 0 % (0-25 %) when the rotational velocity of the mechanical probe was reduced by half. The findings of this study are of interest as they show that protective reflex cough, an important mechanism that allows clearing airways even during sleep or anesthesia, is tuned by mechanical stimulus velocity.
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Affiliation(s)
- B Demoulin
- Research Unit EA 3450 DevAH-Development, Adaptation and Handicap, Campus Biologie Santé, University of Lorraine, Vandoeuvre-les-Nancy,
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Foucaud L, Demoulin B, Leblanc AL, Ioan I, Schweitzer C, Demoulin-Alexikova S. Modulation of protective reflex cough by acute immune driven inflammation of lower airways in anesthetized rabbits. PLoS One 2019; 14:e0226442. [PMID: 31887143 PMCID: PMC6936810 DOI: 10.1371/journal.pone.0226442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/26/2019] [Indexed: 11/19/2022] Open
Abstract
Chronic irritating cough in patients with allergic disorders may reflect behavioral or reflex response that is inappropriately matched to the stimulus present in the respiratory tract. Such dysregulated response is likely caused by sensory nerve damage driven by allergic mediators leading to cough hypersensitivity. Some indirect findings suggest that even acid-sensitive, capsaicin-insensitive A-δ fibers called “cough receptors” that are likely responsible for protective reflex cough may be modulated through immune driven inflammation. The aim of this study was to find out whether protective reflex cough is altered during acute allergic airway inflammation in rabbits sensitized to ovalbumin. In order to evaluate the effect of such inflammation exclusively on protective reflex cough, C-fiber mediated cough was silenced using general anesthesia. Cough provocation using citric acid inhalation and mechanical stimulation of trachea was realized in 16 ovalbumin (OVA) sensitized, anesthetized and tracheotomised rabbits 24h after OVA (OVA group, n = 9) or saline challenge (control group, n = 7). Number of coughs provoked by citric acid inhalation did not differ between OVA and control group (12,2 ±6,1 vs. 17,9 ± 6,9; p = 0.5). Allergic airway inflammation induced significant modulation of cough threshold (CT) to mechanical stimulus. Mechanically induced cough reflex in OVA group was either up-regulated (subgroup named “responders” CT: 50 msec (50–50); n = 5 p = 0.003) or down-regulated (subgroup named “non responders”, CT: 1200 msec (1200–1200); n = 4 p = 0.001) when compared to control group (CT: 150 msec (75–525)). These results advocate that allergen may induce longer lasting changes of reflex cough pathway, leading to its up- or down-regulation. These findings may be of interest as they suggest that effective therapies for chronic cough in allergic patients should target sensitized component of both, reflex and behavioral cough.
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Affiliation(s)
- Laurent Foucaud
- Research Unit EA 3450 DevAH—Development, Adaptation and Handicap, Campus Biologie Santé, University of Lorraine, Vandœuvre-Lès-Nancy, France
| | - Bruno Demoulin
- Research Unit EA 3450 DevAH—Development, Adaptation and Handicap, Campus Biologie Santé, University of Lorraine, Vandœuvre-Lès-Nancy, France
| | - Anne-Laure Leblanc
- Research Unit EA 3450 DevAH—Development, Adaptation and Handicap, Campus Biologie Santé, University of Lorraine, Vandœuvre-Lès-Nancy, France
| | - Iulia Ioan
- Research Unit EA 3450 DevAH—Development, Adaptation and Handicap, Campus Biologie Santé, University of Lorraine, Vandœuvre-Lès-Nancy, France
- Department of Pediatric Functional Testing, Hôpital d’Enfants, CHRU de Nancy, Vandoeuvre-Les-Nancy, France
| | - Cyril Schweitzer
- Research Unit EA 3450 DevAH—Development, Adaptation and Handicap, Campus Biologie Santé, University of Lorraine, Vandœuvre-Lès-Nancy, France
- Department of Pediatric Functional Testing, Hôpital d’Enfants, CHRU de Nancy, Vandoeuvre-Les-Nancy, France
| | - Silvia Demoulin-Alexikova
- Research Unit EA 3450 DevAH—Development, Adaptation and Handicap, Campus Biologie Santé, University of Lorraine, Vandœuvre-Lès-Nancy, France
- Department of Pediatric Functional Testing, Hôpital d’Enfants, CHRU de Nancy, Vandoeuvre-Les-Nancy, France
- * E-mail:
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Abstract
The distal airway of the lung is innervated by vagus nerve. Upon stimulation, vagus nerve endings release acetylcholine or neuropeptides via C-fiber afferents to regulate lung infection and immunity. Vagal sensory nerve endings, brain integration center, acetylcholine and α7 nicotinic acetylcholine receptor (nAChR) expressing cells are key components of pulmonary parasympathetic inflammatory reflex. Meanwhile, this local machinery synergizes with spleen (as a functional hub of cholinergic anti-inflammatory pathway) to finely tune recruitment of the splenic α7 nAChR+CD11b+ cells into the inflamed lungs during lung infection. Recent studies have showed that lung group 2 innate lymphoid cells (ILC2) express both α7 nAChR and neuropeptide receptors. Acetylcholine and neuropeptides can regulate ILC2 and reshape pulmonary infection and immunity. Among the airway epithelial cells, pulmonary neuroendocrine cells are rare cell population; however, these cells are innervated by sensory nerve endings and they could secrete neuropeptides that influence lung infection and immunity.
