Nagashima M, Sasakawa T, Schaller S J, Martyn J A J
Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Shriners Hospitals for Children®-Boston, and Harvard Medical School, Boston, MA, USA.
Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Shriners Hospitals for Children®-Boston, and Harvard Medical School, Boston, MA, USA Klinikum Rechts der Isar, Technische Universitat Munchen, Klinik fur Anaesthesiologie, Munchen, Germany.
Br J Anaesth. 2015 Jul;115(1):122-7. doi: 10.1093/bja/aev037. Epub 2015 Apr 1.
Train-of-four (TOF) fade during nerve-mediated muscle contraction is postulated to be attributable to inhibition of prejunctional nicotinic α3β2 acetylcholine receptors (nAChRs), while decrease of twitch tension is attributable to block of postjunctional muscle nAChRs. The validity of these presumptions was tested using specific prejunctional and postjunctional nAChR antagonists, testing the hypothesis that fade is not always a prejunctional phenomenon.
Pentobarbital anaesthetized mice had TOF fade measured after administration of: either 0.9% saline; the prejunctional α3β2 nAChR antagonist, dihydro-β-erythroidine (DHβE); the postjunctional nAChR antagonists, α-bungarotoxin (α-BTX) or α-conotoxin GI; and a combination of α-BTX and DHβE; or a combination of α-conotoxin GI and DHβE.
Saline caused no neuromuscular changes. Administration of muscle nAChR antagonists, α-BTX or α-conotoxin GI caused significant decrease of twitch tension and TOF fade compared with baseline (P<0.01). DHβE alone caused no change of twitch tension or fade even after 90 min, but its coadministration with α-BTX or α-conotoxin GI significantly accelerated the onset of paralysis and degree of fade compared with α-BTX or α-conotoxin GI alone (P<0.01).
Occupation of postjunctional nAChRs alone by α-BTX or α-conotoxin GI causes fade. As the prejunctional effects of DHβE on fade became manifest only when co-administered with α-BTX or α-conotoxin GI, specific inhibition of prejunctional nAChR alone is not necessary and sufficient to cause fade. Fade observed during repetitive nerve stimulation can be because of block of either postjunctional nAChRs alone, or block of prejunctional and postjunctional nAChRs together.
神经介导的肌肉收缩过程中,四个成串刺激(TOF)衰减被推测是由于接头前烟碱型α3β2乙酰胆碱受体(nAChRs)受到抑制,而单收缩张力降低则是由于接头后肌肉nAChRs被阻断。使用特异性接头前和接头后nAChR拮抗剂对这些推测的正确性进行了检验,以验证衰减并不总是接头前现象这一假设。
戊巴比妥麻醉的小鼠在给予以下药物后测量TOF衰减:0.9%生理盐水;接头前α3β2 nAChR拮抗剂二氢-β-刺桐啶(DHβE);接头后nAChR拮抗剂α-银环蛇毒素(α-BTX)或α-芋螺毒素GI;α-BTX与DHβE的组合;或α-芋螺毒素GI与DHβE的组合。
生理盐水未引起神经肌肉变化。与基线相比,给予肌肉nAChR拮抗剂α-BTX或α-芋螺毒素GI导致单收缩张力显著降低和TOF衰减(P<0.01)。单独给予DHβE即使在90分钟后也未引起单收缩张力或衰减的变化,但其与α-BTX或α-芋螺毒素GI联合给药时,与单独使用α-BTX或α-芋螺毒素GI相比,显著加速了麻痹的发生和衰减程度(P<0.01)。
单独使用α-BTX或α-芋螺毒素GI占据接头后nAChRs会导致衰减。由于DHβE对接头前衰减的作用仅在与α-BTX或α-芋螺毒素GI联合给药时才显现,因此仅对接头前nAChR进行特异性抑制并不足以导致衰减。在重复神经刺激过程中观察到的衰减可能是由于单独阻断接头后nAChRs,或同时阻断接头前和接头后nAChRs。