Effects of Fentanyl, Diazepam, and the Combination of Both on Arterial Baroreflex and Sympathetic Nerve Activity in Intact and Baro-Denervated Dogs

Taneyama, Chikuni; Gotô, Hiroshi; Kohno, Naoko; Benson, Kirk T.; Sasao, Junichi; Arakawa, Kasumi

doi:10.1213/00000539-199307000-00009

Cited by 45 publications

(24 citation statements)

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“…2,2s We reported that the effect of fentanyl on arterial baroreflex control of sympathetic nerve activity in dogs was negligible. 24 The current study also indicates this, since AHR/'ASBP was similar under the isoflurane-N20 anaesthesia with and without fentanyl before surgical stimulation (Figure 2). In the presence of surgical stimulation, however, fentanyl preserved heart rate baroreflex sensitivity ( Figure 2) and prevented an increase in ACTH (Figure 3), presumably by suppressing visceral surgical noxious stimuli during upper abdominal surgery.…”

Section: Discussionsupporting

confidence: 74%

Surgical stress attenuates reflex heart rate response to hypotension

Kohno

Taneyama

1998

Can J Anaesth

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Purpose: The baroreflex-mediated increase in heart rate (HR) in response to acute reduction of systolic blood pressure (SBP) was studied in order to assess whether the changes in arterial baroreflex sensitivity depend on the intensity of surgical stress, and location of visceral and somatic stimulation during surgery. Methods: Patients were divided into visceral stimulation groups [upper ( n --30) and lower (n = 30) abdominal surgery] and somatic stimulation groups [upper in = 25) and lower (n = 25) limbs, and chest wall (n = 25) surgery]. Acute hypotension as a baroreflex depressor test was induced by prostaglandin E~ (PGE,) 10 min before surgical incision (control) and during surgical manipulation under isoflurane-N20 anaesthesia or isoflurane-N20-fentanyl anaesthesia. Plasma level of ACTH was measured in an additional 40 patients who underwent upper abdominal surgery. Results: During upper abdominal surgery, the heart rate baroreflex sensitivity (AHR/ASBP) was depressed from -0.47 _+ 0.05 (control) to -0.01 _+ 0.04 (P < 0.05). The reflex heart rate baroreflex sensitivity remained unchanged and was similar among the remaining groups of patients. The concentration of ACTH increased from 12.5 -+ 1.0 (control) to 343 +-78.6 pg.ml-' (P < 0.05) with isoflurane-N20 anaesthesia but did not change with isoflu~ne-N20-fentanyl anaesthesia during upper abdominal surgery. Conclusion: Upper abdominal surgery is associated with the most stressful stimulation to attenuate heart rate baroreflex sensitivity. Integrity of the baroreflex can be preserved by adding opioids to supplement inhalation anaesthesia.Objectif : L~augmentation de la fr~quence cardiaque (FC) ~ m~diation baror~flexe en r~ponse ~ une diminution soudaine de la tension art&ielle systolique (-I-AS) a &~ ~tudi& dans le but d'~valuer si les changements de sensibilit~ art&ielle baror~flexe d~pendent de I'intensit~ du stress chirurgical et du si~ge de la stimulation visc&ale et somatique pendant la chirurgie. M&hode : Les patients ont ~t~ r~partis en diff6rents groupes : selon une stimulation visc&ale [chirurgie abdominale haute (n = 30) et basse ( n = 30)] et selon une stimulation somatique [chirurgie des membres sup6rieurs (n =25) et inf&ieurs (n = 25) ou chirurgie de la paroi thoracique (n = 25)]. Une hypotension soudaine, sous forme de test d~presseur baror~flexe, a ~t~ induite par la prostaglandine E, (PGE~) 10 rain avant I'incision chirurgicale (groupe t~moin) et pendant la manipulation chirurgicale sous anesth&ie avec isoflurane N20 ou sous anesth&ie avec isoflurane N20 et fentanyl. Le niveau plasmatique d'ACTH a ~t~ mesur~ chez 40 patients additionnels admis pour une chirurgie abdominale haute. R~sultats : Pendant la chirurgie abdominale haute, la sensibilit~ de la fr~quence cardiaque baror~flexe (AFC / ATAS) &ait abaiss~e de -0,47 _+ 0,05 (t~moin) ~ -0,01 + 0,04 (P < 0,05). La sensibilit~ r6flexe de la fr~quence cardiaque baror~flexe n'a pas chang~ et 6tait similaire parmi les autres groupes de patients. La concentration d'ACTH a augment~ de 12,5 -1,0 (t...

