Stoyek Matthew R, Schmidt Michael K, Wilfart Florentin M, Croll Roger P, Smith Frank M
Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada.
Department of Anesthesia, Pain Management and Perioperative Care, Dalhousie University, Halifax, Nova Scotia, Canada; and.
Am J Physiol Regul Integr Comp Physiol. 2017 Dec 1;313(6):R669-R679. doi: 10.1152/ajpregu.00467.2016. Epub 2017 Sep 6.
In addition to their intended clinical actions, all general anesthetic agents in common use have detrimental intrasurgical and postsurgical side effects on organs and systems, including the heart. The major cardiac side effect of anesthesia is bradycardia, which increases the probability of insufficient systemic perfusion during surgery. These side effects also occur in all vertebrate species so far examined, but the underlying mechanisms are not clear. The zebrafish heart is a powerful model for studying cardiac electrophysiology, employing the same pacemaker system and neural control as do mammalian hearts. In this study, isolated zebrafish hearts were significantly bradycardic during exposure to the vapor anesthetics sevoflurane (SEVO), desflurane (DES), and isoflurane (ISO). Bradycardia induced by DES and ISO continued during pharmacological blockade of the intracardiac portion of the autonomic nervous system, but the chronotropic effect of SEVO was eliminated during blockade. Bradycardia evoked by vagosympathetic nerve stimulation was augmented during DES and ISO exposure; nerve stimulation during SEVO exposure had no effect. Together, these results support the hypothesis that the cardiac chronotropic effect of SEVO occurs via a neurally mediated mechanism, while DES and ISO act directly upon cardiac pacemaker cells via an as yet unknown mechanism.
除了其预期的临床作用外,所有常用的全身麻醉剂在手术中和手术后对包括心脏在内的器官和系统都有有害的副作用。麻醉的主要心脏副作用是心动过缓,这增加了手术期间全身灌注不足的可能性。这些副作用在迄今为止所研究的所有脊椎动物物种中也都存在,但潜在机制尚不清楚。斑马鱼心脏是研究心脏电生理学的有力模型,其使用的起搏器系统和神经控制与哺乳动物心脏相同。在本研究中,分离的斑马鱼心脏在暴露于挥发性麻醉剂七氟烷(SEVO)、地氟烷(DES)和异氟烷(ISO)期间显著心动过缓。由DES和ISO诱导的心动过缓在自主神经系统心脏内部分的药理学阻断期间持续存在,但SEVO的变时效应在阻断期间消除。在DES和ISO暴露期间,迷走交感神经刺激引起的心动过缓增强;SEVO暴露期间的神经刺激没有影响。总之,这些结果支持以下假设:SEVO的心脏变时效应通过神经介导机制发生,而DES和ISO通过一种尚不清楚的机制直接作用于心脏起搏细胞。