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Germano-Filho PA, Cavalcanti IL, Micuci AJQR, Velarde LGC, de Boer HD, Verçosa N. Recurarization with magnesium sulfate administered after two minutes sugammadex reversal: A randomized, double-blind, controlled trial. J Clin Anesth 2023; 89:111186. [PMID: 37393856 DOI: 10.1016/j.jclinane.2023.111186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023]
Abstract
STUDY OBJECTIVE The current study tested the hypothesis that magnesium sulfate after reversal with sugammadex causes recurarization. DESIGN A single-center, prospective, randomized, double-blind, controlled trial. SETTING Terciary care hospital in Rio de Janeiro, Brazil. PATIENTS Included 60 patients undergoing for elective otolaryngological surgery. INTERVENTIONS All patients received total intravenous anesthesia and a single dose of rocuronium (0.6 mg/kg). In 30 patients, the neuromuscular blockade was reversed with sugammadex (4 mg/kg) at the reappearance of one or two posttetanic counts (deep-blockade series). In 30 other patients, sugammadex (2 mg/kg) was administered at the reappearance of the second twitch of the train-of-four (moderate-blockade series). After the normalized train-of-four ratio recovered to ≥0.9, the patients in each series were randomized to receive intravenous magnesium sulfate (60 mg/kg) or placebo for 10 min. Neuromuscular function was measured by acceleromyography. MEASUREMENTS The primary outcome was the number of patients who exhibited recurarization (normalized train-of-four ratio < 0.9). The secondary outcome was rescue with an additional dose of sugammadex after 60 min. MAIN RESULTS In the deep-blockade series, a normalized train-of-four ratio < 0.9 occurred in 9/14 (64%) patients receiving magnesium sulfate and 1/14 (7%) receiving placebo, RR 9.0 (95% CI: 62-1.30), and (p = 0.002), with four rescues with sugammadex. In the moderate-blockade series, neuromuscular blockade recurred in 11/15 (73%) patients receiving magnesium sulfate and in 0/14 (0%) receiving placebo (p < 0.001), with two rescues. The absolute differences in recurarization were 57% and 73% in the deep-blockade and moderate-blockade, respectively. CONCLUSIONS Single-dose magnesium sulfate led to a normalized train-of-four ratio < 0.9, 2 min after recovery from rocuronium-induced deep and moderate neuromuscular blockade using sugammadex. Additional sugammadex reversed prolonged recurarization.
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Affiliation(s)
- Paulo A Germano-Filho
- Department of Surgery, Anesthesiology, Surgical Sciences Postgraduate Program, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Department of General and Specialized Surgery, Anesthesiology, Universidade Federal Fluminense, Niterói, Brazil.
| | - Ismar L Cavalcanti
- Department of General and Specialized Surgery, Anesthesiology, Universidade Federal Fluminense, Niterói, Brazil; Department of General and Specialized Surgery, Anesthesiology, Medical Sciences Postgraduate Program, Universidade Federal Fluminense, Niterói, Brazil
| | - Angelo J Q R Micuci
- Department of Anesthesiology, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Luis G C Velarde
- Department of Statistics, Medical Sciences Postgraduate Program Universidade Federal Fluminense, Niterói, Brazil
| | - Hans D de Boer
- Department of Anesthesiology and Pain Medicine, Martini General Hospital, Groningen, the Netherlands
| | - Nubia Verçosa
- Department of Surgery, Anesthesiology, Surgical Sciences Postgraduate Program, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Sousa-Soares C, Noronha-Matos JB, Correia-de-Sá P. Purinergic Tuning of the Tripartite Neuromuscular Synapse. Mol Neurobiol 2023; 60:4084-4104. [PMID: 37016047 DOI: 10.1007/s12035-023-03317-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/14/2023] [Indexed: 04/06/2023]
Abstract