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Affiliation(s)
- Y Huang
- Key Laboratory of Molecular Virology and Immunology, Unit of Respiratory Infection and Immunity, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
| | - C Zhao
- Key Laboratory of Molecular Virology and Immunology, Unit of Respiratory Infection and Immunity, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
| | - X Su
- Key Laboratory of Molecular Virology and Immunology, Unit of Respiratory Infection and Immunity, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
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Effect-site concentration of remifentanil for smooth emergence from sevoflurane anesthesia in patients undergoing endovascular neurointervention. PLoS One 2019; 14:e0218074. [PMID: 31185050 PMCID: PMC6559654 DOI: 10.1371/journal.pone.0218074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/12/2019] [Indexed: 11/25/2022] Open
Abstract
During emergence from general anesthesia, coughing caused by the endotracheal tube frequently occurs and is associated with various adverse complications. In patients undergoing endovascular neurointervention, achieving smooth emergence from general anesthesia without coughing is emphasized since coughing is associated with intracranial hypertension. Therefore, the up-and-down method was introduced to determine the effective effect-site concentration (Ce) of remifentanil to prevent coughing in 50% and 95% (EC50 and EC95) of patients during emergence from sevoflurane anesthesia for endovascular neurointervention. A total of 43 participants, American Society of Anesthesiologists class I or II participants, aged from 20 to 70 years who were undergoing endovascular neurointervention through transfemoral catheter for cerebrovascular disease were enrolled. Using the up-and-down method with isotonic regression, the EC50 and EC95 of remifentanil to prevent coughing during emergence from sevoflurane anesthesia were determined. We also investigated differences of hemodynamic and recovery profiles between the cough suppression group and the cough group. In total, 38 of 43 patients were included for estimation of EC50 and EC95. The EC50 and EC95 of remifentanil to prevent coughing were 1.42 ng/mL (95% confidence interval [CI], 1.28–1.56 ng/mL) and 1.70 ng/mL (95% CI, 1.67–2.60 ng/mL), respectively. There was comparable emergence and recovery data between the cough suppression group (n = 22) and the cough group (n = 16). However, the Ce of remifentanil and total dose of remifentanil were significantly higher in the cough suppression group (P = 0.002 and P = 0.004, respectively). Target-controlled infusion of remifentanil at 1.70 ng/mL could effectively prevent extubation-related coughing in 95% of neurointervention patients, which could ensure smooth emergence.
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Airway hypersensitivity induced by eosinophil granule-derived cationic proteins. Pulm Pharmacol Ther 2019; 57:101804. [PMID: 31096035 DOI: 10.1016/j.pupt.2019.101804] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/07/2019] [Accepted: 05/11/2019] [Indexed: 01/05/2023]
Abstract
Vagal bronchopulmonary C-fiber sensory nerves play an important role in the manifestation of airway hypersensitivity, a common and prominent pathophysiological feature of airway inflammatory diseases. Eosinophil granule-derived cationic proteins are known to be involved in the mucosal damage and development of bronchial hyperresponsiveness during allergic airway inflammation. In view of these background information, we have carried out a series of studies to investigate the effect of cationic proteins on these C-fiber afferents and the mechanism(s) possibly involved; a summary of these studies is presented in this mini-review. Intra-tracheal instillation of either eosinophil granule-derived (e.g., major basic protein, MBP) or synthetic cationic proteins (e.g., poly-l-lysine) induced a sporadic, but intense and lingering discharge of pulmonary C-fibers, and greatly enhanced the chemical and mechanical sensitivities of these afferents in anesthetized rats. The stimulatory and sensitizing effects of these proteins were completely nullified when their cationic charges were neutralized or removed. Furthermore, in isolated rat bronchopulmonary capsaicin-sensitive neurons, eosinophil granule cationic proteins induced a direct and long-lasting (>60 min) but reversible sensitizing effect on their responses to chemical and electrical stimulations. More importantly, our study showed that these cationic proteins exerted an inhibitory effect on the sustained delayed-rectifier voltage-gated K+ current and the A-type, fast-inactivating K+ current; these actions were at least in part responsible for the sensitizing effect in these neurons. In awake mice, intra-tracheal instillation of MBP also induced a slowly developing (peaking in 2-3 days), progressive and sustained (lasting for 3-7 days) elevation of the cough responses to inhaled irritant gases. Taken together, these findings suggest that the enhanced sensitivity of bronchopulmonary C-fibers induced by the eosinophil granule cationic proteins may be a contributing factor in the pathogenesis of bronchial hyperresponsiveness and chronic cough associated with eosinophilic infiltration of the airways.
