A role for changes in axonal excitability in general anesthesia

Propofol decreases the axonal excitability in rat primary sensory afferents

AIMS

The aim of this present study was to investigate the changes of peripheral sensory nerve excitability produced by propofol.

MAIN METHODS

In a recently described in vitro model of rodent saphenous nerve we used the technique of threshold tracking (QTRAC®) to measure changes of axonal nerve excitability of Aβ-fibres caused by propofol. Concentrations of 10 μMol, 100 μMol and 1000 μMol were tested. Latency, peak response, strength-duration time constant (τSD) and recovery cycle of the sensory neuronal action potential (SNAP) were recorded.

KEY FINDINGS

Our results have shown that propofol decreases nerve excitability of rat primary sensory afferents in vitro. Latency increased with increasing concentrations (0μMol: 0.96 ± 0.07ms; 1000μMol 1.10 ± 0.06ms, P<0.01). Also, propofol prolonged the relative refractory period (0μMol: 1.79 ± 1.13ms; 100 μMol: 2.53 ± 1.38ms, P<0.01), and reduced superexcitability (0 μMol: -14.0±4.0%; 100μMol: -9.5 ± 5.5%) and subexcitability (0μMol: 7.5 ± 1.2%; 1000μMol: 3.6 ± 1.2) significantly during the recovery cycle (P<0.01).

SIGNIFICANCE

Our results have shown that propofol decreases nerve excitability of primary sensory afferents. The technique of threshold tracking revealed that axonal voltage-gated ion channels are significantly affected by propofol and therefore might be at least partially responsible for earlier described analgesic effects.

Changes in axonal excitability of primary sensory afferents with general anaesthesia in humans

BACKGROUND

Intraoperative monitoring of neuronal function is important in a variety of surgeries. The type of general anaesthetic used can affect the interpretation and quality of such recordings. Although the principal effects of general anaesthetics are synaptically mediated, the extent to which they affect excitability of the peripheral afferent nervous system is unclear.

METHODS

Forty subjects were randomized in a stratified manner into two groups, anaesthetized with either propofol or sevoflurane. The threshold tracking technique (QTRAC(®)) was used to measure nerve excitability parameters of the sensory action potential of the median nerve before and after induction of general anaesthesia.

RESULTS

Several parameters of peripheral sensory afferent nerve excitability changed after induction of general anaesthesia, which were similar for both propofol and sevoflurane. The maximum amplitude of the sensory nerve action potential decreased in both groups (propofol: 25.3%; sevoflurane: 29.5%; both P<0.01). The relative refractory period [mean (sd)] also decreased similarly in both groups [propofol: -0.6 (0.7) ms; sevoflurane: -0.3 (0.5) ms; both P<0.01]. Skin temperature at the stimulation site increased significantly in both groups [propofol: +1.2 (1.0)°C; sevoflurane: +1.7 (1.4)°C; both P<0.01].

CONCLUSIONS

Small changes in excitability of primary sensory afferents after the induction of anaesthesia with propofol or sevoflurane were detected. These effects, which were non-specific and are possibly explained by changes observed in temperature, demonstrate possible anaesthetic effects on intraoperative neuromonitoring.

Volatile anesthetics significantly suppress central and peripheral mammalian sodium channels

1. Voltage-dependent sodium channels are important for neuronal signal propagation and integration. 2. Non-mammalian preparations, such as squid giant axon, have sodium channels which have been found to be insensitive to clinical anesthetic concentrations. 3. On the other hand, sodium channels from mammalian neurons are much more sensitive to block by volatile anesthetics. 4. Due to a significant hyperpolarizing shift in steady-state inactivation, IC50s for sodium channel block at potentials close to the resting membrane potential overlapped with clinical anesthetic concentrations. 5. Hence, sodium channels in mammalian neurons may be sensitive molecular targets of volatile anesthetics.

Effects of volatile anaesthetics on a high conductance calcium dependent potassium channel in cultured hippocampal neurons

(1) The effects of isoflurane and halothane (at nominal concentrations of 4%) were studied on a high conductance Ca2+-dependent K+ channel using inside-out patches from cultured rat hippocampal neurons. (2) With physiological-like concentrations of K+ across patches (140 mM internal and 5 mM external), unitary activity from a 4 pA channel (conductance near 100 pS) was evident in excised patches. (3) Isoflurane or halothane had no effects on unitary properties of K (Ca) including channel amplitudes and open and closed times. The channel open probability was also unchanged in the presence of the volatile agent. The results suggest that macroscopic high conductance K (Ca) currents in hippocampal neurons would be relatively insensitive to high concentrations of inhalational anaesthetics.

Halothane depresses action potential conduction in hippocampal axons

General anesthetics are thought to depress the central nervous system (CNS) by acting at synapses; however, only a few studies have compared effects on axonal conduction with effects on synaptic responses using mammalian CNS preparations. The present study used glutamate receptor antagonists (CNQX/APV) or low calcium to block synaptic transmission, allowing Schaffer-collateral axon fiber volleys to be recorded from rat hippocampal brain slices. Since fiber volleys are compound action potentials, they provide a measure of axonal conduction in Schaffer-collateral fibers. Clinical concentrations of the inhalational anesthetic, halothane (1 rat MAC, 1.2 vol.%), produced an 18 +/- 2.3% depression of fiber volley amplitudes (mean +/- S.D.; p < 0.001 ANOVA, n = 10). Depression of action potential conduction accounted for approximately 30% of the overall depression of synaptic transmission produced by halothane at this concentration. Halothane-induced fiber volley depression occurred with little change in conduction velocity, similar to the effect seen with decreased stimulus intensity, but significantly different from the decreased velocity produced by tetrodotoxin (100 nM, p < 0.005). The results indicate that halothane can depress axonal conduction at clinically relevant concentrations and that this depression could contribute to the CNS depression that is associated with anesthesia.

Potentiation by capsaicin of lidocaine's phasic impulse block in isolated rat sciatic nerve

Compound action potentials (CAPs) of A- and C-fibres were recorded from isolated sciatic nerves of the rat to determine whether lidocaine-induced phasic impulse block was affected by low doses of capsaicin. Preceding impulse activity produced phasic reductions of the amplitudes of both A- (5.7 +/- 1.3%) and C-CAPs (20.7 +/- 7.0%) in drug-free solution. Capsaicin alone (50 microM) did not change the activity-induced reductions of the heights of both CAPs (A-CAP: 6.2 +/- 1.7%, C-CAP: 22.3 +/- 8.0%). Lidocaine (100 microM) caused differential phasic blocks between the A-CAP (20.1 +/- 3.7%; n = 7) and the C-CAP (33.8 +/- 4.9% n = 7). Lidocaine's phasic impulse block was potentiated after 30 min of subsequent capsaicin administration (A-CAP: 40.6 +/- 4.7%, n = 7; C-CAP: 48.8 +/- 5.5% n = 9). Capsaicin's phasic potentiating effects were reversed after 30 min of washing. These results suggest that capsaicin may be a useful agent for the reversible potentiation of phasic impulse blockade by lidocaine.

Molecular and cellular mechanisms of general anaesthesia

General anaesthetics are much more selective than is usually appreciated and may act by binding to only a small number of targets in the central nervous system. At surgical concentrations their principal effects are on ligand-gated (rather than voltage-gated) ion channels, with potentiation of postsynaptic inhibitory channel activity best fitting the pharmacological profile observed in general anaesthesia. Although the role of second messengers remains uncertain, it is now clear that anaesthetics act directly on proteins rather than on lipids.