静注硫酸镁对腰硬联合麻醉患者术后疼痛和寒战反应的影响

目的:探讨腰硬联合麻醉中静脉输注50 mg/kg和25 mg/kg两种剂量的硫酸镁对术后镇痛和寒战的的影响。方法:90名腰硬联合麻醉(CSEA)下行全子宫切除术的患者随机分成3组。在腰麻注药后即刻,MGI组30分钟内静脉输注硫酸镁25 mg/kg继以10 mg/kg/h的速度输注至手术结束;MGⅡ组输注硫酸镁50 mg/kg,然后以10 mg/kg/h的速度输注;C组注入等量生理盐水。观察术后24小时的疼痛评分(视觉模拟评分法:VAS),术后镇痛药物的用量,寒战的发生率。结果:三组术后镇痛用药量由低到高依次为MGII组,MGI组,C组(P<0.001)。术后VAS评分,MGII组较C组减少,(P<0.05);在12 h,24 h,MGII组较MGI组减少,MGI组在2 h,4 h较C组减少(P<0.05)。术后寒战在C组发生率最高,在MGI组与MGII组发生率少,组间有统计学差异(P=0.007)。结论:腰硬联合麻醉中静脉输注两种剂量的硫酸镁均可以改善术后镇痛,减少术后寒战的发生率,大剂量硫酸镁更有效,但也可能伴随更大的血流动力学波动。     

Modification of antiallodynic and antinociceptive effects of morphine by peripheral and central action of fluoxetine in a neuropathic mice model

We have previously reported that serotonin concentration was reduced in the brain of mice with neuropathic pain and that it may be related to reduction of morphine analgesic effects. To further prove this pharmacological action, we applied fluoxetine, a selective serotonin reuptake inhibitor, to determine whether it suppressed neuropathic pain and examined how its different administration routes would affect antinociceptive and antiallodynic effects of morphine in diabetic (DM) and sciatic nerve ligation (SL) mice, as models of neuropathic pain. Antiallodynia and antinociceptive effect of drugs were measured by using von Frey filament and tail pinch tests, respectively. Fluoxetine given alone, intracerebroventicularly (i.c.v., 15 microg/mouse) or intraperitoneally (i.p., 5 and 10 mg/kg) did not produce any effect in either model. However, fluoxetine given i.p. enhanced both antiallodynic and antinociceptive effects of morphine. Administration of fluoxetine i.c.v., slightly enhanced only the antiallodynic effect of morphine in SL mice. Ketanserine, a serotonin 2A receptor antagonist (i.p., 1 mg/kg) and naloxone, an opioid receptor antagonist (i.p., 3 mg/kg), blocked the combined antinociceptive effect of fluoxetine and morphine. Our data show that fluoxetine itself lacks antinociceptive properties in the two neuropathy models, but it enhances the analgesic effect of morphine in the periphery and suggests that co-administration of morphine with fluoxetine may have therapeutic potential in treatment of neuropathic pain.     

Effect of serotonin on thermoregulation in normothermic hibernators and during arousal from deep hypothermia

Serotonin, intraperitoneally injected (10 mg/kg) to arousing from hibernation ground squirrels, blocked the increase of body temperature and shivering thermogenesis and decreased O2 consumption. Serotonin administered to normothermic active animals also decreased body temperature and O2 consumption. However, compensative increase of muscle electrical activity in response to considerable decrease of the body temperature was not observed. Serotonin is suggested to take part in the control of body temperature set-point.     

Cardiovascular and thermoregulatory responses to vasotocin and angiotensin II in the pigeon.