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Lin AH, Athukorala A, Gleich GJ, Lee LY. Cough responses to inhaled irritants are enhanced by eosinophil major basic protein in awake mice. Am J Physiol Regul Integr Comp Physiol 2019; 317:R93-R97. [PMID: 30995073 DOI: 10.1152/ajpregu.00081.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A distinct association between airway eosinophilia and chronic cough is well documented. Eosinophil granule-derived cationic proteins, such as major basic protein (MBP), have been shown to activate and enhance the excitability of bronchopulmonary C-fiber sensory nerves, which may then lead to an increase in cough sensitivity. This study was carried out to determine whether cough responses to inhaled irritant gases were altered by delivery of MBP into the airways. An awake mouse moved freely in a recording chamber that was ventilated with a constant flow of air or irritant gas mixture. Cough responses to separate inhalation challenges of sulfur dioxide (SO2; 300 and 600 ppm) and ammonia (NH3; 0.1 and 0.2%), each for 5-min duration, were measured daily for 3 days before and for up to 8 days after MBP (10-20 µg) instillation into the trachea. During control, inhalations of SO2 and NH3 consistently elicited cough responses in a dose-dependent manner. After MBP treatment, cough responses to both SO2 and NH3 increased significantly and progressively and reached peaks 2-3 days after the treatment before returning to control level in 3-7 days. In sharp contrast, cough responses to these irritant gases were not affected by the treatment with the vehicle of MBP. These results suggest that the MBP-induced lingering elevation of cough responsiveness may be a contributing factor in the pathogenesis of chronic cough associated with eosinophilic infiltration of the airways.
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Affiliation(s)
- An-Hsuan Lin
- Department of Physiology, University of Kentucky , Lexington, Kentucky
| | - Ashami Athukorala
- Department of Physiology, University of Kentucky , Lexington, Kentucky
| | - Gerald J Gleich
- Department of Dermatology, University of Utah , Salt Lake City, Utah.,Department of Medicine, University of Utah , Salt Lake City, Utah
| | - Lu-Yuan Lee
- Department of Physiology, University of Kentucky , Lexington, Kentucky
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Poliacek I, Kotmanova Z, Veternik M, Pitts T, Martvon L, Misek J, Jakus J, Simera M. The motor pattern of tracheobronchial cough is affected by inspiratory resistance and expiratory occlusion - The evidence for volume feedback during cough expiration. Respir Physiol Neurobiol 2018; 261:9-14. [PMID: 30583067 DOI: 10.1016/j.resp.2018.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/14/2018] [Accepted: 12/21/2018] [Indexed: 01/18/2023]
Abstract
The role of pulmonary stretch receptor discharge and volume feedback in modulation of tracheobronchial cough is not fully understood. The current study investigates the effect of expiratory occlusion with or without preceding inspiratory resistance (delivery of tidal or cough volume by the ventilator lasting over the active cough expiratory period) on the cough motor pattern. Experiments on 9 male cats under pentobarbital sodium anesthesia have shown that inspiratory resistance followed by expiratory occlusion increased cough inspiratory and expiratory efforts and prolonged several time intervals (phases) related to muscle activation during cough. Expiratory occlusion (at regular cough volume) decreased number of coughs, increased amplitudes of abdominal electromyographic activity, inspiratory and expiratory esophageal pressure during cough and significantly prolonged cough temporal features. Correlation analysis supported major changes in cough expiratory effort and timing due to the occlusion. Our results support a high importance of volume feedback, including that during cough expulsion, for generation and modulation of cough motor pattern with obstruction or expiratory airway resistances, the conditions present during various pulmonary diseases.
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Affiliation(s)
- Ivan Poliacek
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Institute of Medical Biophysics, Mala Hora 4, 03601, Martin, Slovakia
| | - Zuzana Kotmanova
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Institute of Medical Biophysics, Mala Hora 4, 03601, Martin, Slovakia
| | - Marcel Veternik
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Institute of Medical Biophysics, Mala Hora 4, 03601, Martin, Slovakia
| | - Teresa Pitts
- Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, University of Louisville, 511 S. Floyd Street MDR 616, Louisville, KY, 40207, USA
| | - Lukas Martvon
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Institute of Medical Biophysics, Mala Hora 4, 03601, Martin, Slovakia
| | - Jakub Misek
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Institute of Medical Biophysics, Mala Hora 4, 03601, Martin, Slovakia
| | - Jan Jakus
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Institute of Medical Biophysics, Mala Hora 4, 03601, Martin, Slovakia
| | - Michal Simera
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Institute of Medical Biophysics, Mala Hora 4, 03601, Martin, Slovakia.
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Effect of topical ropivacaine on the response to endotracheal tube during emergence from general anesthesia: a prospective randomized double-blind controlled study. BMC Anesthesiol 2018; 18:134. [PMID: 30261837 PMCID: PMC6161381 DOI: 10.1186/s12871-018-0601-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/20/2018] [Indexed: 12/13/2022] Open
Abstract
Background The airway reflex such as cough is common accompanied with severe fluctuations of hemodynamics during emergence. This prospective double-blind randomized controlled trial tested the hypothesis that topical ropivacaine may reduce extubation response and postoperative sore throat. Methods Fifty-four patients undergoing thyroidectomy were randomly assigned to two groups. The patients in Group R were received 0.75% ropivacaine, which was sprayed on the tracheal mucosa, epiglottis, tongue base, and glottis to achieve uniform surface anesthesia. As control, patients in Group C were received the same volume saline. The primiary outcome was the incidence and grade of cough during peri-extubation. Results The incidence (34.62% vs. 76.92%, P = 0.002) of cough during extubation were lower in Group R compared to Group C. Meanwhile, the sore throat visual acuity score at 12 h after surgery was lower in Group R than that in Group C (2.00 vs. 3.50, P = 0.040). Conclusion Topical anesthesia with 0.75% ropivacaine before intubation can significantly reduce the incidence of cough during peri-extubation. Meanwhile, it reduced hemodynamic fluctuations and postoperative throat pain without influence patients recovery. Trial registration Chinese Clinical Trial Registry, ChiCTR1800014412 (date of registration January 2018).
