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Tanaka S, Yamamoto K, Yoshida S, Tomio R, Fujimoto T, Osaka M, Ishikawa T, Shimizu T, Akao N, Nishimatsu T. Anesthetic Fade in Intraoperative Transcranial Motor Evoked Potential Monitoring Is Mainly due to Decreased Synaptic Transmission at the Neuromuscular Junction by Propofol Accumulation. J Neurol Surg A Cent Eur Neurosurg 2024; 85:451-456. [PMID: 37257841 DOI: 10.1055/a-2103-7381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND We previously reported that normalization of motor evoked potential (MEP) monitoring amplitude by compound muscle action potential (CMAP) after peripheral nerve stimulation prevented the expression of anesthetic fade (AF), suggesting that AF might be due to reduced synaptic transfer in the neuromuscular junction. METHODS We calculated the time at which AF began for each of craniotomy and spinal cord surgery, and examined whether AF was avoided by CMAP after peripheral nerve stimulation normalization in each. Similar studies were also made with respect to the upper and lower limb muscles. RESULTS AF was observed in surgery lasting 160 minutes for craniotomy and 260 minutes or more for spinal surgery, and 195 minutes in the upper limb muscles and 135 minutes in the lower limb muscles. In all the series, AF could be avoided by CMAP after peripheral nerve stimulation normalization. CONCLUSION AF of MEP occurred in both craniotomy and spinal cord surgery, and it was also corrected by CMAP after peripheral nerve stimulation. AF is considered to be mainly due to a decrease in synaptic transfer of the neuromuscular junction due to the accumulation of propofol because of the avoidance by CMAP normalization. However, it may be partially due to a decrease in the excitability of pyramidal tracts and α-motor neurons, because AF occurred earlier in the lower limb muscles than in the upper limb muscles.
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Affiliation(s)
- Satoshi Tanaka
- Department of Neurosurgery, Numata Neurosurgery & Cardiovascular Hospital, Numata, Gunma, Japan
| | - Kenta Yamamoto
- Department of Clinical Laboratory, Numata Neurosurgery & Cardiovascular Hospital, Numata, Gunma, Japan
| | - Shinsuke Yoshida
- Department of Neurosurgery, Saitama Medical Center, Kawagoe, Saitama, Japan
| | - Ryosuke Tomio
- Department of Neurosurgery, Honjo Neurosurgery & Spinal Surgery Clinic, Honjo, Saitama, Japan
| | - Takeshi Fujimoto
- Department of Neurosurgery, Numata Neurosurgery & Cardiovascular Hospital, Numata, Gunma, Japan
| | - Misuzu Osaka
- Department of Neurosurgery, Numata Neurosurgery & Cardiovascular Hospital, Numata, Gunma, Japan
| | - Toshio Ishikawa
- Department of Neurosurgery, Numata Neurosurgery & Cardiovascular Hospital, Numata, Gunma, Japan
| | - Tsunemasa Shimizu
- Department of Neurosurgery, Numata Neurosurgery & Cardiovascular Hospital, Numata, Gunma, Japan
| | - Norio Akao
- Department of Neurosurgery, Numata Neurosurgery & Cardiovascular Hospital, Numata, Gunma, Japan
| | - Terutaka Nishimatsu
- Department of Neurosurgery, Numata Neurosurgery & Cardiovascular Hospital, Numata, Gunma, Japan
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Effect of Compound Muscle Action Potential After Peripheral Nerve Stimulation Normalization on Anesthetic Fade of Intraoperative Transcranial Motor-Evoked Potential. J Clin Neurophysiol 2021; 38:306-311. [PMID: 32187041 DOI: 10.1097/wnp.0000000000000692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Anesthetic fade refers to the time-dependent decrease in the amplitude of the intraoperative motor-evoked potential. It is thought to be caused by the accumulation of propofol. The authors examined whether normalization by the compound muscle action potential (CMAP) after peripheral nerve stimulation could compensate for anesthetic fade. METHODS In 1,842 muscles in 578 surgeries, which did not exhibit a motor-neurologic change after the operation, the motor-evoked potential amplitude was normalized by the CMAP amplitude after peripheral nerve stimulation, and the CMAP amplitude and operation times were analyzed. RESULTS The amplitudes of both motor-evoked potential and CMAP increased over time after peripheral nerve stimulation because of the disappearance of muscle-relaxant action. Especially, after peripheral nerve stimulation, CMAP significantly increased from the beginning to the end of the operation. Anesthetic fade in transcranial motor-evoked potential monitoring seemed to occur at more than 235 minutes of surgery based on the results of a receiver operating characteristic analysis of the operation time and relative amplitudes. Although the mean amplitude without CMAP normalization at more than 235 minutes was significantly lower than that at less than 235 minutes, the mean amplitude with normalization by CMAP after peripheral nerve stimulation at more than 235 minutes was not significantly different from that at less than 235 minutes. CONCLUSIONS Compound muscle action potential after peripheral nerve stimulation normalization was able to avoid the effect of anesthetic fade. Anesthetic fade was seemed to be caused by a decrease in synaptic transmission at the neuromuscular junction because of propofol accumulation by this result.
