Department of Anesthesiology, Nara Medical University, Nara 634-8522, Japan.
Anesth Analg. 2010 Apr 1;110(4):1126-32. doi: 10.1213/ANE.0b013e3181d278f7.
beta-Adrenoreceptor antagonists provide neuroprotection against focal cerebral ischemia, but the effects of these antagonists on experimental global cerebral ischemia are unknown. That is, the effect of beta-adrenoreceptor antagonism in vulnerable brain regions after ischemic insult has not been examined. Therefore, we investigated the neuroprotective effects of preischemic or postischemic administration of propranolol (a nonselective beta-adrenoreceptor antagonist), esmolol, and landiolol (selective beta-adrenoreceptor 1 antagonists) against forebrain ischemia in rats.
IV administration of saline 10 microL . h(-1), propranolol 100 microg . kg(-1) . min(-1), esmolol 200 microg . kg(-1) . min(-1), or landiolol 50 microg . kg(-1) . min(-1) in male Sprague-Dawley rats was started 30 minutes before or 60 minutes after 8-minute bilateral carotid artery occlusion combined with hypotension (35 mm Hg) under isoflurane (1.5%) anesthesia. All drugs were administered continuously until 5 days after reperfusion, and the animals were evaluated neurologically and histologically after this 5-day period.
Preischemic treatment with propranolol, esmolol, or landiolol failed to provide neuroprotection against forebrain ischemia in the hippocampus. Rats treated with propranolol tended to have a worse score for motor activity and a higher mortality rate (up to 64%), but the differences with other groups were not statistically significant. Postischemic treatment with esmolol and landiolol, but not with propranolol, reduced neuronal injury after forebrain ischemia. However, motor activity did not differ among rats treated postischemically with any of the beta-adrenoreceptor antagonists or saline.
Postischemic treatment with esmolol and landiolol provided neuroprotection in the hippocampus in rats subjected to bilateral carotid artery occlusion combined with hemorrhagic shock, whereas treatment with propranolol failed to show neuroprotection. We suggest that concomitant beta-blockade and shock might work as a systemic depressant, rather than a neuroprotectant, resulting in exacerbation of cerebral ischemia.
β-肾上腺素受体拮抗剂可提供针对局灶性脑缺血的神经保护,但这些拮抗剂对实验性全脑缺血的作用尚不清楚。也就是说,缺血后易损脑区β-肾上腺素受体拮抗作用尚未被检测到。因此,我们研究了普萘洛尔(非选择性β-肾上腺素受体拮抗剂)、艾司洛尔和拉贝洛尔(选择性β-肾上腺素受体 1 拮抗剂)在大鼠前脑缺血中的预缺血或缺血后给药对大脑的神经保护作用。
雄性 Sprague-Dawley 大鼠在异氟烷(1.5%)麻醉下进行 8 分钟双侧颈总动脉闭塞合并低血压(35mmHg),在 30 分钟前或 60 分钟后开始静脉输注生理盐水 10μL/h、普萘洛尔 100μg/kg/min、艾司洛尔 200μg/kg/min 或拉贝洛尔 50μg/kg/min。所有药物持续输注至再灌注后 5 天,在这 5 天后对动物进行神经学和组织学评估。
预缺血给予普萘洛尔、艾司洛尔或拉贝洛尔治疗未能对海马区的前脑缺血提供神经保护。给予普萘洛尔的大鼠运动活动评分往往较差,死亡率较高(高达 64%),但与其他组的差异无统计学意义。与普萘洛尔相比,缺血后给予艾司洛尔和拉贝洛尔治疗可减少前脑缺血后的神经元损伤,但缺血后给予任何β-肾上腺素受体拮抗剂或生理盐水治疗的大鼠运动活动并无差异。
在进行双侧颈总动脉闭塞合并失血性休克的大鼠中,缺血后给予艾司洛尔和拉贝洛尔治疗可提供海马区的神经保护作用,而普萘洛尔治疗则未能显示神经保护作用。我们认为,同时给予β-阻断和休克可能作为一种全身性抑制剂,而不是神经保护剂,从而加重脑缺血。