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Kim HY, Kim JY, Ahn SH, Lee SY, Park HY, Kwak HJ. Predicting effective remifentanil concentration in 95% of patients to prevent emergence cough after laryngomicroscopic surgery. Medicine (Baltimore) 2018; 97:e11258. [PMID: 29952995 PMCID: PMC6039629 DOI: 10.1097/md.0000000000011258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Smooth emergence or cough prevention is a clinically important concern in patients undergoing laryngomicroscopic surgery (LMS). The purpose of this study was to estimate the effective concentration of remifentanil in 95% of patients (EC95) for the prevention of emergence cough after LMS under propofol anesthesia using the biased coin design (BCD) up-down method.A total of 40 adult patients scheduled to undergo elective LMS were enrolled. Anesthesia induction and maintenance were performed with target-controlled infusion of propofol and remifentanil. Effective effect-site concentration (Ce) of remifentanil in 95% of patients for preventing emergence cough was estimated using a BCD method (starting from 1 ng/mL with a step size of 0.4 ng/mL). Hemodynamic and recovery profiles were observed after anesthesia.According to the study protocol, 20 patients were allocated to receive remifentanil Ce of 3.0 ng/mL, and 20 patients were assigned to receive lower concentrations of remifentanil, from 1.0 to 2.6 ng/mL. Based on isotonic regression with a bootstrapping method, EC95 (95% CI) of remifentanil Ce for the prevention of emergence cough from LMS was found to be 2.92 ng/mL (2.72-2.97 ng/mL). Compared with patients receiving lower concentrations of remifentanil, the incidence of hypoventilation before extubation and extubation time were significantly higher in those receiving remifentanil Ce of 3.0 ng/mL. However, hypoventilation incidence after extubation and staying time in the recovery room were comparable between the 2 groups.Using a BCD method, the EC95 of remifentanil Ce for the prevention of emergence cough was estimated to be 2.92 ng/mL (95% CI: 2.72-2.97 ng/mL) after LMS under propofol anesthesia.
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Affiliation(s)
- Ha Yeon Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon
| | - Jong Yeop Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon
| | - Soo Hwan Ahn
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon
| | - Sook Young Lee
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon
| | - Hee Yeon Park
- Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Republic of Korea
| | - Hyun Jeong Kwak
- Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Republic of Korea
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Sensitivity of airway cough-related afferents is influenced by female sex hormones. Respir Physiol Neurobiol 2018; 257:12-17. [PMID: 29326052 DOI: 10.1016/j.resp.2018.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/12/2017] [Accepted: 01/08/2018] [Indexed: 01/06/2023]
Abstract
Chronic hypersensitivity cough syndrome affects mainly postmenopausal women; however, the pathogenesis of cough hypersensitivity in this demographic is not entirely understood. The role of sex hormones in cough has never been studied in detail; however, sex hormones seem to play an important role in the lung health of women. Our study was aimed to analyse the effect of female sex hormones (oestrogen - E2 and progesterone - Pg) on cough sensitivity measured by inhalation of capsaicin in follicular and luteal phases of menstrual cycle, characterized by significantly different concentrations of sex hormones. These data were compared with a matched group of women taking oral contraceptives. Cough sensitivity to capsaicin increased in luteal phase in subjects with normal menstrual cycle, and this functional change was not present in group with contraceptive pills. The cough sensitivity correlates with the Pg/E2 ratio, and relative lack of oestrogen in luteal phase is associated with higher cough sensitivity to capsaicin.
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15
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Sex differences in cough reflex. Respir Physiol Neurobiol 2017; 245:122-129. [DOI: 10.1016/j.resp.2016.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/07/2016] [Accepted: 12/08/2016] [Indexed: 12/31/2022]
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16
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P S L, Miskan MM, Y Z C, Zaki RA. Staggering the dose of sugammadex lowers risks for severe emergence cough: a randomized control trial. BMC Anesthesiol 2017; 17:137. [PMID: 29020936 PMCID: PMC5637258 DOI: 10.1186/s12871-017-0430-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/02/2017] [Indexed: 12/18/2022] Open
Abstract
Background Cough on emergence has been reported as a common adverse reaction with sugammadex reversal. We investigated if staggering the dose of sugammadex will reduce emergence cough in a single-center, randomized, double-blinded study. Methods A hundred and twenty ASA 1–3 adults were randomly reversed with 1 mg/kg sugammadex prior to extubation followed by another 1 mg/kg immediately after extubation (staggered group), single dose of 2 mg/kg sugammadex (single bolus group) or neostigmine 0.02 mg/kg with glycopyrrolate (neostigmine group). Results We found 70% of patients (n = 28) reversed with single boluses of sugammadex had Grade 3 emergence cough compared to 12.5% (n = 5) in the staggered sugammadex group and 17.5% (n = 7) in the neostigmine group (p < 0.001). Besides cough, emergence agitation also appeared highest in the single bolus sugammadex group (n = 14, 35%, p = 0.005). On the other hand, staggering sugammadex lowered risks of developing severe cough (RR 0.2, p < 0.001) and agitation (RR 0.43, p = 0.010) on emergence in addition to cough (RR 0.25, p = 0.039) and early sore throat (RR 0.70, p = 0.036) in the post-anesthetic care unit. The risks for severe emergence cough (RR 0.86, p = 0.762), severe cough in the post-anesthetic care unit (RR 1.0, p = 1.000) and sore throat (RR 1.17, p = 0.502) were also not different between the staggered sugammadex group and control given neostigmine. In terms of timing, there was no delay in time taken from discontinuing anesthetic agents to reversal and extubation if sugammadex was staggered (emergence time 6.0 ± 3.2 s, p = 0.625 and reversal time 6.5 ± 3.5, p = 0.809). Conclusions Staggering the dose of sugammadex for reversal will effectively decrease common emergence and early postoperative complications. Trial registration ANZCTR Number ACTRN12616000116426. Retrospectively registered on 2nd February 2016.