The cardiovascular and thermoregulatory effects of intrahypothalamically (preoptic/anterior hypothalamus) and intravenously injected arginine vasotocin (AVT) and [Val5]angiotensin II (ANG II) were measured at 2 degrees C in the pigeon (Columba livia). In addition, the effects of intrahypothalamic and intravenous injections of AVT on respiratory rates were measured at 10-15 degrees C. Intrahypothalamic and intravenous AVT (500 ng and 20 micrograms/kg, respectively) reduced shivering and body temperature but had no effects on blood pressure, heart rate or respiratory rate. Intrahypothalamic (500 ng and 1 microgram) and intravenous (3 micrograms/kg) ANG II elevated blood pressure. If the blood pressure increased slowly, the shivering and body temperature also increased, whereas a rapid rise in blood pressure inhibited shivering and lowered body temperature. Intravenous ANG II produced tachycardia but intrahypothalamic ANG II did not affect the heart rate.     

Effect of L-DOPA analogues in sidman avoidance performance in mice

Mice were trained to avoid foot shock by turning a drum mounted in the wall of a behavioral chamber. L-DOPA (178 to 320 mg/kg i.p.) and D-DOPA (320 to 1000 mg/kg, i.p.) but not L-3-0-methyl-DOPA (178 to 560 mg/kg, i.p.) significantly reduced the number of responses made by the animals. Pretreatment with Ro. 4-4602 (50 mg/kg, i.p.), a peripheral DOPA-decarboxylase inhibitor, enhanced the depressant effect of L-DOPA but not that of D-DOPA. Inhibition of central DOPA-decarboxylase (Ro. 4-4602, 500 mg/kg, i.p.) partially reduced the depressant effect of L-DOPA but not that of D-DOPA These results suggest that only part of the depressant action of L-DOPA is due to its central decarboxylation.     

Mechanisms of suppression of physiological function in hypothermia and a way of their restoration without body warming

It was shown that in hypothermic rats (rectal temperature 25-22 degrees C) it was possible to stimulate responses that had been suppressed by cold (i. e. thermoregulation and breathing) with the aid of injecting a solution of ethylenediaminetetraacetic acid disodium salt (EDTA) in quantity 16.5 mg/100 g of body weight (0.0045 mmol/100 g) into the blood stream of the cooled animals. EDTA connects calcium ions in blood and forms complexes. It was shown that enhancement of cold shivering intensity and that of breathing (in 5 min after beginning the injection of EDTA) coincided with a 42-45 % reduction of [Ca2+] in the blood]. After 15 min following the beginning of injection of EDTA [Ca2+] into the blood stream, a return to the initial level was observed in cooled animals. Simultaneously we observed suppression of the cold shivering and breathing. The repeated injection of EDTA again caused similar fall of [Ca2+] in the blood and the following enhancement of cold shivering and breathing.     

Improving cold tolerance in elderly rats by aminophylline

During severe cold exposure, old rats (23-26 months) were less capable in maintaining normal body temperature as compared to young rats (6-9 months) due to lower rate of heat production (HP). Single injection of optimal doses of aminophylline (AMPY; 10 and 18.7 mg/kg, i.p.), a phosphodiesterase inhibitor which enhances the intracellular cyclic AMP concentration, significantly increased the rate of HP in old rats to levels beyond the control values observed in young rats. Consequently, cold tolerance of the old rats was significantly improved. This AMPY-improved cold tolerance is apparently not due to increased non-shivering thermogenesis (NST) since AMPY failed to enhance norepinephrine-stimulated NST in the old rats. It is likely that AMPY increased substrate mobilization and/or conversion, thereby circumventing the limiting role of substrate availability for shivering thermogenesis. Thus, the age-dependent decrease in cold tolerance may be due to a reduced capacity for substrate mobilization when challenged by cold.     

Inhibition of shivering during restraint hypothermia

Restraint hypothermia has often been described, but its cause has never been clarified. We hypothesized that it might be due to a suppression of shivering thermogenesis. Thus, we restrained conscious rats in an ambient temperature of 2 degrees C while measuring rectal (Tre) and tail skin temperatures, metabolic rate (MR), and shivering activity. When rats were cold exposed but not restrained, Tre fell 1.4 +/- 0.2 degrees C (SE) during the 1st h. When these same rats were restrained, Tre fell at a rate of 6.5 +/- 0.2 degrees C/h. MR averaged 15.7 +/- 1.4 W/kg for the unrestrained rats, but it averaged only 9.0 +/- 1.1 W/kg for the restrained rats. The restrained rats showed no signs of shivering. The animals were then subjected to a restraint adaptation regimen and then reexposed to cold. Restraint now produced a fall in Tre of only 2.6 +/- 0.7 degrees C/h. The animals shivered and generated an MR of 15.8 +/- 0.9 W/kg. Naive rats became hypothermic because restraint suppressed shivering activity. However, adapted rats continued to shiver and remained normothermic. We suggest that a stressful or threatening situation, such as restraint for a naive rat, inhibits shivering and leads to hypothermia in a cold environment. This would not occur in adapted rats because restraint is no longer stressful.     

