Gredell J A, Turnquist P A, Maciver M B, Pearce R A
Department of Anesthesiology, University of Wisconsin, Madison, WI 53706, USA.
Br J Anaesth. 2004 Dec;93(6):810-7. doi: 10.1093/bja/aeh272. Epub 2004 Sep 17.
Propofol (2,6-diisopropylphenol) is a widely used general anaesthetic that modulates gamma-aminobutyric acid type A (GABA(A)) receptors, the major inhibitory neurotransmitter receptor in the brain. Previous studies have found that the concentration of propofol that is required to affect synaptic inhibition in brain slices is much higher than the free concentration that is achieved clinically and that modulates isolated receptors. We tested whether this is accounted for by slow equilibration in brain tissue, and determined the concentration that must be applied to achieve appropriate brain levels.
Rat brain slices 300-microm thick were placed in a solution of 100 microM propofol in artificial cerebrospinal fluid for times ranging from 7.5 to 480 min. Concentrations in these slices were measured by HPLC to determine diffusion and partition coefficients. Electrophysiological measurements of the rate at which effects of 5 microM propofol developed were compared with the calculated rate of increase in tissue concentration.
The diffusion coefficient was approximately 0.02x10(-6) cm2 s(-1), and the brain:artificial cerebrospinal fluid partition coefficient was 36. Diffusion times in brain slices agreed well with time course measurements of propofol-induced depression of synaptic responses, which continued to increase over 5 h. This depression was reversed by blocking GABA inhibition with picrotoxin (100 microM).
Propofol does enhance inhibition in brain slices at a concentration of 0.63 microM in the superfusate, which produces brain concentrations corresponding with those achieved in vivo, but equilibration requires several hours. It is likely that slow diffusion to GABA receptors accounts for the high concentrations (>10 microM) that were needed to depress evoked responses in previous investigations.
丙泊酚(2,6 - 二异丙基苯酚)是一种广泛使用的全身麻醉剂,可调节γ-氨基丁酸A型(GABA(A))受体,这是大脑中主要的抑制性神经递质受体。先前的研究发现,影响脑片突触抑制所需的丙泊酚浓度远高于临床上达到的游离浓度,而该游离浓度可调节分离的受体。我们测试了这是否是由于脑组织中平衡缓慢所致,并确定了为达到适当脑内水平必须应用的浓度。
将300微米厚的大鼠脑片置于含100微摩尔丙泊酚的人工脑脊液溶液中7.5至480分钟。通过高效液相色谱法测量这些脑片中的浓度,以确定扩散系数和分配系数。将5微摩尔丙泊酚作用产生的速率的电生理测量结果与计算出的组织浓度增加速率进行比较。
扩散系数约为0.02×10⁻⁶平方厘米·秒⁻¹,脑与人工脑脊液的分配系数为36。脑片中的扩散时间与丙泊酚诱导的突触反应抑制的时间进程测量结果吻合良好,该抑制在5小时内持续增加。用印防己毒素(100微摩尔)阻断GABA抑制可逆转这种抑制。
在灌流液中浓度为0.63微摩尔时,丙泊酚确实增强了脑片的抑制作用,该浓度产生的脑内浓度与体内达到的浓度相当,但平衡需要数小时。先前研究中抑制诱发反应所需的高浓度(>10微摩尔)可能是由于向GABA受体的缓慢扩散所致。