[An attempt to localize the point of attack of novocaine in the cerebrospinal fluid on respiration and blood circulation]

HIGH LIFE: High altitude fatalities led to pulse oximetry

In 1875, Paul Bert linked high altitude danger to the low partial pressure of oxygen when 2 of 3 French balloonists died euphorically at about 8,600 m altitude. World War I fatal crashes of high altitude fighter pilots led to a century of efforts to use oximetry to warn pilots. The carotid body, discovered in 1932 to be the hypoxia detector, led to most current physiologic understanding of the body's respiratory responses to hypoxia and CO2. The author describes some of his UCSF group's work: In 1963, we reported both the brain's ventral medullary near-surface CO2 (and pH) chemosensors and the role of cerebrospinal fluid in acclimatization to altitude. In 1966, we reported the effect of altitude on cerebral blood flow and later the changes of carotid body sensitivity at altitude and the differences in natives of high altitude. In 1973, pulse oximetry was invented when Japanese biophysicist Takuo Aoyagi read and applied to pulses a largely forgotten 35-year-old discovery by English medical student J. R. Squire of a method of computing oxygen saturation from red and infrared light passing through both perfused and blanched tissue.

Urethane anesthesia reverses the protective effect of noncompetitive NMDA receptor antagonists against cocaine intoxication

The present experiments examined whether pretreatment with the noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonists, MK-801 and dextrorphan, could antagonize cocaine-induced convulsions and lethality in conscious Sprague-Dawley (SD) rats and whether urethane anesthesia alters the observed interactions. Conscious, restrained male SD rats received continuous i.v. infusions of cocaine hydrochloride (1.25 mg/kg.min) until convulsions and death occurred. Cocaine doses of 21.2 +/- 1.8 and 29.5 +/- 2.5 mg/kg caused convulsions and death, respectively, in saline treated rats (n = 8). Convulsions were absent in MK-801 (1 mg/kg, i.v.; n = 8) pretreated rats; the lethal cocaine dose was 44.0 +/- 2.7 mg/kg (p < 0.05). In contrast, urethane anesthesia (1.2 g/kg, i.p.) decreased the dose of cocaine required to cause toxicity, compared to that in saline controls (24.8 +/- 0.8 mg/kg, n = 13), in MK-801 (2.0 +/- 0.3, n = 7; p < 0.01) and in dextrorphan mg/kg, n = 13), in MK-801 (2.0 +/- 0.3, n = 7; p < 0.01) and in dextrorphan (25 mg/kg, i.v.; 13.1 +/- 1.4, n = 6; p < 0.01) pretreated rats. Pressor responses with little change in heart rate were evident during cocaine infusion in vehicle pretreated rats. Bradycardiac responses were noted to cocaine in groups following NMDA receptor blockade. Reversal of the pressor response to cocaine was noted in MK-801 pretreated animals, while dextrorphan pretreatment moderated cocaine-induced increases in blood pressure. Ventilatory support protected against cocaine lethality in urethane anesthetized rats, indicating that respiratory failure is the proximate cause of death with cocaine infusion. However, artificially ventilated rats, pretreated with MK-801, were more sensitive (lethal cocaine dose, 76.6 +/- 8.0 mg/kg, n = 5) than vehicle pretreated rats (129.4 +/- 15.8 mg/kg, n = 6), indicating that MK-801 may increase both the respiratory and the cardiac toxicity of cocaine in urethane anesthetized rats. Interactions between NMDA receptors and cocaine are modified by urethane anesthesia.

Contribution between dorsal and ventrolateral regions of medulla oblongata in vasomotor function of cats