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Section: Discussionsupporting

confidence: 74%

Surgical stress attenuates reflex heart rate response to hypotension

Kohno

Taneyama

1998

Can J Anaesth

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“…Several pharmaceuticals acting on GABA A receptors are known to influence blood pressure (Marty et al, 1986;Taneyama et al, 1993). This study suggests that a component of this effect could be mediated via tonic inhibition and consequently that tonic inhibition may be one target for CNS-mediated therapeutic actions on the cardiovascular system.…”

Section: Introductionmentioning

confidence: 62%

Tonic GABAergic Inhibition of Sympathetic Preganglionic Neurons: A Novel Substrate for Sympathetic Control

Wang¹,

Spary²,

Deuchars³

et al. 2008

J. Neurosci.

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The sympathetic tone is primarily defined by the level of activity of the sympathetic preganglionic neurons. We report a novel inhibitory influence on sympathetic activity, that of tonic GABAergic inhibition which could have a profound global effect on sympathetic outflow. Recording from identified SPNs in the intermediolateral cell column (IML) of rat spinal cord slices, application of the GABA receptor antagonist bicuculline, but not gabazine, elicited a change in voltage that lasted for the duration of application. This response was mediated by a direct effect on SPNs since it persisted in tetrodotoxin and low Ca 2ϩ /high Mg 2ϩ and the amplitude of responses were related to Cl Ϫ concentration in patch solutions. Such tonic inhibitory responses were not observed in interneurons, the other neuronal type in the IML, although ongoing IPSPs were antagonized in these neurons. The effects of bicuculline were enhanced by diazepam but not zolpidem or the GABA modulators THIP and THDOC suggesting a role for ␣5 subunits. PCR using primers for the ␣5 and ␦ subunits indicated the presence of ␣5, but not ␦ subunits in the IML. Firing rates of SPNs were enhanced by bicuculline and decreased by diazepam indicating that this tonic inhibition has a profound effect on the excitability of SPNs. These data indicate a novel influence for controlling the activity of SPNs regardless of their function.

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“…15,17,18 In anesthetized animals, opioid agonists generally decrease sympathetic activity. In anesthetized dogs and cats, fentanyl (5 to 50 g/kg IV) decreases splanchnic nerve activity and catecholamine plasma concentrations 3,4,6,7,9 and inhibits baroreflex responses. 38 In awake humans, however, the effects of opioid receptor agonists are less clear, because associated respiratory depression and/or an altered state of consciousness can hardly be controlled for.…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

“…1,2 Acute administration of -opioid receptor agonists provides little insight in this respect, because any effects are blurred by respiratory depression, an altered state of consciousness, or even anesthesia. [3][4][5][6][7][8][9][10][11] Furthermore, under resting conditions, -opioid receptor blockade by naloxone, which attenuates the effects of endogenous opioids, does not change muscle sympathetic activity (MSA), arterial baroreflex gain, or catecholamine plasma concentrations in healthy volunteers. [12][13][14][15][16] Conversely, naloxone potentiates the increase in MSA during exercise and in response to lower-body negative pressure, indicating inhibition of MSA by endogenous opioids when the sympathetic nervous system is activated.…”

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confidence: 99%

Chronic μ-Opioid Receptor Stimulation in Humans Decreases Muscle Sympathetic Nerve Activity

et al. 2001

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Background-Opioid-addicted patients undergoing detoxification provide a unique opportunity to assess the effects of chronic opioid receptor stimulation on the sympathetic nervous system. We tested the hypothesis that chronic oral methadone intake decreases resting efferent sympathetic nerve activity to muscle (MSA). Furthermore, we assessed whether this effect is reversed by -opioid receptor blockade during antagonist-supported detoxification under general anesthesia. Methods and Results-Fifteen young patients (30Ϯ1 years old, meanϮSEM) with a long history of mono-opioid addiction and under oral methadone substitution therapy (65Ϯ10 mg/d for 21Ϯ6 months) were selected. Peroneal MSA (microneurography) and catecholamine plasma concentrations (high-performance liquid chromatography) were assessed in the awake state and compared with those of age-matched healthy control subjects. The effects of -opioid receptor blockade by naloxone (12.4 mg IV) were determined during propofol anesthesia. Compared with healthy volunteers, resting MSA (4Ϯ2 versus 22Ϯ2 bursts/min, PϽ0.0001) and antecubital venous norepinephrine plasma concentration (100Ϯ64 versus 256Ϯ48 pg/mL, Pϭ0.01) were markedly decreased in addicted patients despite similar arterial blood pressure and heart rate. Opioid receptor blockade markedly increased MSA (5Ϯ2 to 24Ϯ3 bursts/min) and norepinephrine (49Ϯ12 to 305Ϯ48 pg/mL) and epinephrine (13Ϯ2 to 482Ϯ67 pg/mL) arterial plasma concentrations as well as mean arterial pressure (82Ϯ4 to 108Ϯ3 mm Hg) and heart rate (70Ϯ3 to 86Ϯ4 beats/min). Conclusions-Chronic

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Effects of Fentanyl, Diazepam, and the Combination of Both on Arterial Baroreflex and Sympathetic Nerve Activity in Intact and Baro-Denervated Dogs

Cited by 45 publications

References 0 publications

Surgical stress attenuates reflex heart rate response to hypotension

Surgical stress attenuates reflex heart rate response to hypotension

Tonic GABAergic Inhibition of Sympathetic Preganglionic Neurons: A Novel Substrate for Sympathetic Control

Chronic μ-Opioid Receptor Stimulation in Humans Decreases Muscle Sympathetic Nerve Activity

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