The vertebrate neuromuscular junction (NMJ) is a specialised chemical synapse involved in the transmission of bioelectric signals between a motor neuron and a skeletal muscle fiber, leading to muscle contraction. Typically, the NMJ is a tripartite synapse comprising (a) a presynaptic region represented by the motor nerve ending, (b) a postsynaptic skeletal motor endplate area, and (c) perisynaptic Schwann cells (PSCs) that shield the motor nerve terminal. Increasing evidence points towards the role of PSCs in the maintenance and control of neuromuscular integrity, transmission, and plasticity. Acetylcholine (ACh) is the main neurotransmitter at the vertebrate skeletal NMJ, and its role is fine-tuned by co-released purinergic neuromodulators, like adenosine 5'-triphosphate (ATP) and its metabolite adenosine (ADO). Adenine nucleotides modulate transmitter release and expression of postsynaptic ACh receptors at motor synapses via the activation of P2Y and P2X receptors. Endogenously generated ADO modulates ACh release by acting via co-localised inhibitory A1 and facilitatory A2A receptors on motor nerve terminals, whose tonic activation depends on the neuronal firing pattern and their interplay with cholinergic receptors and neuropeptides. Thus, the concerted action of adenine nucleotides, ADO, and ACh/neuropeptide co-transmitters is paramount to adapting the neuromuscular transmission to the working load under pathological conditions, like Myasthenia gravis. Unravelling these functional complexities prompted us to review our knowledge about the way purines orchestrate neuromuscular transmission and plasticity in light of the tripartite synapse concept, emphasising the often-forgotten role of PSCs in this context.
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Affiliation(s)
- Carlos Sousa-Soares
- Laboratório de Farmacologia e Neurobiologia, MedInUP, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, R. Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
- Centro de Investigação Farmacológica e Inovação Medicamentosa (MedInUP), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - José Bernardo Noronha-Matos
- Laboratório de Farmacologia e Neurobiologia, MedInUP, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, R. Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal.
- Centro de Investigação Farmacológica e Inovação Medicamentosa (MedInUP), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.
| | - Paulo Correia-de-Sá
- Laboratório de Farmacologia e Neurobiologia, MedInUP, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, R. Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal.
- Centro de Investigação Farmacológica e Inovação Medicamentosa (MedInUP), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.
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Kim YB, Choi J, Park C, Choi H, In J, Yang H. Effects of sevoflurane and adenosine receptor antagonist on the sugammadex-induced recovery from rocuronium-induced neuromuscular blockade in rodent phrenic nerve-hemidiaphragm tissue specimens. Pharmacol Res Perspect 2021; 9:e00827. [PMID: 34337892 PMCID: PMC8326504 DOI: 10.1002/prp2.827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022] Open
Abstract
Sevoflurane affects on the A1 receptor in the central nervous system and potentiates the action of neuromuscular blocking agents. In the present study, we investigated whether sevoflurane (SEVO) has the ability to potentiate the neuromuscular blocking effect of rocuronium and if the specific antagonist of adenosine receptor (SLV320) can reverse this effect. In this study, phrenic nerve-hemidiaphragm tissue specimens were obtained from 40 Sprague-Dawley (SD) rats. The specimens were immersed in an organ bath filled with Krebs buffer and stimulated by a train-of-four (TOF) pattern using indirect supramaximal stimulation at 20 s intervals. The specimens were randomly allocated to control, 2-chloroadenosine (CADO), SEVO, or SLV320 + SEVO groups. In the CADO and SLV320 + SEVO groups, CADO and SLV320 were added to the organ bath from the start to a concentration of 10 μM and 10 nM, respectively. We then proceeded with rocuronium-induced blockade of >95% depression of the first twitch tension of TOF (T1) and TOF ratio (TOFR). In the SEVO and SLV320 + SEVO groups, SEVO was added to the Krebs buffer solution to concentration of 400-500 μM for 10 min. Sugammadex-induced T1 and TOFR recovery was monitored for 30 min until >95% of T1 and >0.9 of TOFR were confirmed, and the recovery pattern was compared by plotting these data. T1 recovery in the SEVO and CADO groups was significantly delayed compared with the control and SLV320 + SEVO groups (p < .05). In conclusion, sevoflurane affects on the A1 receptor at the neuromuscular junction and delays sugammadex-induced recovery from neuromuscular blockade.
