The effect of temperature on the nerve-blocking action of benzyl alcohol on the squid giant axon

Effect of precooling injection site and cold anesthetic administration on injection pain, onset, and anesthetic efficacy in maxillary molars with symptomatic irreversible pulpitis: a randomized controlled trial

OBJECTIVE

This randomized controlled clinical trial assessed the analgesic and anesthetic effects of precooling the injection site and administration of refrigerated 2% lignocaine HCl with 1:100,000 epinephrine (LE) in maxillary molars with symptomatic irreversible pulpitis (SIP).

MATERIALS AND METHODS

Sixty patients diagnosed with SIP (preoperative pain score ≥ 85 mm) in maxillary first molars were randomly allocated to two groups. In group I (control), topical gel was applied for a minute followed by conventional LE infiltration, whereas in group II (experimental), topical ice application for 15 s and refrigerated (4-6 °C) LE administration was done prior to endodontic treatment. The primary outcome measure was anesthetic efficacy that was defined as none to weak pain (≤ 36 mm) as measured on Heft Parker visual analog scale (HP-VAS) following access cavity preparation. Pain on injection and onset constituted the secondary outcome measures. The pain on injection was measured using HP-VAS, whereas the onset of anesthesia was assessed using an electric pulp tester (EPT) which was applied on the experimental tooth every minute until no response was elicited. Mann-Whitney U test was performed to analyze the data (p < 0.01).

RESULTS

Experimental group reported a success rate of 86.6% when compared to control group (26.6%) and a statistically significant reduction on injection pain (20.0 mm vs 54.5 mm) (p < 0.01). The onset of anesthesia for experimental group was 2.4 min which was also significantly lower than control group (4.5 min) (p < 0.01).

CONCLUSIONS

Cryotherapy can serve as an effective alternative to conventional anesthesia for achieving success, reduced pain, and faster onset during endodontic treatment of maxillary molars with SIP.

CLINICAL RELEVANCE

Precooling the injection site and cold LE administration can result in effective pulpal anesthesia during endodontic management of maxillary molars in SIP patients.

The Role of Temperature in the Action of Mepivacaine

The role of temperature in the action of local anesthetics was studied in 20 healthy young volunteers with plain 3% mepivacaine injected periapically twice in their maxillary first premolar, the first time with the solution at a temperature of 20 degrees C and the second time at 4 degrees C. The pulpal response was measured with a pulp tester every minute. The onset of pulp anesthesia was found to be of no statistical difference between 20 degrees C and 4 degrees C. On the other hand, mepivacaine at a temperature of 4 degrees C was found to have a statistically significant longer duration of action. Our conclusion is that the drop in temperature of mepivacaine from 20 degrees C to 4 degrees C provides a longer duration of pulpal anesthesia.

The effects of temperature on the interactions between volatile general anaesthetics and a neuronal nicotinic acetylcholine receptor

1. Completely isolated identified neurones from the right parietal ganglion of the pond snail Lymnaea stagnalis were investigated under two-electrode voltage clamp. Neuronal nicotinic acetylcholine receptor (AChR) currents were studied at low acetylcholine concentrations (< or = 200 nM). 2. Inhibition of the ACh-induced currents by three volatile general anaesthetics (halothane, isoflurane and methoxyflurane) and the specific inhibitor (+)-tubocurarine was studied as a function of temperature (over the range 4-25 degrees C). 3. The inhibition by the volatile anaesthetics increased (inhibition constants decreased) with decreasing temperature while the inhibition by (+)-tubocurarine did not change significantly near room temperature, but decreased at lower temperatures. The (+)-tubocurarine inhibition appeared to be competitive in nature and showed no significant voltage-dependence. 4. The van't Hoff plots (logarithms of the dissociation constants against reciprocal absolute temperature) were linear for the anaesthetics, but markedly non-linear for (+)-tubocurarine. From these plots, values for the changes in the standard Gibbs free energy delta G degrees water-->AChR, enthalpy delta H degree water-->AChR, entropy delta S degree water-->AChR and heat capacity delta Cp degree water-->AChR were determined. Tubocurarine was found to bind very much tighter to the receptor than the volatile anaesthetics due, entirely, to a favourable increase in entropy on binding. 5. A comparison between the temperature-dependence of the anaesthetic inhibition of the ACh receptor and that of general anaesthetic potencies in animals indicates that the temperature-dependence of animal potencies might be simply accounted for in terms of changes in anaesthetic/receptor binding.