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Affiliation(s)
- Loh P S
- Department of Anesthesiology and Intensive Care, University Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia.
| | | | - Chin Y Z
- Department of Anesthesiology and Intensive Care, University Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia
| | - R A Zaki
- Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.,Public Health Department, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Ye Z, Ren L, Tang Z, Deng Y, Xie X, Fu Z, Luo Z, Xu F, Zang N, Liu E. Pulmonary C-fiber degeneration downregulates IFN-γ receptor 1 via IFN-α induction to attenuate RSV-induced airway hyperresponsiveness. Virology 2017; 510:262-272. [PMID: 28772166 DOI: 10.1016/j.virol.2017.06.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/25/2017] [Accepted: 06/29/2017] [Indexed: 12/19/2022]
Abstract
Respiratory syncytial virus (RSV) is a leading cause of respiratory infection in infants. Unfortunately, no effective vaccine or treatment against RSV is currently available. Pulmonary C-fibers (PCFs) are critical for regulating pulmonary inflammation and airway hyperresponsiveness (AHR). We previously reported that IFN-γ partially mediated RSV-induced airway disorders. In this study, we found that PCF degeneration alleviated RSV-induced airway inflammation, especially AHR by downregulating IFN-γ receptor 1 (IFNGR1), but had no effect on IFN-γ induction. In contrast, PCF degeneration actually increased IFN-α/β levels, as were the levels of STAT1 and phosphorylated STAT1 (pSTAT1). Exogenous IFN-α treatment induced STAT1 activation and downregulated IFNGR1 expression. These results suggest that PCFs affect IFNGR1 expression by inducing IFN-α to regulate IFN-γ-mediated airway inflammation and AHR. Thus, targeting PCFs activation may help control RSV-induced airway disorders, especially AHR, even with the presence of inflammation.
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Affiliation(s)
- Zhixu Ye
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing 400014, China; Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Luo Ren
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing 400014, China
| | - Zhengzhen Tang
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing 400014, China; Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Yu Deng
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Xiaohong Xie
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Zhou Fu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - ZhengXiu Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Fadi Xu
- Pathophysiology Program, Lovelace Respiratory Research Institute, Albuquerque, NM, 87108, USA
| | - Na Zang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
| | - Enmei Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
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Cough in interstitial lung disease. Pulm Pharmacol Ther 2015; 35:122-8. [DOI: 10.1016/j.pupt.2015.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 10/22/2015] [Accepted: 10/23/2015] [Indexed: 12/15/2022]
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Determination of EC95 of remifentanil for smooth emergence from propofol anesthesia in patients undergoing transsphenoidal surgery. J Neurosurg Anesthesiol 2015; 27:160-6. [PMID: 25105828 DOI: 10.1097/ana.0000000000000094] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In patients undergoing pituitary surgery using a transsphenoidal approach, anesthesia emergence should be smooth with minimal coughing. Recent studies demonstrated that a target-controlled infusion of remifentanil effectively suppresses coughing induced by the endotracheal tube. We investigated the EC95 of remifentanil for smooth emergence without coughing from propofol anesthesia in patients undergoing transsphenoidal hypophysectomy. MATERIALS AND METHODS A total of 41 patients undergoing transsphenoidal hypophysectomy, aged 20 to 65 years, with an ASA physical status of I or II, were enrolled. For all participants, anesthesia was induced and maintained with a target-controlled infusion of remifentanil and propofol using predicted effect-site concentration (Ce). A biased coin design up-and-down sequential allocation and isotonic regression method were used to determine the remifentanil EC95 to prevent emergence coughing. In addition, we observed recovery profiles after anesthesia. RESULTS According to the study design, 19 patients received remifentanil 2.6 ng/mL Ce and 22 patients received a lower Ce, ranging from 1.0 to 2.2 ng/mL. The EC95 of remifentanil to prevent coughing was estimated as 2.51 ng/mL (95% confidence interval, 2.28-2.57 ng/mL). Despite the exclusion of 1 case because of delayed emergence, 17 of 18 patients receiving 2.6 ng/mL of remifentanil had bradypnea (<10 breaths/min) until 3 minutes after extubation. However, end-tidal carbon dioxide was maintained below 55 mm Hg during anesthetic emergence and respiratory rate recovered within 20 minutes of admission to the postanesthetic care unit. CONCLUSIONS The EC95 of remifentanil for smooth emergence from anesthesia was 2.51 ng/mL after transsphenoidal hypophysectomy.