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Affiliation(s)
- Yong Beom Kim
- Department of Anesthesiology and Pain MedicineCollege of MedicineGil Medical CenterGachon UniversityIncheonRepublic of Korea
| | - Jae‐Moon Choi
- Department of Anesthesiology and Pain MedicineAsan Medical CenterUlsan University, College of MedicineSeoulRepublic of Korea
| | - Chungon Park
- Department of Anesthesiology and Pain MedicineCollege of MedicineGil Medical CenterGachon UniversityIncheonRepublic of Korea
| | - Hey‐Ran Choi
- Department of Anaesthesiology and Pain MedicineSeoul Paik HospitalInje University, College of MedicineSeoulRepublic of Korea
| | - Junyong In
- Department of Anesthesiology and Pain MedicineCollege of MedicineIlsan HospitalDonggook UniversityGoyangGyeonggi DoRepublic of Korea
| | - Hong‐Seuk Yang
- Department of Anaesthesiology and Pain MedicineDaejeon Eulji HospitalEulji UniversityDaejeonRepublic of Korea
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Noronha-Matos JB, Oliveira L, Peixoto AR, Almeida L, Castellão-Santana LM, Ambiel CR, Alves-do Prado W, Correia-de-Sá P. Nicotinic α7 receptor-induced adenosine release from perisynaptic Schwann cells controls acetylcholine spillover from motor endplates. J Neurochem 2020; 154:263-283. [PMID: 32011735 DOI: 10.1111/jnc.14975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/01/2020] [Accepted: 01/30/2020] [Indexed: 12/17/2022]
Abstract
Acetylcholine (ACh) spillover from motor endplates occurs after neuronal firing bursts being potentiated by cholinesterase inhibitors (e.g., neostigmine). Nicotinic α7 receptors (α7nAChR) on perisynaptic Schwann cells (PSCs) can control ACh spillover by unknown mechanisms. We hypothesized that adenosine might be the gliotransmitter underlying PSCs-nerve terminal communication. Rat isolated hemidiaphragm preparations were used to measure (1) the outflow of [3 H]ACh, (2) real-time transmitter exocytosis by video-microscopy with the FM4-64 fluorescent dye, and (3) skeletal muscle contractions during high-frequency (50 Hz) nerve stimulation bursts in the presence of a selective α7nAChR agonist, PNU 282987, or upon inhibition of cholinesterase activity with neostigmine. To confirm our prediction that α7nAChR-mediated effects require direct activation of PSCs, we used fluorescence video-microscopy in the real-time mode to measure PNU 282987-induced [Ca2+ ]i transients from Fluo-4 NW loaded PSCs in non-stimulated preparations. The α7nAChR agonist, PNU 282987, decreased nerve-evoked diaphragm tetanic contractions. PNU 282987-induced inhibition was mimicked by neostigmine and results from the reduction of ACh exocytosis measured as decreases in [3 H]ACh release and FM4-64 fluorescent dye unloading. Methyllycaconitine blockage of α7nAChR and the fluoroacetate gliotoxin both prevented inhibition of nerve-evoked ACh release and PSCs [Ca2+ ]i transients triggered by PNU 282987 and neostigmine. Adenosine deamination, inhibition of the ENT1 nucleoside outflow, and blockage of A1 receptors prevented PNU 282987-induced inhibition of transmitter release. Data suggest that α7nAChR controls tetanic-induced ACh spillover from the neuromuscular synapse by promoting adenosine outflow from PSCs via ENT1 transporters and retrograde activation of presynaptic A1 inhibitory receptors.