Local anaesthetic effects of benzene and structurally related molecules, including benzocaine, on the squid giant axon

(1). The effects of benzene and several of its derivatives on sodium currents in the voltage-clamped squid giant axon have been studied. Substances tested were benzene, aniline, benzyl alcohol, propiophenone, 4-amino-propiophenone, methyl benzoate, ethyl benzoate, and 4-amino ethyl benzoate (benzocaine). (2.) All substances tested reduced the sodium current in both intact axons and axons internally perfused with CsF. (3.) There were four major actions of benzene on the sodium current: (a) an increase in the resting level of inactivation, (b) an increase in the depolarization required to produce the maximum current, (c) a decrease in the maximum sodium conductance, and (d) an increase in the rate of inactivation. (4.) 4-amino ethyl benzoate (benzocaine) had actions on the sodium current which were very similar to those of benzene with the exception that the rate of inactivation was scarcely affected and, at comparable shifts, the slope of the steady state inactivation curve was slightly smaller. (5.) The results obtained with the substances structurally intermediate between benzene and 4-amino ethyl benzoate allow some conclusions to be drawn as to the role of each functional group.

The effect of temperature on Na currents in rat myelinated nerve fibres

Voltage clamp experiments were performed in single myelinated nerve fibres of the rat and the effect of temperature on Na currents was investigated between 0 degrees C and 40 degrees C. The amplitude of the peak Na current changed with a Q10 = 1.1 between 40 degrees and 20 degrees C and with a Q10 = 1.3 between 20 degrees and 10 degrees C. Below 10 degrees C the peak Na current changed with a Q10 = 1.9. The temperature coefficient for time-to-peak (tp), the measure for Na activation, and tau h1 and tau h2, the time constants for Na inactivation changed throughout the temperature range. Q10 for all of these kinetic parameters increased from 1.8-2.1 between 40 degrees and 20 degrees C to 2.6-2.7 between 20 degrees and 10 degrees C. Below 10 degrees C Q10 increased to 3.7 for tau h1 and tp, and to 2.9 for tau h2. When the series resistance artifacts were minimized by addition of 6 nM TTX, the Q10's at T less than 10 degrees C were 2.9-3.0. When the temperature was decreased from 20 degrees to 0 degrees C, both the curve relating Na permeability to potential, PNa(V), and the steady state Na inactivation curve, h infinity (V), were reversibly shifted towards more negative potentials by 6 mV and 11 mV, respectively. When the temperature was increased from 20 degrees to 37 degrees C no shifts occurred. The Hodgkin-Huxley rate constants alpha h(V) and beta h(V) were calculated from h infinity (V) and tau h (or tau h1) at 20 degrees and 4 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)

The involvement of calcium in the intestinal response to secretagogues in the rat

The involvement of Ca2+ in the regulation of intestinal secretion was investigated in stripped sheets of rat mid-intestine. Removal of serosal Ca2+ together with the addition of EGTA at concentrations of 0.5 and 1 mM inhibited the rise in short-circuit current (s.c.c.) induced by both acetylcholine and theophylline, a similar degree of inhibition being observed with both secretagogues. Ca2+-free serosal fluid with 0.5 mM-EGTA added reduced significantly the rises in s.c.c. induced by A23187, acetylcholine, 5-hydroxytryptamine, theophylline, dibutyryl cyclic AMP and prostaglandin E2, but not the increased s.c.c. associated with glucose absorption. The Ca2+ channel blocker verapamil produced similar results. The calmodulin antagonist trifluoperazine inhibited secretagogue action while its sulphoxide derivative was without effect at the same concentration. The intracellular Ca2+ antagonist TMB-8 reduced the increased s.c.c. observed with acetylcholine and dibutyryl cyclic AMP. The net Cl- secretion, but not the decreased mucosal-to-serosal Na+ flux, induced by acetylcholine was abolished in Ca2+-free conditions. There was no consistent effect on the reduction in the residual ion flux caused by acetylcholine. Absence of Ca2+ converted the stimulation of Cl- secretion induced by dibutyryl cyclic AMP observed under control conditions to an enhancement of net Na+ and Cl- absorption. It is concluded that intestinal secretagogues, whether they act through cyclic AMP or not, require both internal and external sources of Ca2+ if they are to produce their full effects. Moreover, it appears that the nature of the response to dibutyryl cyclic AMP depends on the prevailing Ca2+ concentration.

Temperature-dependence of the action of nerve blocking agents and its relationship to membrane-buffer partition coefficients: thermodynamic implications for the site of action of local anaesthetics

The local anaesthetic action of a series of nerve blocking agents was examined at temperatures between 4 degrees C and 20 degrees C in isolated sciatic nerves from cold-adapted frogs. Cooling alone had little effect on the amplitude of the action potential but the conduction velocity was decreased and the duration increased. Cooling had little effect on the local anaesthetic action of the short chain alkanols but that of the long chain alkanols, benzyl alcohol, benzocaine and pentobarbitone was markedly enhanced. The partition of both short and long chain alkanols and of pentobarbitone into a liposome suspension of similar composition to axonal membrane lipids was reduced by cooling from 40 degrees C to 4 degrees C. The results are not compatible with the lipid hypotheses of anaesthetic action. The implications for the nature of the site of action are discussed.