Interleukin-6 is a centrally acting endogenous pyrogen in the rat.

Intracerebroventricular (i.c.v.) injection of human recombinant interleukin-6 (IL-6; 20-100 ng) caused significant increases in colonic temperature and resting oxygen consumption (VO2) in conscious rats. These effects were prevented by pretreatment with a cyclooxygenase inhibitor (flurbiprofen, 1 mg/kg, i.p.) or a corticotrophin-releasing factor antagonist (alpha-helical CRF9-41, 25 micrograms, i.c.v.). Higher doses of IL-6 (i.c.v.) caused only small changes in VO2 and temperature, and very high doses given intravenously (i.v.) (4 micrograms/kg) were required to stimulate these parameters. Central injection of anti-rat IL-6 antibody inhibited the effects of interleukin-1 beta (i.c.v.) or endotoxin injection (i.p.) on colonic temperature and VO2 in conscious rats. These data indicate that IL-6 is an important endogenous pyrogen that acts within the central nervous system.     

Effect of tropisetron versus placebo on cold-induced oxygen consumption and shivering in male volunteers

In a prospective, randomized, cross-over, placebo-controlled study in healthy male volunteers, we tested the effect of the 5-HT₃ antagonist tropisetron on cold-induced oxygen consumption and shivering.

Cooling was performed by intravenous infusion of isotonic salt solution at 4 °C. Whole-body oxygen consumption (VO₂) was measured with a metabolic monitor. Shivering was qualitatively assessed. When the shivering score evaluated “2” (intense shivering), 5 mg tropisetron or NaCl 0.9% was injected and repeated if necessary, to completely stop shivering.

The VO₂ before shivering (178±9 ml/min/m²) rose significantly during shivering (291±21 ml/min/m²). 5 mg of tropisetron in 2 volunteers and 10 mg in 3 volunteers stopped shivering but it returned (grade 0–1). The VO₂ decreased significantly (209±17 ml/min/m²). Placebo had no effect.

Tropisetron reduced cold-induced VO₂ and intensity of hypothermic shivering. That an additional dose of tropisetron could not stop the shivering totally may indicate that the effect of tropisetron is not dose dependent.     

Amphetamine-induced inhibition of central noradrenergic neurons: a pharmacological analysis

The amphetamine-induced inhibition of brain noradrenaline (NA) containing neurons in the rat locus coeruleus (LC) was pharmacologically analyzed utilizing single unit recording techniques. The presynaptic α-receptor blocking agent yohimbine (10 mg/kg i.p., 30 min before) largely prevented the amphetamine-induced depression of LC units in contrast to prazosin (0.6 mg/kg i.p., 30 min) or phenoxybenzamine (20 mg/kg, 30 min) which both slow preference for postsynaptic α-receptors. The β-receptor blocking agent, propranolol (10 mg/kg, 30 min), as well as the peripherally but not centrally active α-receptor blocking drug phentolamine (10 mg/kg, i.p., 30 min), also did not block the amphetamine effect. The LC inhibition by amphetamine was blocked by pretreatment with reserpine (10 mg/kg, i.p., 5 h), which caused almost total depletion of brain catecholamines. However, unlike the amphetamine-induced inhibition of central dopamine (DA) neurons the NA cell inhibition was not blocked by pretreatment with a tyrosine hydroxylase inhibitor (α-MT, 50 or 250 mg/kg i.p., 30 min). These results suggest that the amphetamine-induced inhibition of NA neurons in the LC is an indirect effect, mediated via activation of central α-receptors of presynaptic character. The lack of antagonism by α-MT indicate that the NA release by amphetamine, unlike its effect on brain DA, is not critically dependent on the rate of tyrosine hydroxylation. Thus the euphoriant action of amphetamine, which is blocked by α-MT, may be associated with release of DA rather than NA in brain.     

