Role of vagal and spinal sensory pathways on eupneic diaphragmatic activity

Training to yoga respiration selectively increases respiratory sensation in healthy man

Because yoga practitioners think they are benefiting from their breath training we hypothesized that yoga respiration training (YRT) could modify the respiratory sensation. Yoga respiration (YR) ("ujjai") consisted of very slow, deep breaths (2-3 min(-1)) with sustained breath-hold after each inspiration and expiration. At inclusion in the study and after a 2-month YRT program, we determined in healthy subjects their eupneic ventilatory pattern and their capacity to discriminate external inspiratory resistive loads (respiratory sensation), digital tactile mechanical pressures (somesthetic sensation) and sound-pressure stimulations (auditory sensation). Data were compared to a gender-, age-, and weight-matched control group of healthy subjects who did not undergo the YRT program but were explored at the same epochs. After the 2-month YRT program, the respiratory sensation increased. Thus, both the exponent of the Steven's power law (Psi=kPhin) and the slope of the linear-linear plot between Psi and mouth pressure (Pm) were significantly higher, and the intercept with ordinate axis of the Psi versus Pm relationship was lower. After YRT, the peak Pm developed against inspiratory loads was significantly lower, reducing the load-induced activation of respiratory afferents. YRT induced long-lasting modifications of the ventilatory pattern with a significant lengthening of expiratory duration and a modest tidal volume increase. No significant changes in somesthetic and auditory sensations were noted. In the control group, the respiratory sensation was not modified during a 15-min period of yoga respiration, despite the peak Pm changes in response to added loads were then significantly reduced. These data suggest that training to yoga respiration selectively increases the respiratory sensation, perhaps through its persistent conditioning of the breathing pattern.

Persistence of diaphragmatic contraction influences the pulmonary inflammatory response to mechanical ventilation

Because we already showed (Brégeon, F., Roch, A., Delpierre, S., Ghigo, E., Autillo-Touati, A., Kajikawa, O., Martin, T., Pugin, J., Portugal, H., Auffray, J., Jammes, Y., 2002. Conventional mechanical ventilation of healthy lungs induced pro-inflammatory cytokine gene transcription, Respir. Physiol. Neurobiol. 132, 191-203) that non-injurious mechanical ventilation (MV) elicited inflammatory signal in paralyzed rabbits having normal lungs, we examined the role of neuromuscular blockade in the pulmonary inflammatory response. In the bronchoalveolar lavage fluid (BALF), leukocyte count, MCP-1 and IL-8 cytokine concentrations (ELISA) and mRNAs (reverse transcription polymerase chain reaction, RT-PCR) were measured in paralyzed (P) or non-paralyzed (NP) rabbits ventilated for a 6-h period. Compared to the P group and despite the tidal volume was the same, we measured in the NP one a lower compliance of the respiratory system (Crs,stat), a longer inspiratory time (Ti), a negative inspiratory tracheal pressure (Ptr) wave preceding the pump-induced positive pressure wave, and a higher peak tracheal pressure. Moreover, in NP animals, gross autopsy showed negligible lung abnormalities, and marked reduction of leukocyte count and lung cytokines (P < 0.05). Thus, the absence of neuromuscular blockade decreased the pulmonary chemotactic response to MV suggesting that the total suppression of negative pressure waves elicited by the diaphragmatic (di) contractions could be involved in this lung response to positive pressure MV.

Changes in respiratory pattern and arterial blood gases during sedation with propofol or midazolam in spinal anesthesia

STUDY OBJECTIVE

To investigate changes in respiratory pattern and arterial blood gases during sedation with propofol or midazolam in spinal anesthesia.

DESIGN

Randomized, placebo-controlled study.

SETTING

Operating room of a university-affiliated hospital.

PATIENTS

40 ASA physical status I and II patients who required spinal anesthesia.

INTERVENTIONS

Spinal anesthesia with tetracaine and subsequent sedation with propofol (n = 15), midazolam (n = 15), or placebo (n = 10) was performed.

MEASUREMENTS

Respiratory pattern [rib cage contribution to the tidal volume (%RC) and phase shift between rib cage and abdominal movements (PSrc-ab)] with a respiratory inductive plethysmograph (Respigraph) and arterial blood gas analysis (pH, pO2, and pCO2) were recorded.

MAIN RESULTS

Spinal anesthesia per se increased %RC by 35% without changing PSrc-ab values (1.00). Sedation with propofol and midazolam decreased %RC by 60% and by 40%, respectively. PSrc-ab increased in both groups following sedation, and the increase in this parameter was higher in the propofol group (1.12) than in the midazolam group (1.04). In the placebo group, %RC decreased by 20% without any change in PSrc-ab. The decrease in pO2 was more significant in the propofol group (65.1 mmHg) than in the midazolam (74.2 mmHg) and placebo (83.1 mmHg) groups.

CONCLUSION

Significant decreases in %RC and pO2 during propofol sedation seem to depend on paradoxical respiration due, in part, to upper airway obstruction; therefore, attention should be directed to the respiratory pattern during sedation, especially with propofol.