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Affiliation(s)
- José B Noronha-Matos
- Laboratório de Farmacologia e Neurobiologia, Centro de Investigação Farmacológica e Inovação Medicamentosa (MedInUP), ICBAS, Universidade do Porto, Porto, Portugal
| | - Laura Oliveira
- Laboratório de Farmacologia e Neurobiologia, Centro de Investigação Farmacológica e Inovação Medicamentosa (MedInUP), ICBAS, Universidade do Porto, Porto, Portugal
| | - Ana R Peixoto
- Laboratório de Farmacologia e Neurobiologia, Centro de Investigação Farmacológica e Inovação Medicamentosa (MedInUP), ICBAS, Universidade do Porto, Porto, Portugal
| | - Liliana Almeida
- Laboratório de Farmacologia e Neurobiologia, Centro de Investigação Farmacológica e Inovação Medicamentosa (MedInUP), ICBAS, Universidade do Porto, Porto, Portugal
| | | | - Célia R Ambiel
- Departamento de Ciências Fisiológicas, Universidade Estadual de Maringá, Paraná, Brazil
| | - Wilson Alves-do Prado
- Departamento de Farmacologia e Terapêutica, Universidade Estadual de Maringá, Paraná, Brazil
| | - Paulo Correia-de-Sá
- Laboratório de Farmacologia e Neurobiologia, Centro de Investigação Farmacológica e Inovação Medicamentosa (MedInUP), ICBAS, Universidade do Porto, Porto, Portugal
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Kim YB, Yang HS, Kim HJ, Choi HR, In J, Yoon SY, Ro YJ. Effects of neuromuscular presynaptic muscarinic M 1 receptor blockade on rocuronium-induced neuromuscular blockade in immobilized tibialis anterior muscles. Clin Exp Pharmacol Physiol 2018; 45:1309-1316. [PMID: 30005130 PMCID: PMC6282578 DOI: 10.1111/1440-1681.13012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/10/2018] [Accepted: 07/12/2018] [Indexed: 11/29/2022]
Abstract
This in vivo study tested the hypothesis that the modulation of acetylcholine (ACh) release by the M1 muscarinic receptor (mAChR) in the neuromuscular junction of disused muscles may affect the tensions of the muscles during the neuromuscular monitoring of a rocuronium‐induced neuromuscular block and compared the results with those obtained from normal muscles. A total of 20 C57BL/6 (wild‐type) and 10 α7 knock out (α7KO) mice were used in this experiment. As a pre‐experimental procedure, knee and ankle joints of right hind limbs were fixed by needle pinning at the 90° flexed position. After 2 weeks, the main experiment was performed. Both tendons of the tibialis anterior (TA) muscles were obtained, and the muscle tensions were recorded while the dose‐responses of rocuronium were measured three times in the same mouse by the serial administration of pirenzepine (0, 0.001 and 0.01 μg/g). Weight losses were observed after 2 weeks of immobilization in both groups, and a decrease in the mass of TA muscles at the immobilized side was observed compared to those of the contralateral nonimmobilized side. Tension depression of the TA muscles at immobilized side of the α7KO group was faster than those of the wild‐type group, but these differences decreased after the administration of pirenzepine. The tension depressions were similar regardless of the pirenzepine doses at the same side in the group. Tension depression may become more rapid in the α7 AChR‐expressed disused muscles by the decreased release of ACh release upon neuronal firing by the blockade of facilitatory M1mAChR
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Affiliation(s)
- Yong Beom Kim
- Department of Anesthesiology and Pain Medicine, Gil Medical Center, College of Medicine, Gachon University, Incheon, Korea
| | - Hong-Seuk Yang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Korea
| | - Ha Jung Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Korea
| | - Hey-Ran Choi
- Department of Anaesthesiology and Pain Medicine, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Junyong In
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Ilsan Hospital, Dongguk University, Gyeonggido, Korea
| | - Soon-Young Yoon
- Department of Anesthesiology and Pain Medicine, Gil Medical Center, College of Medicine, Gachon University, Incheon, Korea
| | - Young Jin Ro
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Korea
