The effects of naloxone on the analgesic activities of general anaesthetics

Neurobiology of nitrous oxide-induced antinociceptive effects

Nitrous oxide (N2O), or laughing gas, has been used for clinical anesthesia for more than a century and is still commonly used. While the anesthetic/hypnotic mechanisms of N2O remain largely unknown, the underlying mechanisms of its analgesic/antinociceptive effects have been elucidated during the last several decades. Evidence to date indicate that N2O induces opioid peptide release in the periaqueductal gray area of the midbrain leading to the activation of the descending inhibitory pathways, which results in modulation of the pain/nociceptive processing in the spinal cord. The types of opioid peptide induced by N2O and the subtypes of opioid receptors that mediate the antinociceptive effects of N2O appear to depend on various factors including the species and/or strain, the regions of the brain, and the paradigms of behavior testing used for the experiments. Among three types of descending inhibitory pathways, the descending noradrenergic inhibitory pathway seems to play the most prominent role. The specific elements involved are now being resolved.

Nitrous oxide induces feeding in the nondeprived rat that is antagonized by naltrexone

Three experiments investigated a possible effect of nitrous oxide (N2O) on food intake in nondeprived male hooded rats in independent groups designs. Experiment 1 demonstrated a concentration-related increase in intake with increasing level of nitrous oxide (10-40% N2O), reaching statistical significance at 20% N2O when compared to room air controls (p < 0.05). In experiment 2, pretreatment with 10 and 20 mg/kg of the benzodiazepine antagonist, flumazenil, failed to significantly attenuate 30% N2O-induced hyperphagia. In Experiment 3, pretreatment with the opioid antagonist, naltrexone, effectively antagonized 30% N2O-induced hyperphagia. Pronounced attenuation (to 59% of 30% N2O-induced intake level over a 1 h period) at the lowest dose of naltrexone (0.1 mg/kg, p < 0.01) compared to vehicle level resulted in a shallow dose-response curve across the dose range tested (0.1-10.0 mg/kg). These results suggest that an endogenous opioid mechanism is prominently involved in the N2O-induced ingestive response.

Effects of subanesthetic concentrations of nitrous oxide on cold-pressor pain in humans

Nitrous oxide (N2O) has analgesic properties as determined in both animal and human research. In the present study, we sought to determine whether N2O given in subanesthetic concentrations would reduce cold pressor (CP)-induced pain. A crossover, double-blind study was conducted in 10 healthy volunteers. Each subject participated in four separate sessions, and in each session the effects of one of four concentrations of N2O in oxygen (0, 20, 30, and 40%) were assessed. The duration of inhalation was 40 min, and within each session, subjects immersed their nondominant arm in water (2-3 degrees C) twice for 3 min (at 10 and 30 min intrainhalation). Pain intensity, the degree to which the pain was bothersome (measured on a verbal scale of 0-10, 0 = "not at all" and 10 = "extremely" painful/bothersome), and pain quality [measured by the short-form McGill Pain Questionnaire (SF-MPQ)] were assessed during the forearm immersion. Mood effects were measured with the use of visual analogue scales (VAS) in the presence and absence of pain. Self-reported pain intensity and bothersomeness, SF-MPQ ratings of "sharp pain" and "throbbing pain," and VAS rating of "unpleasant bodily sensations" were significantly reduced by N2O (p < 0.05) in a concentration-dependent manner. Nitrous oxide had a number of effects on mood (e.g., increased VAS ratings of "stimulated," "high," "coasting," "carefree," and "having pleasant bodily sensations"). The cold-water immersion also influenced mood, but had little impact on modulating N2O effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Nitrous oxide selectively releases Met5-enkephalin and Met5-enkephalin-Arg6-Phe7 into canine third ventricular cerebrospinal fluid

The role of the opioid receptor-endogenous opioid peptide system in mediating analgesia induced by nitrous oxide has been a controversial subject. Most previous studies provided only indirect evidence either to support or refute the involvement of opioid receptors and/or endogenous opioid peptides. To provide more direct evidence, we measured concentrations of five naturally occurring endogenous opioid peptides in third ventricular cerebrospinal fluid from eight acclimated dogs with chronically implanted ventricular catheters. Paired samples of cerebrospinal fluid were obtained from each animal when breathing room air or 66-75 vol% nitrous oxide in oxygen through a face mask. Endogenous opioid peptides were physically separated using reversed phase high-performance liquid chromatography and quantified using radioimmunoassays. Nitrous oxide inhalation increased cerebrospinal fluid concentrations of met5-enkephalin from a control value of 0.30 +/- 0.07 (mean +/- SEM, n = 8) to 42.4 +/- 8.1 pmol/mL (P = 0.0006). Increases ranged from 28 to more than 400 times the control value. Met5-enkephalin-arg6-phe7 concentrations also increased from 14.5 +/- 2.5 to 57.6 +/- 17.8 pmol/mL (P = 0.018). No significant changes were noted in concentrations of dynorphin A, dynorphin B, or beta-endorphin. These results directly support the hypothesis that nitrous-oxide-induced analgesia involves the proenkephalin-derived family of endogenous opioid peptides.

Strain-dependent differences in responsiveness of mice to nitrous oxide (N2O) antinociception

N2O antinociception was assessed in eight inbred and two outbred mouse strains. Results indicated the following order of responsiveness among the 10 strains: A/J (most sensitive), C57BL/6ByJ, C57BL/6J, BALB/cByJ, C3H/HeJ, Swiss-Webster, CXBK/ByJ, ICR, CBA/J and DBA/2J (least sensitive). These results demonstrate significant strain-dependent differences in antinociceptive responsiveness to N2O. The weak antinociceptive response to N2O in the DBA/2J strain, which is sensitive to morphine and U-50, 488H, indicates some underlying neurobiological difference in the DBA/2J mouse that imparts resistance to N2O. The responsiveness of CXBK/ByJ mice to N2O indicates that mu-opioid receptors may not play an important role in N2O antinociception in mice.

