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Biomedical subjects

C A DiFazio

Publications and source records attributed to C A DiFazio.

16 recordsLinked to original sources

Nitric oxide synthase inhibitor dose-dependently and reversibly reduces the threshold for halothane anesthesia. A role for nitric oxide in mediating consciousness?

Nitric oxide is a newly recognized cell messenger for the activation of soluble guanylate cyclase and is produced from L-arginine by the enzyme nitric oxide synthase in a wide variety of tissues, including vascular endothelium and brain. Inhalational anesthetics inhibit nitric oxide production from vascular endothelium and also decrease resting cyclic guanosine monophosphate content in multiple brain regions. Halothane has been shown to depress neurotransmission by L-glutamate and N-methyl-D-aspartate. These amino acid neurotransmitters are known to increase neuronal cyclic guanosine monophosphate content by stimulation of nitric oxide production. To investigate the possible involvement of the L-arginine-to-nitric oxide pathway in the anesthetic state, the effect of a specific nitric oxide synthase inhibitor, nitroG-L-arginine methyl ester, on the minimum alveolar concentration (MAC) for halothane anesthesia was determined in Sprague-Dawley rats. Bolus injection of nitroG-L-arginine methyl ester at 0, 1, 5, 10, 20, and 30 mg/kg resulted in a dose-dependent reduction in MAC for halothane of 0 +/- 0, 2.3 +/- 0.4, 21.5 +/- 3.9, 30.5 +/- 2.4, 51.0 +/- 7.8, and 26.0 +/- 2.8%, respectively. NitroG-L-arginine methyl ester had no effect on MAC for halothane. Bolus infusion of L-arginine 300 mg/kg after MAC reduction by nitroG-L-arginine methyl ester 10 mg/kg resulted in an immediate and complete reversal of the MAC reduction. No reversal was observed after infusion of D-arginine 300 mg/kg.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Oxidoreductases

Thiopental reduces halothane MAC in rats.

The anesthetic contribution of specific plasma concentrations of thiopental has not been previously defined in laboratory animals. The plasma thiopental concentrations needed to reduce the anesthetic requirement for halothane by fractions of the minimum alveolar anesthetic concentration (MAC) were assessed in the rat. After steady-state thiopental plasma concentrations were established with a constant infusion, the tail-clamp technique was used to determine control MAC and the MAC of halothane with increasing concentrations of thiopental. We observed progressive reductions in halothane MAC. This required logarithmic increases in thiopental concentration rather than linear ones. A nonlinear reduction in anesthetic requirement was noted with an approximate 50% reduction in MAC at a thiopental plasma concentration of 7.4 micrograms/mL and an approximate 90% reduction at 32 micrograms/mL. Thiopental appears to provide essentially complete anesthesia in the rat model with a logarithmic contribution of increasing plasma concentrations.

Animals

Ketorolac does not decrease the MAC of halothane or depress ventilation in rats.

To determine the effects of intravenous (IV) ketorolac on anesthesia and the mechanisms involved, we evaluated its effects on minimum alveolar anesthetic concentration (MAC) and ventilation in halothane-anesthetized rats. Ketorolac in clinical (0.2 and 2 mg/kg) and large (20 and 40 mg/kg) IV doses did not affect the MAC of halothane (0.82% +/- 0.02%). Resting end-tidal CO2 tension (5.1% +/- 0.1%) and the slope of the CO2 response curves (70 +/- 6 mL.min-1.%-1) were also unaffected by IV ketorolac. The mean arterial blood pressure did not significantly change after ketorolac in doses of 0.2, 2, or 20 mg/kg but decreased significantly (P less than 0.05) after 40 mg/kg (placebo 99 +/- 8 mm Hg; ketorolac 87 +/- 6 mm Hg). This study demonstrates that MAC, ventilation, and mean arterial blood pressure are unaffected by clinical doses of IV ketorolac. Furthermore, the lack of effect on MAC and ventilation from larger doses suggests that ketorolac does not have mechanisms of action in the central nervous system.

Analgesics

Pharmacology of narcotic analgesics.

Opioid receptors are described and differentiated by their affinities for specific agonists and antagonists. Their sites of action and receptor activities are discussed. Tachyphylaxis and tolerance are described and methods for overcoming these problems are recommended. Suggestions are made regarding future drugs to act at specific receptors.

Analgesics, Opioid

Effects of lidocaine on the anesthetic requirements for nitrous oxide and halothane.