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Proportional Downscaling of Glutamatergic Release Sites by the General Anesthetic Propofol at Drosophila Motor Nerve Terminals. eNeuro 2020; 7:ENEURO.0422-19.2020. [PMID: 32019872 PMCID: PMC7053172 DOI: 10.1523/eneuro.0422-19.2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 01/12/2023] Open
Abstract
Propofol is the most common general anesthetic used for surgery in humans, yet its complete mechanism of action remains elusive. In addition to potentiating inhibitory synapses in the brain, propofol also impairs excitatory neurotransmission. We use electrophysiological recordings from individual glutamatergic boutons in male and female larval Drosophila melanogaster motor nerve terminals to characterize this effect. We recorded from two bouton types, which have distinct presynaptic physiology and different average numbers of release sites or active zones. We show that a clinically relevant dose of propofol (3 μm) impairs neurotransmitter release similarly at both bouton types by decreasing the number of active release sites by half, without affecting release probability. In contrast, an analog of propofol has no effect on glutamate release. Coexpressing a truncated syntaxin1A protein in presynaptic boutons completely blocked this effect of propofol. Overexpressing wild-type syntaxin1A in boutons also conferred a level of resistance by increasing the number of active release sites to a physiological ceiling set by the number of active zones or T-bars, and in this way counteracting the effect of propofol. These results point to the presynaptic release machinery as a target for the general anesthetic. Proportionally equivalent effects of propofol on the number of active release sites across the different bouton types suggests that glutamatergic circuits that involve smaller boutons with fewer release sites may be more vulnerable to the presynaptic effects of the drug.
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Woll KA, Guzik-Lendrum S, Bensel BM, Bhanu NV, Dailey WP, Garcia BA, Gilbert SP, Eckenhoff RG. An allosteric propofol-binding site in kinesin disrupts kinesin-mediated processive movement on microtubules. J Biol Chem 2018; 293:11283-11295. [PMID: 29844014 PMCID: PMC6065180 DOI: 10.1074/jbc.ra118.002182] [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: 01/30/2018] [Revised: 05/24/2018] [Indexed: 12/20/2022] Open
Abstract
Microtubule-based molecular motors mediate transport of intracellular cargo to subdomains in neurons. Previous evidence has suggested that the anesthetic propofol decreases the average run-length potential of the major anterograde transporters kinesin-1 and kinesin-2 without altering their velocity. This effect on kinesin has not been observed with other inhibitors, stimulating considerable interest in the underlying mechanism. Here, we used a photoactive derivative of propofol, meta-azipropofol (AziPm), to search for potential propofol-binding sites in kinesin. Single-molecule motility assays confirmed that AziPm and propofol similarly inhibit kinesin-1 and kinesin-2. We then applied AziPm in semiquantitative radiolabeling and MS microsequencing assays to identify propofol-binding sites within microtubule-kinesin complexes. The radiolabeling experiments suggested preferential AziPm binding to the ATP-bound microtubule-kinesin complex. The photolabeled residues were contained within the kinesin motor domain rather than at the motor domain-β-tubulin interface. No residues within the P-loop of kinesin were photolabeled, indicating an inhibitory mechanism that does not directly affect ATPase activity and has an effect on run length without changing velocity. Our results also indicated that when the kinesin motor interacts with the microtubule during its processive run, a site forms in kinesin to which propofol can then bind and allosterically disrupt the kinesin-microtubule interaction, resulting in kinesin detachment and run termination. The discovery of the propofol-binding allosteric site in kinesin may improve our understanding of the strict coordination of the motor heads during the processive run. We hypothesize that propofol's potent effect on intracellular transport contributes to various components of its anesthetic action.