In cats anesthetized with alpha-chloralose and urethane, the medulla oblongata was explored with electrical and/or chemical stimulation for vasopressor actions. Chemical stimulation included semimicroinjection of sodium glutamate or microinjection of dl-homocysteic acid (DLH). The dorsal (DM), particularly its dorsomedial (DMM) portion, and the ventrolateral (VLM) regions were found to be most sensitive to both electrical and chemical stimulation. In between these two regions there was an area in the ventral portion of the gigantocellular and the parvocellular reticular nuclei that was sensitive to electrical and somewhat sensitive also to chemical stimulation. The responses to chemical stimulation indicate the existence of perikarya in these three areas for vasopressor actions. The most active response of VLM followed microinjection of DLH into the region of nu. paragigantocellularis lateralis (PGL) and subretrofacial nu. These responses were about 30% greater than those from DM where the most active area was found in the DMM region including the nu. and tractus solitarius. When an extensive area of VLM was lesioned bilaterally with kainic acid (KA, 1 micrograms/100 nl), the resting systemic arterial blood pressure (SAP) fell 42% and the pressor response on DM stimulation fell by more than 80%. In contrast, after similar KA bilateral destruction of DM the resting SAP fell 38% and the pressor responses from 67%. When only a limited area in the PGL/subretrofacial nu. of the rostral VLM (3-4 pressor sites, 1 mm apart) on one side was lesioned, the resting SAP remained unaltered while the pressor response on the ipsilateral DMM decreased 76%. On the other hand, when a similar smaller KA lesion (3-4 sites) was made in the DMM, although the resting SAP did not change, the pressor response on stimulation of the ipsilateral rostral VLM decreased 28%. Further lesioning of the contralateral DMM then decreased the rostral VLM pressor response 62% without much alternation in the resting SAP. Results of the present experiments are in accordance with our previous results that neuronal perikarya for vasopressor action exist not only in VLM but also in DM (18,34) with the function of VLM slightly predominant over DM. It seems highly possible that reciprocal innervation exists between DM and VLM, at least between DMM and the PGL/subretrofacial nu. region.

Function of the ventrolateral medulla in the control of the circulation

The CNS control of the cardiovascular system involves the coordination of a series of complex neural mechanisms which integrate afferent information from a variety of peripheral receptors and produce control signals to effector organs for appropriate physiological responses. Although it is generally thought that these control signals are generated by a network of neural circuits that are widely distributed in the CNS, over the last two decades a considerable body of experimental evidence has accumulated suggesting that several of these circuits involve neurons found on or near the ventral surface of the medulla oblongata. Neurons in the VLM have been shown to be involved in the maintenance of vasomotor tone, in baroreceptor and chemoreceptor (central and peripheral) reflex mechanisms, in mediating the CIR and somatosympathetic reflexes and in the control of the secretion of vasopressin. These physiological functions of VLM neurons have been supported by neuroanatomical and electrophysiological studies demonstrating direct connections with a number of central structures previously implicated in the control of the circulation, including the IML, the site of origin of sympathetic preganglionic axons, and the SON and PVH, the site of origin of neurohypophyseal projecting axons containing AVP. Considerable suggestive evidence has also been obtained regarding the chemical messengers involved in transmitting information from VLM neurons to other central structures. There have been developments suggesting a role for monoamines and neuropeptides in mediating the neural and humoral control of SAP by neurons in the VLM. This review presents a synthesis of the literature suggesting a main role for VLM neurons in the control of the circulation.

Vasopressor neurons in the rostral ventrolateral medulla of the rabbit

Neurons within the rostral ventrolateral medulla oblongata project directly to the intermediolateral column in the thoracolumbar spinal cord. This paper reviews evidence obtained from experiments in the rabbit regarding the anatomical connections and physiological, pharmacological and histochemical properties of these cells. The following hypotheses are discussed: an increase in the firing rate of these neurons leads to a rise in arterial pressure due to sympathetic vasoconstriction, but does not affect respiratory or other somatomotor activity; the bulbospinal pathway originating from these neurons is an essential component of the central pathways mediating baroreceptor and other cardiovascular reflexes; these neurons receive tonic GABAergic inhibitory inputs, which are not all of baroreceptor origin; many of these bulbospinal neurons synthesize adrenalize. The possible role of adrenaline in the function of these neurons is considered.

Morphology of the medullary chemosensitive fields. 1. Mapping of the neuronal matrix by a horseradish peroxidase technique

A modified horseradish peroxidase labelling technique was used to study the distribution pattern of neurons in the central chemosensitive fields of the medulla oblongata of cats. In several cryosectioned medullae a mapping of superficially located HRP-labelled neurons was achieved. The distribution and configuration of the labelled neurons indicate that most of them belong to the nucleus paragigantocellularis lateralis. However, by varying the time of incubation it was possible to identify different types of neurons. On the basis of certain aspects of the HRP incorporation mode and neuronal topography a specific type of small-sized neurons has been identified. Some functional implications of these small neurons with respect to their possible chemosensitive activity are discussed.