The effects of various plasma concentrations of lidocaine on nitrous oxide anesthesia in man and halothane requirements in the dog were studied. The response to incision of the skin was observed in 20 patients who were anesthetized with nitrous oxide, 70% inspired, and oxygen, 30%, plus various plasma levels of lidocaine. In addition, changes in the MAC of halothane in dogs were observed at various levels of lidocaine. In both circumstances lidocaine concentrations of 3 to 6 microgram/ml decreased anesthetic requirements approximately 10 to 28%. At clinically common concentrations of lidocaine, significant decreases in anesthetic requirements should be anticipated.

Adolescent

Lidocaine and its metabolites in the newborn.

Concentrations of lidocaine and its metabolites were measured chromatographically in the blood and urine of mothers and babies after epidural administration of lidocaine to the mother for cesarean delivery. Delivery occurred a mean time of 29.83 plus or minus 8.64 minutes after a mean dose of 398.33 plus or minus 63.38 mg to the mother, at which time mean maternal venous plasma concentration was 1.70 plus or minus 0.77 mug/ml. Of the total molar quantity of lidocaine and metabolite recovered from the newborns' urine in the first 12 hours of life, 50.63 per cent appeared as unchanged lidocaine, while 49.37 per cent appeared as metabolites. In the second 12 hours of life, 23.37 per cent appeared as unchanged lidocaine, while 76.63 per cent appeared as metabolites. We conclude that the greater proportion of metabolite excretion in the second 12 hours is evidence that the new born is capable of metabolizing lidocaine.

Anesthesia, Epidural

Hepatic clearance of lidocaine during N2O anesthesia in dogs.

Lidocaine catabolism under N2O anesthesia was evaluated in 5 dogs given a lidocaine infusion of 2 mg/kg/min for 20 minutes. Comparison of results with those of a prior similar study with halothane to be significantly faster in the animals given N2O. The extraction ratio for lidocaine, which did not vary with its arterial concentration, was significantly lower with halothane than with N2O. Decreased hepatic catabolism of drugs such as lidocaine should be anticipated in patients anesthetized with potent inhalation agents such as halothane.

Anesthesia, Inhalation

The anesthetic potency of lidocaine in the rat.

The anesthetic effect of lidocaine was evaluated in rats by determining the change in anesthetic requirement of cyclopropane MAC that was produced by blood concentrations of lidocaine in the clinically useful range. A linear reduction in anesthetic requirement was produced with concentrations up to 1 mug/ml. Further increases in lidocaine up to 5.5 mug/ml resulted in no further decrease in cyclopropane requirement. Lidocaine was found to contribute a maximum MAC fraction of 0.4.

Anesthesia, Intravenous

Effects of pH on protein binding of lidocaine.

Protein binding of lidocaine (2.5, 5, 10, and 20 microgram/ml in fresh plasma was studied from pH 5.6 to pH 9.8. Percent binding of lidocaine was inversely related to hydrogen-ion and lidocaine concentrations.

Anesthesia, Local

In vitro diffusion of lidocaine across endotracheal tube cuffs.

Smooth emergence from general endotracheal anesthesia is frequently complicated by coughing induced by stimulation from an endotracheal tube. Lidocaine and other local anesthetics have been shown to anesthetize important rapidly adpating stretch receptors in the dog trachea. With the aim of providing a reservoir for continuous lidocaine release to adjacent tracheal tissue, we examined the ability of clinically used concentrations of lidocaine to diffuse across a commonly used endotracheal tube cuff. Cuffs were filled with either 2% or 4% lidocaine and placed in a 200 mL bath with samples drawn at time intervals up to 360 minutes. Samples were then analyzed for lidocaine concentration. Another set of endotracheal tube cuffs were prefilled for one or 2.5 hours with 2% or 4% lidocaine, emptied, and then refilled with 2% lidocaine. They were then bathed and sampled as above. Cuffs exposed to 4% lidocaine during the prefilling or the diffusion stages resulted in significantly higher concentrations of lidocaine in the baths throughout the time course of the experiment, although all groups demonstrated a rise in the concentration of lidocaine in the baths with time. The highest concentration obtained was 17.49 +/- 2.03 micrograms/mL after 360 minutes. We conclude lidocaine diffuses across endotracheal tube cuffs in a fashion that may enable the cuff to serve a potentially useful role as a reservoir for local anesthetic. This in turn appears to have the potential to smooth emergence from general endotracheal anesthesia in those patients in whom tracheal stimulation may be a complicating factor.

Anesthesia Recovery Period