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Affiliation(s)
- Kellie A Woll
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania 19104
| | - Stephanie Guzik-Lendrum
- Department of Biological Sciences and the Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York 12180
| | - Brandon M Bensel
- Department of Biological Sciences and the Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York 12180
| | - Natarajan V Bhanu
- Department of Biochemistry and Biophysics, Epigenetics Program, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania 19104
| | - William P Dailey
- Department of Chemistry, University of Pennsylvania School of Arts and Sciences, Philadelphia, Pennsylvania 19104
| | - Benjamin A Garcia
- Department of Biochemistry and Biophysics, Epigenetics Program, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania 19104
| | - Susan P Gilbert
- Department of Biological Sciences and the Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York 12180
| | - Roderic G Eckenhoff
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania 19104.
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Karunanithi S, Troup M, van Swinderen B. Using Drosophila to Understand General Anesthesia: From Synapses to Behavior. Methods Enzymol 2018; 602:153-176. [PMID: 29588027 DOI: 10.1016/bs.mie.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Investigating mechanisms of general anesthesia requires access to multiple levels of neuronal function, from effects at individual synapses to responses in behaving animals. Drosophila melanogaster provides an excellent model to test different theories for general anesthesia because it offers robust methods for testing local as well as global target processes, in an animal that is similarly impacted by these diverse drugs as humans. Here, we outline methods to quantify two such endpoints, neurotransmission and behavioral responsiveness, focusing on the intravenous drug propofol.
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Affiliation(s)
- Shanker Karunanithi
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia; School of Medical Science and Menzies Health Institute Queensland, Griffith University Gold Coast Campus, Gold Coast, QLD, Australia
| | - Michael Troup
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
| | - Bruno van Swinderen
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia.
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Arena A, Lamanna J, Gemma M, Ripamonti M, Ravasio G, Zimarino V, De Vitis A, Beretta L, Malgaroli A. Linear transformation of the encoding mechanism for light intensity underlies the paradoxical enhancement of cortical visual responses by sevoflurane. J Physiol 2016; 595:321-339. [PMID: 27416731 DOI: 10.1113/jp272215] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 06/30/2016] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS The mechanisms of action of anaesthetics on the living brain are still poorly understood. In this respect, the analysis of the differential effects of anaesthetics on spontaneous and sensory-evoked cortical activity might provide important and novel cues. Here we show that the anaesthetic sevoflurane strongly silences the brain but potentiates in a dose- and frequency-dependent manner the cortical visual response. Such enhancement arises from a linear scaling by sevoflurane of the power-law relation between light intensity and the cortical response. The fingerprint of sevoflurane action suggests that circuit silencing can boost linearly synaptic responsiveness presumably by scaling the number of responding units and/or their correlation following a sensory stimulation. ABSTRACT General anaesthetics, which are expected to silence brain activity, often spare sensory responses. To evaluate differential effects of anaesthetics on spontaneous and sensory-evoked cortical activity, we characterized their modulation by sevoflurane and propofol. Power spectra and the bust-suppression ratio from EEG data were used to evaluate anaesthesia depth. ON and OFF cortical responses were elicited by light pulses of variable intensity, duration and frequency, during light and deep states of anaesthesia. Both anaesthetics reduced spontaneous cortical activity but sevoflurane greatly enhanced while propofol diminished the ON visual response. Interestingly, the large potentiation of the ON visual response by sevoflurane was found to represent a linear scaling of the encoding mechanism for light intensity. To the contrary, the OFF cortical visual response was depressed by both anaesthetics. The selective depression of the OFF component by sevoflurane could be converted into a robust potentiation by the pharmacological blockade of the ON pathway, suggesting that the temporal order of ON and OFF responses leads to a depression of the latter. This hypothesis agrees with the finding that the enhancement of the ON response was converted into a depression by increasing the frequency of light-pulse stimulation from 0.1 to 1 Hz. Overall, our results support the view that inactivity-dependent modulation of cortical circuits produces an increase in their responsiveness. Among the implications of our findings, the silencing of cortical circuits can boost linearly the cortical responsiveness but with negative impact on their frequency transfer and with a loss of the information content of the sensory signal.