Acute tolerance to nitrous oxide in humans

The goal of this research was to determine whether the level of analgesia produced by nitrous oxide remains constant for the duration of a typical dental procedure or whether acute tolerance reduces the drug's efficacy. A computer-controlled stimulator delivered brief (approx. 1 msec) electrical pulses to a vital maxillary incisor which had been found to have normal sensitivity in a preliminary session. Subjects were trained to indicate the occurrence of a barely perceptible sensation (i.e., detection threshold) as well as a minimally painful sensation (i.e., pain threshold). On the experimental day, all subjects breathed a non-odorized placebo gas mixture during a 10-min baseline condition, and were then randomly assigned to receive either an odorized placebo gas mixture or an odorized 35-40% nitrous oxide/oxygen gas mixture for 46 min. Detection and pain thresholds were assessed repeatedly during the baseline and gas exposure conditions. Placebo control subjects had little change of either sensory threshold. Subjects breathing nitrous oxide significantly increased both detection and pain thresholds within 2-8 min following the onset of the drug. However, maintenance of the drug's effect was not consistent between subjects, despite continuous administration of a constant concentration of nitrous oxide. Some subjects had a relatively constant elevation of sensory thresholds throughout the nitrous oxide administration period, and others returned to baseline sensitivity values and therefore were acutely tolerant.

Staircase assessment of the magnitude and time-course of 50% nitrous-oxide analgesia

The analgesic effect of 50% nitrous oxide and oxygen on thermal pain sensations was evaluated in a placebo-controlled, double-blind crossover design. In a session immediately before oral surgery, 20 patients used a seven-point verbal scale to rate the intensity of pain sensations evoked by three-second thermal stimuli delivered to 14 sites on the volar forearm at 20-second intervals by a 1-cm-diameter contact thermode. Subjects rated 36 stimuli while breathing room air and then two additional sets of 36 stimuli while inhaling 50% nitrous oxide and oxygen during one set and oxygen placebo during the other. Each of these two stimulus sets was preceded by a two-minute induction of the agent, and the sets were separated by a three-minute washout period. Order of administration was randomized and counterbalanced. Stimulus temperatures were adjusted continuously by an interactive computer program so that response could be maintained at predetermined levels. This method resulted in a continuous measure of analgesia in units of stimulus intensity. Results showed that, in comparison with placebo, nitrous oxide significantly increased the stimulus temperatures (mean = 0.42 degrees C) required to make the same response [F (11,209) = 6.76, p less than 0.0001], indicating analgesia. This increase was one-third to one-half that observed with clinical doses of intravenous fentanyl. Analgesic effects were apparent at three min and wanted 10 min after termination of nitrous-oxide inhalation. These times closely correlated with previous measures of alveolar concentration, further supporting the fast but modest analgesic action of nitrous oxide.

Effect of subtype-selective opioid receptor blockers on nitrous oxide antinociception in rats

Nitrous oxide antinociception in rats was evaluated by the warm water tail withdrawal test following central pretreatment with blockers of various opioid receptor subtypes. The analgesic dose, 50% (AD50) value for nitrous oxide antinociception was significantly elevated by MR-2266 (which is relatively selective for kappa-opioid receptors) and increased to a lesser degree by ICI-174,864 (which is selective for delta-opioid receptors). However, pretreatment with beta-funaltrexamine (which is selective for mu-opioid receptors), even at extremely high doses, was ineffective in altering the AD50 for nitrous oxide antinociception. According to these findings, nitrous oxide antinociception, as evaluated in this paradigm, appears to be mediated by kappa- and possibly delta- but not mu-opioid receptors.

Influence of narcotic antagonist drugs upon nitrous oxide analgesia in mice

Nitrous oxide produced a concentration-related suppression of phenylquinone-induced abdominal constriction in mice. This analgesic effect was significantly reduced (but not abolished) by systemic pretreatment with (-)-naloxone or naltrexone but not (+)-naloxone. Systemic pretreatment with methylnaltrexone failed to appreciably influence nitrous oxide analgesia; however, methylnatrexone, administered centrally, significantly attenuated the drug effect. Furthermore, nitrous oxide analgesia was significantly reduced by MR-2266 (which is relatively selective for kappa-opioid receptors) but not by beta-funaltrexamine (which is selective for mu-opioid receptors) at the doses employed in this study. These findings suggest that nitrous oxide analgesia might involve an activation of kappa-opioid receptors in the central nervous system; however, a possible involvement of mu-opioid receptors is not absolutely precluded by this study.

Analgesic (sub anesthetic) nitrous oxide interacts with the endogenous opioid system: a review of the evidence

The concept that anesthesia and analgesia are distinct states and therefore are possibly mediated by different mechanisms is stressed. Analgesic nitrous oxide is shown to act at specific rather than non specific central nervous system sites, as well as having a large number of actions similar to morphine the classical opioid. This includes the fact that specific opioid antagonists attenuate the effects of both morphine and analgesic nitrous oxide. Evidence is also provided showing that nitrous oxide may be a partial agonist and that it may interact with the endogenous opioid system by the release of endogenous opioids, and/or by direct action at the mu, delta, sigma and kappa receptors.