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Abstract
Cough affects all individuals at different times, and its economic burden is substantial. Despite these widespread adverse effects, cough research relies on animal models, which hampers our understanding of the fundamental cause of cough. Postnasal drip is speculated to be one of the most frequent causes of chronic cough; however, this is a matter of debate. Here we show that mechanical stimuli by postnasal drip cause chronic cough. We distinguished human cough from sneezes and expiration reflexes by airflow patterns. Cough and sneeze exhibited one-peak and two-peak patterns, respectively, in expiratory airflow, which were also confirmed by animal models of cough and sneeze. Transgenic mice with ciliary dyskinesia coughed substantially and showed postnasal drip in the pharynx; furthermore, their cough was completely inhibited by nasal airway blockade of postnasal drip. We successfully reproduced cough observed in these mice by injecting artificial postnasal drip in wild-type mice. These results demonstrated that mechanical stimulation by postnasal drip evoked cough. The findings of our study can therefore be used to develop new antitussive drugs that prevent the root cause of cough.
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21
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Niimi A, Chung KF. Evidence for neuropathic processes in chronic cough. Pulm Pharmacol Ther 2015; 35:100-4. [PMID: 26474678 DOI: 10.1016/j.pupt.2015.10.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/09/2015] [Accepted: 10/09/2015] [Indexed: 12/16/2022]
Abstract
Chronic cough is a very common symptom for which patients seek medical attention but can often be difficult to manage, because associated causes may remain elusive and treatment of any associated causes does not always provide adequate relief. Current antitussives have limited efficacy and undesirable side-effects. Patients with chronic cough typically describe sensory symptoms suggestive of upper airway and laryngeal neural dysfunction. They often report cough triggered by low-level physical and chemical stimuli supporting the recently emerging concept of 'cough hypersensitivity syndrome'. Chronic cough is a neuropathic condition that could be secondary to sensory nerve damage caused by inflammatory, infective and allergic factors. Mechanisms underlying peripheral and central augmentation of the afferent cough pathways have been identified. Successful treatment of chronic cough with agents used for treating neuropathic pain, such as gabapentin and amitriptyline, would also support this concept. Further research of neuropathic cough may lead to the discovery of more effective antitussives in the future.
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Affiliation(s)
- Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Kian Fan Chung
- Experimental Studies, National Heart and Lung Institute, Imperial College London, UK; Royal Brompton NIHR Biomedical Research Unit, London, UK
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Chung KF, Canning B, McGarvey L. Eight International London Cough Symposium 2014: Cough hypersensitivity syndrome as the basis for chronic cough. Pulm Pharmacol Ther 2015; 35:76-80. [PMID: 26341666 DOI: 10.1016/j.pupt.2015.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 08/31/2015] [Indexed: 02/01/2023]
Abstract
At the Eighth International London Cough Conference held in London in July 2014, the focus was on the relatively novel concept of cough hypersensitivity syndrome (CHS) as forming the basis of chronic cough. This concept has been formulated following understanding of the neuronal pathways for cough and a realisation that not all chronic cough is usually associated with a cause. The CHS is defined by troublesome coughing triggered by low level of thermal, mechanical or chemical exposure. It also encompasses other symptoms or sensations such as laryngeal hypersensitivity, nasal hypersensitivity and possibly also symptoms related to gastrooesopahgeal reflux. The pathophysiologic basis of the CHS is now being increasingly linked to an enhancement of the afferent pathways of the cough reflex both at the peripheral and central levels. Mechanisms involved include the interactions of inflammatory mechanisms with cough sensors in the upper airways and with neuronal pathways of cough, associated with a central component. Tools for assessing CHS in the clinic need to be developed. New drugs may be developed to control CHS. A roadmap is suggested from the inception of the CHS concept towards the development of newer antitussives at the Symposium.
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Affiliation(s)
- Kian Fan Chung
- Experimental Studies, National Heart and Lung Institute, Imperial College London, UK; Royal Brompton NIHR Biomedical Research Unit, London, UK.
| | - Brendan Canning
- The Johns Hopkins Asthma and Allergy Center, Baltimore, MD 21224, USA
| | - Lorcan McGarvey
- Department of Respiratory Medicine, Centre for Infection and Immunity, Queen's University Belfast, UK
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Undem BJ, Zaccone E, McGarvey L, Mazzone SB. Neural dysfunction following respiratory viral infection as a cause of chronic cough hypersensitivity. Pulm Pharmacol Ther 2015; 33:52-6. [PMID: 26141017 DOI: 10.1016/j.pupt.2015.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/16/2015] [Accepted: 06/26/2015] [Indexed: 02/03/2023]
Abstract
Respiratory viral infections are a common cause of acute coughing, an irritating symptom for the patient and an important mechanism of transmission for the virus. Although poorly described, the inflammatory consequences of infection likely induce coughing by chemical (inflammatory mediator) or mechanical (mucous) activation of the cough-evoking sensory nerves that innervate the airway wall. For some individuals, acute cough can evolve into a chronic condition, in which cough and aberrant airway sensations long outlast the initial viral infection. This suggests that some viruses have the capacity to induce persistent plasticity in the neural pathways mediating cough. In this brief review we present the clinical evidence of acute and chronic neural dysfunction following viral respiratory tract infections and explore possible mechanisms by which the nervous system may undergo activation, sensitization and plasticity.
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Affiliation(s)
- Bradley J Undem
- Department of Medicine, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, USA.
| | - Eric Zaccone
- Department of Medicine, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, USA
| | - Lorcan McGarvey
- Centre of Infection and Immunity, The Queen's University of Belfast, Belfast, Northern Ireland, BT12 6BJ, UK.
| | - Stuart B Mazzone
- School of Biomedical Sciences, The University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia.