Thermosensitivity of the preoptic region and the spinal cord in the golden hamster

1. 1.|The effects of thermal stimulation of the preoptic region (POAH) and the spinal cord on non-shivering thermogenesis (NST) and shivering were studied in euthermic golden hamsters.

2. 2.|Shivering intensity is suppressed by heating the POAH but is independent of spinal cord temperature. Therefore, NST in the interscapular brown adipose tissue does not suppress shivering.

3. 3.|NST is inhibited by heating of the POAH as well as of spinal cord. It is discussed that the control of NST by two different central thermosensitive areas is significant for thermoregulation during exercise.

Evidence that the hypothermic response of mice to delta-9-tetrahydrocannabinol is not mediated by changes in thermogenesis in brown adipose tissue.

Delta 9-Tetrahydrocannabinol (20 mg/kg i.p.) and propranolol (20 and 50 mg/kg i.p.) produced marked falls in the rectal temperatures of mice kept at an ambient temperature of 22 degrees C. Propranolol (50 mg/kg i.p.) also decreased the thermogenic activity of brown fat, as measured by a decrease in the level of [3H]GDP binding to mitochondria obtained from mouse interscapular brown adipose tissue. In contrast, delta 9-tetrahydrocannabinol (20 mg/kg i.p.) did not affect mitochondrial GDP binding even though the dose used was one shown previously to depress heat production. GDP binding was also unaffected by this cannabinoid in brown adipose tissue taken from mice that had been kept at 13 degrees C instead of 22 degrees C. In mice kept at 34 degrees C, isoprenaline (0.25 and 1.0 mg/kg s.c.) induced a marked rise in rectal temperature and increased the level of GDP binding to brown fat mitochondria. Propranolol (50 mg/kg i.p.) prevented the hyperthermic response to isoprenaline, the mice becoming hypothermic instead. Delta 9-Tetrahydrocannabinol (20 mg/kg i.p.) had no effect on isoprenaline-induced hyperthermia. We conclude from these data that there is no significant involvement of brown adipose tissue in the hypothermic response of mice to delta 9-tetrahydrocannabinol.     

Effects of some putative amino acid neurotransmitters on the stimulated TSH secretion in male rats

The importance of several amino acids (glycine, L-glutamic acid, L-serine, taurine and beta-alanine) in the regulation of the stimulated secretion of TSH was studied in male rats using both peripheral and central administration of the amino acids. Glycine (10-200 mg/kg i.p.), L-glutamic acid (10-500 mg/kg i.p.) and L-serine (500 mg/kg i.p.) decreased significantly the cold-induced TSH secretion whereas beta-alanine (1-500 mg/kg i.p.) and taurine (10-100 mg/kg i.p.) were not effective. The effect of L-glutamic acid (100 mg i.p.) was partially antagonized by bicuculline (1 mg/kg i.p.) but not by picrotoxin (1 or 2 mg/kg i.p.). Only glycine (50 and 100 mg/kg i.p.) inhibited the TRH-stimulated TSH secretion. When the intracerebroventricular route was used, L-serine (50 micrograms/rat) decreased the TSH could response whereas glycine and L-glutamic acid (1-50 micrograms/rat) had no clear effect. We conclude that glycine, glutamate and serine inhibit the cold-induced TSH secretion in the male rat. The action of serine and glycine is possibly mediated through the periventricular hypothalamus and the anterior pituitary, respectively. The inhibition caused by glutamate seems to be partially mediated through the bicuculline-sensitive GABA receptors in the hypothalamus. Taurine and beta-alanine play no role in the control of rat TSH secretion.     