Neurophysiological background of central neural cardiovascular-respiratory coordination: basic remarks and experimental approach

This paper is comprised of a review of past contributions and their theoretical consequences and a presentation of new results in studies of the origin of sympathetic rhythms and tone. Two basic mechanisms are involved: a primary intracentral coupling with the main cardiovascular-respiratory rhythm (MCRR) generator and a secondary reflex coupling. It was found that the activity and rhythms of certain sympathetic efferents, such as the cervical sympathetic, are closely related to the MCRR. Other efferents, such as the renal sympathetics, are loosely linked and follow drives from other circuits in the genesis of their rhythms and tone. New experimental evidence is given that rhythmic and tonic activity in sympathetic nerves originates from several sources. Hence central respiratory-autonomic systems interaction is not explained by simplistic concepts.

Elimination of central chemosensitivity by coagulation of a bilateral area on the ventral medullary surface in awake cats

Breathing and respiratory response to CO2 were observed in 6 awake cats and 1 control before and after bilateral coagulation of the formerly described area S (Schläfke and Loeschcke, 1967) on the ventral medullary surface under hyperoxic conditions. Ventilation decreased, PCO2 rose and CO2 response was almost or completely abolished in 4 cats, and moderately reduced in 2 cats. Inhalation of CO2 had an inhibitory effect on ventilation in two cases. In some instances the respiratory frequency was increased by CO2. Periodic breathing as well as spontaneous hyperventilation elicited by 'arousal' indicate parallels to the Pickwickian or Ondine's curse syndrome. No respiratory changes were produced by a lesion on the pyramidal tract medial to the area S. It is concluded that central chemosensitivity can be eliminated within the superficial layer of the area S. The loss of CO2 response seems to be correlated with complete destruction of the superficial nerve cells located within the area S (Petrovický, 1968) and degeneration within the ventral part of the nucleus paragigantocellularis.

A vasodepressor effect of pentobarbitone sodium

1. In anaesthetized cats under artificial ventilation, a few milligrams of pentobarbitone sodium injected into the cerebral ventricles produced a pronounced fall in arterial blood pressure, which was central in origin and resulted from inhibition of vasomotor tone.2. Pentobarbitone sodium was more effective in lowering blood pressure when injected into the cerebral ventricles than when injected into the cisterna magna, yet the pentobarbitone sodium did not act on structures in the ventricular wall, but acted on structures reached from the subarachnoid space.3. To produce its vasodepressor effect, the pentobarbitone sodium had to pass through the foramina of Luschka into the subarachmoid space beneath the medulla oblongata and to penetrate its ventral surface in a region caudal to the trapezoid bodies and lateral to the pyramids. This was the outcome of experiments in which the pentobarbitone sodium was injected into or perfused through the cerebral ventricles with or without an outflow cannula inserted into the aqueduct or into the fourth ventricle, and of experiments in which pentobarbitone sodium solutions were applied by means of Perspex rings to this region of the exposed ventral surface of the medulla. Whereas the application of pentobarbitone sodium to this region on one side had a weak vasodepressor effect only, its application on both sides produced a pronounced fall in arterial blood pressure.4. The region where pentobarbitone acted on topical application covers the region where nerve cells are found in the marginal glia immediately under the pia mater. The possibility is discussed that these cells are the morphological substrate on which the pentobarbitone acts, that arterial blood pressure is maintained by their activity which is suppressed by the pentobarbitone sodium.

Procaine perfused into cerebral ventricles and subarachnoid space in conscious and anaesthetized dogs

1. Perfusion of 1% procaine into the cerebral ventricles of conscious dogs produced mild paresis, defaecation, vomiting, jerky movements of eyelids, brisk nystagmus, increase in amplitude of respiration and sometimes loss of consciousness. Procaine 2% produced paralysis, loss of consciousness and sometimes respiratory depression.2. Procaine 2% perfused into the cerebral ventricles of dogs under chloralose anaesthesia produced an initial increase in amplitude of respiration, which preceded its final depression, which is due primarily to procaine and only partly to a change in pH.3. The site of action for the initial increase in amplitude of respiration was in the fourth ventricle, for it did not occur on perfusion of procaine into the cranial subarachnoid space.4. Perfusion of spinal subarachnoid space with procaine is enough to cause respiratory failure even when the procaine does not reach the medulla.