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Kim YB, Lee S, Choi HR, In J, Chang YJ, Kim HJ, Ro YJ, Yang HS. Effects of adenosine receptor agonist on the rocuroniuminduced neuromuscular block and sugammadex-induced recovery. Korean J Anesthesiol 2018; 71:476-482. [PMID: 29690754 PMCID: PMC6283708 DOI: 10.4097/kja.d.17.00011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Several types of receptors are found at neuromuscular presynaptic membranes. Presynaptic inhibitory A1 and facilitatory A2A receptors mediate different modulatory functions on acetylcholine release. This study investigated whether adenosine A1 receptor agonist contributes to the first twitch tension (T1) of train-of-four (TOF) stimulation depression and TOF fade during rocuronium-induced neuromuscular blockade, and sugammadex-induced recovery. Methods Phrenic nerve-diaphragm tissues were obtained from 30 adult Sprague-Dawley rats. Each tissue specimen was randomly allocated to either control group or 2-chloroadenosine (CADO, 10 μM) group. One hour of reaction time was allowed before initiating main experimental data collection. Loading and boost doses of rocuronium were sequentially administered until > 95% depression of the T1 was achieved. After confirming that there was no T1 twitch tension response, 15 min of resting time was allowed, after which sugammadex was administered. Recovery profiles (T1, TOF ratio [TOFR], and recovery index) were collected for 1 h and compared between groups. Results There were statistically significant differences on amount of rocuronium (actually used during experiment), TOFR changes during concentration-response of rocuronium (P = 0.04), and recovery profiles (P < 0.01) of CADO group comparing with the control group. However, at the initial phase of this experiment, dose-response of rocuronium in each group demonstrated no statistically significant differences (P = 0.12). Conclusions The adenosine A1 receptor agonist (CADO) influenced the TOFR and the recovery profile. After activating adenosine receptor, sugammadex-induced recovery from rocuronium-induced neuromuscular block was delayed.
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Affiliation(s)
- Yong Beom Kim
- Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Sangseok Lee
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Korea
| | - Hey Ran Choi
- Department of Anesthesiology and Pain Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Junyong In
- Department of Anesthesiology and Pain Medicine, Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Young Jin Chang
- Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Ha Jung Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Young Jin Ro
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Hong-Seuk Yang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
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Kim YB, Lee S, Lee KC, Kim HJ, Ro YJ, Yang HS. Effects of presynaptic muscarinic cholinoreceptor blockade on neuromuscular transmission as assessed by the train-of-four and the tetanic fade response to rocuronium. Clin Exp Pharmacol Physiol 2018; 44:795-802. [PMID: 28394450 PMCID: PMC5519946 DOI: 10.1111/1440-1681.12763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 03/29/2017] [Accepted: 03/31/2017] [Indexed: 11/27/2022]
Abstract
This study investigated the effect of muscarinic M1 and M2 receptor antagonists on the rocuronium‐induced train of four (TOF) fade and tetanic fade, respectively. Ex‐vivo phrenic nerves and diaphragms were obtained from adult Sprague‐Dawley rats and stabilized in Krebs buffer; the nerve‐stimulated muscle TOF fade was observed at 20 s intervals. For the TOF study, phrenic nerves and diaphragms were incubated with pirenzepine (an M1 blocker) at concentrations of 0 nmol L−1 (control), 10 nmol L−1 (PZP10), or 100 nmol L−1 (PZP100). Rocuronium was then administered incrementally until the first twitch tension had depressed by >95% during TOF stimulation. The mean TOF ratios were compared when the first twitch tensions were depressed by 40%‐50%. For the tetanic fade study, 50 Hz/5 s tetani was applied initially, 30 min after the administration of a loading dose of rocuronium and methoctramine (an M2 receptor blocker, loaded at 0 μmol L−1 [control], 1 μmol L−1 [MET1], or 10 μmol L−1 [MET10]). The EC95 of rocuronium was significantly lower in the PZP10 group than in the control group. In the PZP10 group, the TOF ratios at 50% and first twitch tension depression were significantly lower than those in the control group (P=.02). During tetanic stimulation, the tetanic fade was significantly enhanced in the MET10 group compared to the other groups. This study shows that antagonists of muscarinic M1 and M2 receptors affect the rocuronium‐induced neuromuscular block as demonstrated by the reduced EC95 and TOF ratios (M1 antagonist, pirenzepine) or the enhanced 50‐Hz tetanic fade (M2 antagonist, methoctramine).