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NMDA and GABA receptors as potential targets in cough hypersensitivity syndrome. Curr Opin Pharmacol 2015; 22:29-36. [DOI: 10.1016/j.coph.2015.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/02/2015] [Accepted: 03/02/2015] [Indexed: 12/21/2022]
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Narula M, McGovern AE, Yang SK, Farrell MJ, Mazzone SB. Afferent neural pathways mediating cough in animals and humans. J Thorac Dis 2014; 6:S712-9. [PMID: 25383205 DOI: 10.3978/j.issn.2072-1439.2014.03.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 03/04/2014] [Indexed: 12/12/2022]
Abstract
The airways and lungs are densely innervated by sensory nerves, which subserve multiple roles in both the normal physiological control of respiratory functions and in pulmonary defense. These sensory nerves are therefore not homogeneous in nature, but rather have physiological, molecular and anatomical phenotypes that reflect their purpose. All sensory neuron subtypes provide input to the central nervous system and drive reflex changes in respiratory and airway functions. But less appreciated is that ascending projections from these brainstem inputs to higher brain regions can also induce behavioural changes in respiration. In this brief review we provide an overview of the current understanding of airway sensory pathways, with specific reference to those involved in reflex and behavioural cough responses following airways irritation.
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Affiliation(s)
- Monica Narula
- 1 School of Biomedical Sciences, University of Queensland, QLD 4072, Australia ; 2 The Florey Institute of Neuroscience and Mental Health, VIC 3010, Australia
| | - Alice E McGovern
- 1 School of Biomedical Sciences, University of Queensland, QLD 4072, Australia ; 2 The Florey Institute of Neuroscience and Mental Health, VIC 3010, Australia
| | - Seung-Kwon Yang
- 1 School of Biomedical Sciences, University of Queensland, QLD 4072, Australia ; 2 The Florey Institute of Neuroscience and Mental Health, VIC 3010, Australia
| | - Michael J Farrell
- 1 School of Biomedical Sciences, University of Queensland, QLD 4072, Australia ; 2 The Florey Institute of Neuroscience and Mental Health, VIC 3010, Australia
| | - Stuart B Mazzone
- 1 School of Biomedical Sciences, University of Queensland, QLD 4072, Australia ; 2 The Florey Institute of Neuroscience and Mental Health, VIC 3010, Australia
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Lee JH, Choi SH, Choi YS, Lee B, Yang SJ, Lee JR. Does the type of anesthetic agent affect remifentanil effect-site concentration for preventing endotracheal tube-induced cough during anesthetic emergence? Comparison of propofol, sevoflurane, and desflurane. J Clin Anesth 2014; 26:466-74. [PMID: 25200640 DOI: 10.1016/j.jclinane.2014.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 02/04/2014] [Accepted: 02/12/2014] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVE To investigate whether the type of anesthetic agent administered affects the antitussive effect of remifentanil. DESIGN Prospective randomized study. SETTING Operating room of a university hospital. PATIENTS 78 ASA physical status 1 and 2 women, aged 20 to 65 years, who were scheduled to undergo a thyroidectomy. INTERVENTIONS Patients were randomly assigned to three groups to receive anesthesia with propofol (Group P), sevoflurane (Group S), or desflurane (Group D). The main anesthetics were titrated to maintain a target Bispectral Index for hypnosis of 40 to 60. Remifentanil was administered via effect-site target-controlled infusion (TCI). To determine the effective remifentanil effect-site concentration (Ce) to suppress coughing in each group, the up-and-down sequential allocation design was used. MEASUREMENTS The half maximal effective concentration (EC50) values of remifentanil for preventing coughing in the groups were estimated using isotonic regression and compared among the groups. MAIN RESULTS The EC50 of remifentanil for cough suppression in Group P [1.60 ng/mL (98.3% CI, 0.92-1.75 ng/mL)] was statistically lower than in Group D [1.96 ng/mL (98.3% CI, 1.81-2.50 ng/mL)]. The EC50 in Group S was 1.75 ng/mL (98.3% CI, 1.39-2.13 ng/mL), which was higher than in Group P and lower than in Group D, but did not differ significantly from either group. CONCLUSIONS Remifentanil administration for cough suppression during emergence should be customized to the anesthetic agent.
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Affiliation(s)
- Jae Hoon Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Seung Ho Choi
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Yong Seon Choi
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Bahn Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Shi Joon Yang
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Jeong-Rim Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 120-752, Korea.
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Vashisht A, Chhabra SK, Banerjee BD, Ravi K. Rapidly adapting receptor activity during oxidative stress induced airway hyperresponsiveness. Respir Physiol Neurobiol 2013; 186:273-84. [PMID: 23501538 DOI: 10.1016/j.resp.2013.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 03/10/2013] [Accepted: 03/10/2013] [Indexed: 01/14/2023]
Abstract
The responses of airway rapidly adapting receptors (RARs) to ovalbumin challenge and histamine were investigated in guinea pigs which were sensitized with ovalbumin. Sensitization alone increased the basal RAR activity. Antigen challenge stimulated them. Histamine doses which caused a 50% increase in airway resistance (ED50) were reduced immediately and 24h after antigen challenge indicating respectively early and late onset airway hyperresponsiveness. At these doses, there was a greater stimulation of the RARs compared to controls. An increase in lipid peroxidation and a decrease in glutathione peroxidase were observed also. With oral intake of vitamins C and E, attenuations in the basal RAR activity, the responses of RARs to antigen challenge and the oxidative stress were observed. With an increase in ED50, the RAR response to histamine became similar as in control. It is concluded that by decreasing the RAR responses to allergen and histamine, antioxidants may reduce reflex bronchoconstriction occurring in asthmatics.