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Affiliation(s)
- Alessandro Arena
- Università Vita-Salute San Raffaele, Milan, Italy.,Neurobiology of Learning Unit, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Jacopo Lamanna
- Università Vita-Salute San Raffaele, Milan, Italy.,Neurobiology of Learning Unit, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Gemma
- Department of Neuro-anaesthesia and Neuro-intensive Care, Ospedale San Raffaele, Milan, Italy
| | - Maddalena Ripamonti
- Università Vita-Salute San Raffaele, Milan, Italy.,Neurobiology of Learning Unit, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Giuliano Ravasio
- Department of Veterinary Science and Public Health, Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Zimarino
- Università Vita-Salute San Raffaele, Milan, Italy.,Neurobiology of Learning Unit, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Assunta De Vitis
- Department of Neuro-anaesthesia and Neuro-intensive Care, Ospedale San Raffaele, Milan, Italy
| | - Luigi Beretta
- Department of Neuro-anaesthesia and Neuro-intensive Care, Ospedale San Raffaele, Milan, Italy
| | - Antonio Malgaroli
- Università Vita-Salute San Raffaele, Milan, Italy.,Neurobiology of Learning Unit, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
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Castro Fonseca MD, Da Silva JH, Ferraz VP, Gomez RS, Guatimosim C. Comparative presynaptic effects of the volatile anesthetics sevoflurane and isoflurane at the mouse neuromuscular junction. Muscle Nerve 2015; 52:876-84. [DOI: 10.1002/mus.24589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Matheus De Castro Fonseca
- Departamento de Morfologia, Instituto de Ciências Biológicas; Universidade Federal de Minas Gerais; Av. Antônio Carlos, 6627 Belo Horizonte MG 31270-901 Brasil
| | - Janice Henriques Da Silva
- Departamento de Morfologia, Instituto de Ciências Biológicas; Universidade Federal de Minas Gerais; Av. Antônio Carlos, 6627 Belo Horizonte MG 31270-901 Brasil
| | - Vany Perpetua Ferraz
- Departamento de Química, Instituto de Ciências Exatas; Universidade Federal de Minas Gerais; MG Brasil
| | - Renato Santiago Gomez
- Departamento de Cirurgia, Faculdade de Medicina; Universidade Federal de Minas Gerais; Belo Horizonte MG Brasil
| | - Cristina Guatimosim
- Departamento de Morfologia, Instituto de Ciências Biológicas; Universidade Federal de Minas Gerais; Av. Antônio Carlos, 6627 Belo Horizonte MG 31270-901 Brasil
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Valadão PAC, Naves LA, Gomez RS, Guatimosim C. Etomidate evokes synaptic vesicle exocytosis without increasing miniature endplate potentials frequency at the mice neuromuscular junction. Neurochem Int 2013; 63:576-82. [PMID: 24044896 DOI: 10.1016/j.neuint.2013.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 08/19/2013] [Accepted: 09/08/2013] [Indexed: 11/18/2022]
Abstract
Etomidate is an intravenous anesthetic used during anesthesia induction. This agent induces spontaneous movements, especially myoclonus after its administration suggesting a putative primary effect at the central nervous system or the periphery. Therefore, the aim of this study was to investigate the presynaptic and postsynaptic effects of etomidate at the mouse neuromuscular junction (NMJ). Diaphragm nerve muscle preparations were isolated and stained with the styryl dye FM1-43, a fluorescent tool that tracks synaptic vesicles exo-endocytosis that are key steps for neurotransmission. We observed that etomidate induced synaptic vesicle exocytosis in a dose-dependent fashion, an effect that was independent of voltage-gated Na(+) channels. By contrast, etomidate-evoked exocytosis was dependent on extracellular Ca(2+) because its effect was abolished in Ca(2+)-free medium and also inhibited by omega-Agatoxin IVA (30 and 200nM) suggesting the participation of P/Q-subtype Ca(2+) channels. Interestingly, even though etomidate induced synaptic vesicle exocytosis, we did not observe any significant difference in the frequency and amplitude of miniature end-plate potentials (MEPPs) in the presence of the anesthetic. We therefore investigated whether etomidate could act on nicotinic acetylcholine receptors labeled with α-bungarotoxin-Alexa 594 and we observed less fluorescence in preparations exposed to the anesthetic. In conclusion, our results suggest that etomidate exerts a presynaptic effect at the NMJ inducing synaptic vesicle exocytosis, likely through the activation of P-subtype voltage gated Ca(2+) channels without interfering with MEPPs frequency. The present data contribute to a better understanding about the effect of etomidate at the neuromuscular synapse and may help to explain some clinical effects of this agent.
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Affiliation(s)
| | - Lígia Araújo Naves
- Departamento de Fisiologia e Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Renato Santiago Gomez
- Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Cristina Guatimosim
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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