Increasing background inspiratory resistance changes somatosensory sensations in healthy man

The central purpose of the study was to investigate if increasing background inspiratory resistance, a circumstance which activated afferents from the lungs and respiratory muscles, modified somatosensory and/or auditory sensations in healthy individuals. Estimation of mechanical stimulations applied on the middle finger (somatosensory sensation) and unilateral sound-pressure stimulations (auditory sensation) was based on the computation of Stevens' power function psi = k.phi n, where psi is the estimate and phi is either the somatosensory stimuli or sound-pressures. This was studied during eupnoeic unloaded ventilation then during a 10-min period of loaded breathing followed by a 10-min recovery period. Loaded breathing significantly lowered the estimate of somatosensory stimuli (decreased n coefficient). This effect persisted during the two first minutes of recovery period. By contrast, loaded breathing did not modify the perception of auditory stimulus. As somesthetic and respiratory afferents, but not auditory afferents, project on the same area in the sensory cortex we suggest the existence of central interactions which could explain observations of the difficulties to execute accurate tasks in patients suffering from obstructive lung disease independently from the alterations in their arterial blood gases.

Changes in ventilatory pattern and arterial oxygen saturation during spinal anaesthesia in man

Using a respiratory inductive plethysmograph and a pulse oximeter, we investigated the changes in the respiratory pattern and peripheral oxygen saturation (SpO2) of the finger before and during spinal anaesthesia in 20 surgical patients. The rib cage contribution to the tidal volume (%RC) increased significantly from before (20.4 +/- 4.3%) to during spinal anaesthesia (30.4 +/- 4.8%). However, in those patients who fell asleep 60 min after subarachnoid injection of a local anaesthetic, %RC returned to the preanaesthetic value (23.0 +/- 5.9%). Finger SpO2 increased significantly during spinal anaesthesia, but the femoral arterial oxygen saturation did not change. The authors conclude that spinal anaesthesia increases %RC in conscious patients. However, the increment of %RC does not cause a major change in arterial oxygen saturation.

Quantitative EEG changes under various conditions of hyperventilation in the sensorimotor cortex of the anaesthetized cat

The effects on the EEG rhythms recorded from the sensorimotor cortex (post-sigmoid gyrus) of anaesthetized cats were studied under 4 conditions of artificial mechanical hyperventilation (HV) before and after cervical bilateral vagotomy. In animals with intact vagus nerves, using visual examination, EEG changes were only observed within the 2nd min during HV produced by increased stroke volume (delta V) with associated hypocapnia. Quantitative EEG (qEEG) showed that, for the same increase in minute ventilation and the same degree of hypocapnia, delta V induced a greater and earlier relative decrease (2nd min) in the power density of delta, theta and alpha bands, than increased pump frequency (delta F). The delta F tests produced a fall only in the theta band and within the 3rd min. With constant paCO2, transient modifications occurred only with delta V and were limited to the first 30 sec. In bivagotomized cats, moderate EEG responses to delta V plus associated hypocapnia persisted partly in the alpha band. Finally, no changes appeared with delta V or delta F when the vagus nerves were cut and paCO2 was maintained constant. The present data suggest strongly that, in anaesthetized cats, peripheral vagal afferents from the respiratory system play a major role in the EEG changes caused by artificial hyperventilation.

Pulmonary vagal sensory afferents and spontaneous EEG rhythms in the cat sensorimotor cortex

Interactions between vagal afferent fibres and spontaneous electroencephalographic (EEG) activity, recorded on the sensorimotor cortex of the cat, were studied during the mechanical activation of pulmonary afferents. The interactions were compared to the cortical effects of the electrical stimulation of all vagal fibers or to the chemical activation of unmyelinated vagal afferents (C-fibers) by phenyldiguanide. The present study was performed on anesthetized cats, artificially ventilated with open chest. Over 60 locations were explored on the posterior sigmoid gyrus. Repetitive electrical stimulation (30 Hz, 0.8 ms shock duration) of the contralateral cervical vagus nerve or of both nerves induced within less than 5 s changes in the pattern and periodicity of EEG spindles, associated with depressed background rhythms or rhythmic EEG activities. Cortical responses were also observed after i.v. injection of phenyldiguanide. Changes in activity of pulmonary stretch receptors by lung hyperinflation or suppression of phasic lung inflations ('stop pump') had no effect on the EEG rhythms. On the other hand, expiratory threshold loading or passive hyperdeflation of the lungs elicited EEG changes similar to those obtained by electrical stimulation of all vagal fibers. After bilateral vagotomy, all these responses disappeared or were delayed. The present observations strongly suggest that sensory information carried by thin vagal fibers greatly influences cortical rhythms in the cat sensorimotor cortex.

Role of vagal and spinal sensory pathways in diaphragmatic response to resistive loading

The effects of severe inspiratory (I) or expiratory (E) resistive loads on diaphragmatic activity were studied in two groups of cats anaesthetized with sodium pentobarbital or ethylcarbamate-chloralose. In intact cats, I or E loading never changed the amplitude of integrated diaphragmatic electric myogram (EMG) measured at 1.0 s (Edi 1.0); only I loading, prolonged the duration of diaphragmatic activity (Tdi). After selective procaine block of non-volume related vagal sensory inputs, I or E loading markedly increased Edi 1.0 and changes in Tdi due to I loading persisted. After bivagotomy, which also suppressed volume related vagal feed back, Edi 1.0 increased during I or E loading but change in Tdi disappeared. Initial spinal section at C8 level only reduced changes in Tdi with inspiratory loading. Bivagotomy plus spinal section abolished all load induced changes in diaphragmatic activity. These results suggest that all vagal information from the lungs participate in the mechanism of load compensation but that spinal sensory pathways play a minor role in this response in anaesthetized cats.