Development of tolerance in rats to the hypothermic effects of D-amphetamine and apomorphine

Rats given d-amphetamine (15 mg/kg i.p.) or apomorphine (10 mg/kg i.p.) and placed in a cold environment (4°C) developed marked hypothermia. After daily injections of either drug for seven weeks, the maximal hypothermic responses to d-amphetamine or apomorphine were reduced to 72% and 19% of those obtained initially. Subsequent injection of ET-495, a central dopamine receptor stimulant, caused rectal temperature to decrease only 72% and 49% as much as in control animals. The hypothermic response to apomorphine was also depressed in d-amphetamine-treated animals. These observations suggest that the tolerance to the hypothermic effects of both d-amphetamine and apomorphine that develops is due at least in part to alterations in the sensitivity of dopamine receptors.     

Central benzodiazepine involvement in clonidine cardiovascular actions

It is well known that the GABAergic and noradrenergic systems play an important role in blood pressure and heart rate regulation. Benzodiazepines and beta-carbolines, respectively, increase or decrease the probability of chloride-channel opening induced by GABA. The aim of this study was to determine, in conscious rats, the interaction existing between the central alpha2-adrenoceptor stimulation induced by clonidine and the facilitation or impairment of benzodiazepine receptor activity through the administration of either diazepam, a benzodiazepine receptor agonist, or methyl 6,7-dimethoxy-4-ethyl-beta-carboline-3-carboxylate (DMCM), an inverse benzodiazepine agonist. Clonidine (5-10 microg, intracerebroventricularly) reduced heart rate and increased mean blood pressure by activation of central alpha2-adrenoceptors. Diazepam (2 mg/kg, intravenously (i.v.)) induced an increase in heart rate, while DMCM (0.3 mg/kg, i.v.) elicited a bradycardic effect. The bradycardic effects induced by both clonidine and DMCM were antagonized by the prior administration of methylatropine (1.5 mg/kg, i.v.). DMCM (0.3 mg/kg, i.v.) prevented the clonidine effects on heart rate and mean blood pressure, while diazepam (2 mg/kg, i.v.) failed to modify these effects. Our results suggest that the bradycardic effects of clonidine are mediated by a vagal stimulation and are related to the activation of a GABAergic pathway.     

Effects of methylenechloride-soluble fraction of Japanese angelica root extract,ligustilide and butylidenephthalide,on pentobarbital sleep in group-housed and socially isolated mice

We previously showed that the extract of Japanese angelica root (JAR-E) reversed the decrease in pentobarbital (PB) sleep induced by isolation stress and yohimbine and methoxamine, stimulants of central noradrenergic systems, in mice. Here, we tested the effects of several fractions from JAR-E and ligustilide and butylidenephthalide, phthalide components of JAR-E, on PB sleep in isolated mice to elucidate the mechanism of the action of JAR-E. Methanol-soluble (Met-S) and -insoluble (Met-IS) fractions were obtained from JAR-E. Methylenechloride-soluble (MC-S) and -insoluble fractions (MC-IS) were prepared from Met-S. MCS (11.4–76 mg/kg, p.o.) reversed the isolation stress-induced decrease in PB sleep, but neither Met-IS (0.8–2.4 g/kg, p.o.) nor MC-IS (0.7–2 g/kg, p.o.) had the same effect. The i.p. administration of MC-S exhibited a similar activity to that observed after the p.o. administration of the same fraction. Ligustilide (5–20 mg/kg, i.p.) and butylidenephthalide (10–30 mg/kg, i.p.) reversed PB sleep decrease in isolated mice. Both components (20 mg/kg, i.p.) attenuated the suppressive effects of yohimbine (30 nmol, i.c.v.), methoxamine (200 nmol, i.c.v.) and a benzodiazepine inverse agonist FG7142 (10 mg/kg, i.p.) on PB sleep in group-housed mice. These results suggest the contribution of ligustilide and butylidenephthalide to the effect of JAR-E on PB sleep in isolated mice, and implicate central noradrenergic and/or GABA_a systems in the effects of these components.     

