Turner L A, Vodanovic S, Hoffmann R G, Kampine J P, Bosnjak Z J
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee 53226, USA.
Anesthesiology. 1995 Jun;82(6):1438-46. doi: 10.1097/00000542-199506000-00015.
An action of epinephrine at alpha adrenoceptors has been reported to slow conduction in Purkinje fibers exposed to halothane. In Purkinje fibers one pharmacologically distinguishable alpha 1-adrenoceptor subtype (alpha 1B) sensitive to the noncompetitive antagonist chloroethylcholinidine mediates decreases in automaticity. Another alpha 1 subtype (alpha 1A), sensitive to the competitive antagonist WB4101, increases spontaneous rate and action potential duration by a mechanism thought to involve hydrolysis of membrane phosphoinositides by phospholipase C. This study examined the dose-response relation and receptor-effector mechanisms underlying depression of conduction in canine Purkinje fibers by epinephrine with halothane.
Conduction velocity was determined in vitro by measuring the conduction time between action potentials recorded from two Purkinje fibers located about 6 mm apart along the length of free running portions of the ventricular conduction system, the false tendons. Velocity was evaluated at 1-min intervals during trials of rapid exposure to different agonists in groups of 6-12 preparations.
Epinephrine (0.2-5.0 microM) transiently decreased Purkinje conduction velocity in a dose-related manner by as much as 33% (at 5 microM epinephrine with 0.86 mM (2.8%) halothane). Velocity decreased by 5% (P < or = 0.01) at an epinephrine concentration similar to "just-threshold" dysrhythmogenic plasma epinephrine concentrations (0.2 microM epinephrine with 0.46 mM halothane) reported in halothane-anesthetized dogs. The decreases of conduction velocity were blocked by prazosin but not by metoprolol, were produced by phenylephrine but not by clonidine, and were antagonized by equimolar (0.5 microM) concentrations of WB4101 more so (P < or = 0.01) than by chloroethylclonidine. WB4101 (0.1 microM) produced 87% inhibition of the response to 0.2 microM epinephrine after chloroethylclonidine pretreatment, indicating mediation by the alpha 1A subtype. Other agonists linked to cardiac phospholipase C activation, including endothelin 1 (40 nM) and the muscarinic agonist carbamylcholine (1 mM), also decreased conduction velocity in fibers exposed to halothane.
Clinically relevant concentrations of epinephrine transiently depress conduction in Purkinje fibers exposed to halothane by activating cardiac alpha 1 adrenoceptors, largely but not exclusively the WB4101-sensitive alpha 1A subtype, reportedly coupled to stimulation of phospholipase C and generation of the second messengers diacylglycerol and inositol trisphosphate. Anesthetic potentiation of cardiac alpha 1-adrenoceptor effects may contribute to the generation of halothane-epinephrine dysrhythmias by abnormally slowing conduction and facilitating reentry.
据报道,肾上腺素作用于α肾上腺素受体可减慢暴露于氟烷的浦肯野纤维的传导速度。在浦肯野纤维中,一种对非竞争性拮抗剂氯乙胆碱有药理学差异的α1肾上腺素受体亚型(α1B)介导自律性降低。另一种对竞争性拮抗剂WB4101敏感的α1亚型(α1A),通过一种被认为涉及磷脂酶C水解膜磷脂酰肌醇的机制,增加自发频率和动作电位持续时间。本研究探讨了肾上腺素与氟烷联合作用导致犬浦肯野纤维传导抑制的剂量反应关系及受体 - 效应器机制。
通过测量沿心室传导系统游离运行部分(假腱索)长度相距约6mm的两根浦肯野纤维记录的动作电位之间的传导时间,在体外测定传导速度。在6 - 12个标本的组中,在快速暴露于不同激动剂的试验期间,每隔1分钟评估一次速度。
肾上腺素(0.2 - 5.0μM)以剂量相关的方式使浦肯野纤维传导速度短暂降低多达33%(在5μM肾上腺素与0.86mM(2.8%)氟烷存在时)。在与氟烷麻醉犬中报道的“刚好阈值”致心律失常血浆肾上腺素浓度相似的肾上腺素浓度(0.2μM肾上腺素与0.46mM氟烷)下,速度降低了5%(P≤0.01)。传导速度的降低被哌唑嗪阻断,但未被美托洛尔阻断;由去氧肾上腺素引起,但未被可乐定引起;并且被等摩尔浓度(0.5μM)的WB4101拮抗的程度(P≤0.01)比氯乙可乐定更大。氯乙胆碱预处理后,WB4101(0.1μM)对0.2μM肾上腺素的反应产生了87%的抑制,表明由α1A亚型介导。其他与心脏磷脂酶C激活相关的激动剂,包括内皮素1(40nM)和毒蕈碱激动剂氨甲酰胆碱(1mM),也降低了暴露于氟烷的纤维的传导速度。
临床相关浓度的肾上腺素通过激活心脏α1肾上腺素受体,短暂抑制暴露于氟烷的浦肯野纤维的传导,主要但并非唯一地通过对WB4101敏感的α1A亚型,据报道该亚型与磷脂酶C的刺激和第二信使二酰基甘油和肌醇三磷酸的产生有关。心脏α1肾上腺素受体效应的麻醉增强作用可能通过异常减慢传导和促进折返,导致氟烷 - 肾上腺素心律失常的发生。