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Affiliation(s)
- A Vashisht
- Department of Physiology, V.P. Chest Institute, University of Delhi, Delhi, India
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Lavinka PC, Dong X. Molecular signaling and targets from itch: lessons for cough. COUGH 2013; 9:8. [PMID: 23497684 PMCID: PMC3630061 DOI: 10.1186/1745-9974-9-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 02/08/2013] [Indexed: 01/05/2023]
Abstract
Itch is described as an unpleasant sensation that elicits the desire to scratch, which results in the removal of the irritant from the skin. The cough reflex also results from irritation, with the purpose of removing said irritant from the airway. Could cough then be similar to itch? Anatomically, both pathways are mediated by small-diameter sensory fibers. These cough and itch sensory fibers release neuropeptides upon activation, which leads to inflammation of the nerves. Both cough and itch also involve mast cells and their mediators, which are released upon degranulation. This common inflammation and interaction with mast cells are involved in the development of chronic conditions of itch and cough. In this review, we examine the anatomy and molecular mechanisms of itch and compare them to known mechanisms for cough. Highlighting the common aspects of itch and cough could lead to new thoughts and perspectives in both fields.
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Affiliation(s)
- Pamela Colleen Lavinka
- The Solomon H, Snyder Department of Neuroscience, Center for Sensory Biology, Johns Hopkins University School of Medicine, 725 N Wolfe Street, Baltimore, MD, 21205, USA.
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Canning BJ, Mori N, Lehmann A. Antitussive effects of the peripherally restricted GABAB receptor agonist lesogaberan in guinea pigs: comparison to baclofen and other GABAB receptor-selective agonists. COUGH 2012; 8:7. [PMID: 23025757 PMCID: PMC3520872 DOI: 10.1186/1745-9974-8-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 09/07/2012] [Indexed: 12/17/2022]
Abstract
UNLABELLED BACKGROUND Gastroesophageal reflux disease (GERD) is a common cause of chronic cough. Both acid and nonacid reflux is thought to play a role in the initiation of coughing and cough hypersensitivity. The GABAB receptor agonist lesogaberan was developed as a peripherally restricted anti-reflux therapy that reduces the frequency of transient lower esophageal sphincter relaxations (TLESR; the major cause of reflux) in animals and in patients with GERD. GABAB receptor agonists have also been shown to possess antitussive effects in patients and in animals independent of their effects on TLESR, suggesting that lesogaberan may be a promising treatment for chronic cough. METHODS We have assessed the direct antitussive effects of lesogaberan (AZD3355). The effects of other GABAB receptor agonists were also determined. Coughing was evoked in awake guinea pigs using aerosol challenges with citric acid. RESULTS Lesogaberan dose-dependently inhibited citric acid evoked coughing in guinea pigs. Comparable effects of the GABAB receptor agonists baclofen and 3-aminopropylphosphinic acid (3-APPiA) on cough were also observed. Baclofen produced obvious signs of sedation and respiratory depression. By contrast, both lesogaberan and 3-APPiA (both inactivated centrally by GABA transporters) were devoid of sedative effects and did not alter respiratory rate. CONCLUSIONS Together, the data suggest that lesogaberan and related GABAB receptor agonists may hold promise as safe and effective antitussive agents largely devoid of CNS side effects.
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Affiliation(s)
- Brendan J Canning
- Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, Maryland, 21224, USA.
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Moran MM, McAlexander MA, Bíró T, Szallasi A. Transient receptor potential channels as therapeutic targets. Nat Rev Drug Discov 2011; 10:601-20. [PMID: 21804597 DOI: 10.1038/nrd3456] [Citation(s) in RCA: 421] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Transient receptor potential (TRP) cation channels have been among the most aggressively pursued drug targets over the past few years. Although the initial focus of research was on TRP channels that are expressed by nociceptors, there has been an upsurge in the amount of research that implicates TRP channels in other areas of physiology and pathophysiology, including the skin, bladder and pulmonary systems. In addition, mutations in genes encoding TRP channels are the cause of several inherited diseases that affect a variety of systems including the renal, skeletal and nervous system. This Review focuses on recent developments in the TRP channel-related field, and highlights potential opportunities for therapeutic intervention.
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Affiliation(s)
- Magdalene M Moran
- Hydra Biosciences, 790 Memorial Drive, Cambridge, Massachusetts 02139, USA
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Mazzone SB, McGovern AE, Cole LJ, Farrell MJ. Central nervous system control of cough: pharmacological implications. Curr Opin Pharmacol 2011; 11:265-71. [DOI: 10.1016/j.coph.2011.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 05/19/2011] [Indexed: 02/06/2023]
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Lee JH, Koo BN, Jeong JJ, Kim HS, Lee JR. Differential effects of lidocaine and remifentanil on response to the tracheal tube during emergence from general anaesthesia. Br J Anaesth 2011; 106:410-5. [PMID: 21205628 DOI: 10.1093/bja/aeq396] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J H Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 250 Seongsan-no, Seodaemun-gu, 120-752 Seoul, Republic of Korea
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