Central antidopaminergic properties of 2-bromolisuride, an analogue of the ergot dopamine agonist lisuride

2-Bromolisuride (2-Br-LIS), a derivative of the ergot dopamine (DA) agonist lisuride, was investigated in rodents in comparison with the DA antagonist haloperidol with regard to its influence on DA related behaviour, cerebral DA metabolism and prolactin (PRL) secretion. 2-Br-LIS produced catalepsy in mice (ED50 3.3 mg/kg i.p.), antagonized apomorphine-induced stereotypies in mice (ED50 0.4 mg/kg i.p.), antagonized DA agonist-induced stereotypies in rats (0.1-1.56 mg/kg i.p.), inhibited locomotor activity in rats (0.025-6.25 mg/kg i.p.), antagonized the hyperactivity produced by various DA agonists in rats (0.025-6.25 mg/kg i.p.) and inhibited the apomorphine-induced hypothermia in mice (0.05-0.78 mg/kg i.p.). 2-Br-LIS (0.03-10 mg/kg i.p.) stimulated DA biosynthesis and DOPAC formation in the striatum and DA rich limbic system of rats, but had no effect on serotonin turnover. In striatum and limbic forebrain of gamma-butyrolactone-pretreated rats 2-Br-LIS reversed the apomorphine-induced inhibition of DOPA accumulation. 2-Br-LIS (0.03 - 3 mg/kg) enhanced PRL secretion in intact male rats. These findings indicate DA antagonistic properties of 2-Br-LIS presumably due to blockade of central pre- and postsynaptic DA receptors being of approximately the same order of potency as haloperidol. 2-Br-LIS is the first ergot compound with definite antidopaminergic properties suggesting its potential usefulness as a neuroleptic.     

Hypoxia-induced changes in shivering and body temperature

Experiments were carried out on conscious cats to evaluate the general characteristics and modes of action of hypoxia on thermoregulation during cold stress. Intact and carotid-denervated (CD) conscious cats were exposed to ambient hypoxia (low inspired O2 fraction) or CO hypoxia in prevailing laboratory (23-25 degrees C) or cold (5-8 degrees C) environments. In the cold, both groups promptly decreased shivering and body temperature when exposed to either type of hypoxia. Small increases in CO2 concentration reinstituted shivering in both groups. At the same inspired concentration of O2, CD animals decreased shivering and body temperature more than intact cats. While this difference resulted, in part, from a lower alveolar PO2 in CD cats, a difference between intact and CD cats was apparent when the two groups were compared at the same alveolar PO2. During more prolonged hypoxia (45 min), shivering returned but did not reach normoxic levels, and body temperature tended to stabilize at a hypothermic value. Exposure to various levels of hypoxia produced graded suppression of shivering, with the result that the change in body temperature varied directly with inspired O2 concentration. Hypoxia appears to act on the central nervous system to suppress shivering and sinus nerve afferents appear to counteract this direct effect of hypoxia. In intact cats, this counteraction appears to be sufficient to maintain body temperature under hypoxic conditions at room temperature but not in the cold.     

Central cardiovascular and thermal effects of prostaglandin F2 alpha in rats.

Administration of PGF2 ALPHA (0.2--6.4 micrograms) into the lateral cerebral ventricle (i.c.v.) induced dose-dependent increases in blood pressure, heart rate and body temperature in urethane-anaesthetised rats, but had no effect on these parameters when the same dose range was administered intravenously. Peripheral pretreatment with sodium meclofenamate (50 mg/kg s.c.) shifted all the dose-response curves for PGF2 alpha (i.c.v.) to the left, but indomethacin (50 mg/kg s.c.) did not significantly affect those changes. Central pretreatment with sodium meclofenamate or indomethacin (1.25 mg per rat i.c.v.) failed to modify significantly the effects of centrally administered PGF2 alpha. The results support previous suggestions that PGF2 alpha may participate in the central control of the cardiovascular and thermoregulatory systems, and also suggest that there may be differences in the sites and/or modes of action between sodium meclofenamate and indomethacin.