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Affiliation(s)
- Yong Beom Kim
- Department of Anaesthesiology and Pain Medicine, Gil Medical Center, College of Medicine, Gachon University, Incheon, Korea
| | - Sangseok Lee
- Department of Anaesthesiology and Pain Medicine, Sangye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Kyeong Chun Lee
- Department of Anaesthesiology and Pain Medicine, Gil Medical Center, College of Medicine, Gachon University, Incheon, Korea
| | - Ha Jung Kim
- Department of Anaesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Korea
| | - Young Jin Ro
- Department of Anaesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Korea
| | - Hong-Seuk Yang
- Department of Anaesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Korea
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Paradoxical neostigmine-induced TOFfade: On the role of presynaptic cholinergic and adenosine receptors. Eur J Pharmacol 2014; 723:389-96. [DOI: 10.1016/j.ejphar.2013.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 10/31/2013] [Accepted: 11/01/2013] [Indexed: 02/07/2023]
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Pereira MW, Correia-de-Sá P, Alves-Do-Prado W. Adenosine A(2A) receptor antagonists are broad facilitators of antinicotinic neuromuscular blockade monitored either with 2 Hz train-of-four or 50 Hz tetanic stimuli. Clin Exp Pharmacol Physiol 2012; 39:869-77. [PMID: 23013133 DOI: 10.1111/j.1440-1681.2012.12004.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
1. The 2 Hz train-of-four ratio (TOF(ratio)) is used to monitor the degree of patient curarization. Using a rat phrenic nerve-hemidiaphragm preparation, we showed that antinicotinic agents, such as hexamethonium, d-tubocurarine and pancuronium, but not cisatracurium, decreased contractions produced by physiological nerve activity patterns (50 Hz) more efficiently than those caused by 2 Hz trains. Uncertainty about the usefulness of the TOF(ratio) to control safe recovery from curarization prompted us to investigate the muscarinic and adenosine neuromodulation of tetanic (50 Hz) fade induced by antinicotinic agents at concentrations that cause a 25% reduction in the TOF(ratio) (TOF(fade)). 2. Tetanic fade caused by d-tubocurarine (1.1 μmol/L), pancuronium (3 μmol/L) and hexamethonium (5.47 mmol/L) was attenuated by blocking presynaptic inhibitory muscarinic M(2) and adenosine A(1) receptors with methoctramine (1 μmol/L) and 1,3-dipropyl-8-cyclopentylxanthine (2.5 nmol/L), respectively. These compounds enhanced rather than decreased tetanic fade induced by cisatracurium (2.2 μmol/L), but they consistently attenuated cisatracurium-induced TOF(fade). The effect of the M(1) receptor antagonist pirenzepine (10 nmol/L) on fade produced by antinicotinic agents at 50 Hz was opposite to that observed with TOF stimulation. Blockade of adenosine A(2A) receptors with ZM 241385 (10 nmol/L) attenuated TOF(fade) caused by all antinicotinic drugs tested, with the exception of the 'pure' presynaptic nicotinic antagonist hexamethonium. ZM 241385 was the only compound tested in this series that facilitated recovery from tetanic fade produced by cisatracurium. 3. The data suggest that distinct antinicotinic relaxants interfere with fine-tuning neuromuscular adaptations to motor nerve stimulation patterns via activation of presynaptic muscarinic and adenosine receptors. These results support the use of A(2A) receptor antagonists together with atropine to facilitate recovery from antinicotinic neuromuscular blockade.
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Affiliation(s)
- Monalisa W Pereira
- Department of Pharmacology and Therapeutic, State University of Maringá, Maringa, Paraná, Brazil
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