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Curare has a voltage-dependent blocking action on the glutamate synapse.

The skeletal muscle of members of Orthoptera and Diptera receives an innervation which is probably glutaminergic. Recent study of the ventral muscle fibres in the larvae of the beetle, Tenebrio molitor, has revealed that the transmitter action can be mimicked by the iontophoretic application of L-glutamate to the junctional sites at which the extracellular excitatory postsynaptic potentials (e.p.s.ps) could be recorded (D.Y. and H.W., unpublished observation). Contrary to the evidence favouring glutamate as a transmitter of junctional excitation in insects, some investigators have found that curare (+)tubocrarine, TC), a classic acetylcholine (ACh) antagonist, suppresses the neurally evoked muscle potentials in the fly Sacophaga, and Tenebrio. Here, we have analysed the action of curare on the neuromuscular junction of Tenebrio larvae and found that curare blocked the glutaminergic transmission by antagonising the transmitter at the postsynaptic site.

Action Potentials↗

A re-examination of curare action at the motor endplate.

Recent evidence indicates that curare, in addition to its competitive' interference with endplate receptors, can block open ionic channels by a 'non-competitive' action on the activated acetylcholine-receptor complex. These findings called for further study of the kinetic behaviour of endplate channels and their modification by curare. Examining impulse-evoked endplate currents and acetylcholine-induced current fluctuations, it is found that the lifetime of the open channel is shortened by relatively high concentrations of curare (greater than 5 micrometer), an effect which shows up most strikingly at hyperpolarized levels of membrane potential (-130 mV and above). No shortening of this kind is observed when a neuromuscular block of equal or greater intensity is produced by a dose of alpha-bungarotoxin. Two other neuromuscular blocking agents, gallamine and pancuronium are shown to have an action on channel kinetics which cannot be explained by competitive receptor binding, but conforms to the hypothesis of rapidly repeated blocking and unblocking of individual ion channels, which had been proposed originally to account for the endplate action of local anaesthetics.

Acetylcholine↗

Dr F.P. de Caux--the first user of curare for anesthesia in England.

Curare was used in the 19th century in England by a wide variety of scientists, physicians and veterinarians. Their experiments indicated many of the properties of the drug, but its clinical usage remained very limited and was reserved for cases of tetanus, hydrophobia and strychnine poisoning. Griffith and Johnson are usually credited with the introduction of curare into clinical anaesthesia in 1942, but a Dr F.P. de Caux working at the North Middlesex Hospital, London, in 1928 utilised curare in a series of seven patients. His work was not widely publicized and this contribution to anaesthetic history has been overlooked by subsequent authors.

Adjuvants, Anesthesia↗

The strychnine-like action of curare and related compounds on the somatosensory evoked response of the rat cortex.

1. Drugs were applied to the cerebral cortex of rats anaesthetized with pentobarbitone and changes measured in the somatosensory primary evoked response.2. Computer-derived averages of thirty-two consecutive responses yielded stable and consistent measurements of the potential changes comprising the evoked response, and comparable records from the opposite (non-drug treated) cortex provided an essential control for systemic actions of the drug.3. The modifications produced by curare and strychnine were indistinguishable. The first positive wave (peak latency 7 msec) was unaltered; the second positive wave (peak latency 11.5 msec) was variably enhanced, and the first and second negative waves (peak latencies 16 and 40 msec) were replaced by a much larger negative wave (peak latency 22 msec).4. The time of onset of the effect on the negative waves and the maximal amplitude attained by the abnormal negative wave were related to the log concentration of the drug used. Curare is approximately 10 times more potent than strychnine.5. Toxiferine I, di-allylnortoxiferine and atropine also produced this effect but were less potent than strychnine.6. Succinylcholine, dihydro-beta-erythroidine and gallamine triethiodide did not produce this effect (in concentrations up to 10(-3)M).7. The observations are consistent with an action of curare and strychnine on an intracortical cholinergic inhibitory system, but other possibilities including a "non-specific excitatory action" cannot be excluded.

Animals↗

An anti-curare effect of hexamethonium at the mammalian neuromuscular junction.

1. Experiments were performed on the isolated phrenic nerve and diaphragm preparation of the rat.2. In preparations partly blocked with (+)-tubocurarine, the twitch amplitude increased after hexamethonium. This enhancement was not seen in preparations partly blocked with Mg(++) or with gallamine. High concentrations of hexamethonium produced failure of contraction.3. Extracellular endplate potentials were recorded from blocked preparations. The administration of hexamethonium resulted in an increased amplitude of these potentials only in curarized muscle.4. Hexamethonium had no anticholinesterase activity nor did it depolarize muscle cells or increase the quantal release of transmitter.5. It is concluded that hexamethonium exerts a specific anti-curare action. Experiments on the recovery of the twitch after washing out antagonists indicate that this process is limited by diffusion. The difference in rates of diffusion of hexamethonium and (+)-tubocurarine does not account for their interaction. The basis of the anti-curare action of hexamethonium is discussed.

Acetylcholine↗

Curare and pancuronium compared: effects on previously undepressed mammalian myoneural junctions.

Curare and pancuronium have multiple effects on previously undepressed rat diaphragm; these include depression of transmitter output and prolongation of the refractory period of prejunctional structures. The effect of curare on motor nerve terminals is greater than that of pancuronium. Both drugs depress postjunctional receptors; but curare, in addition, raises the threshold for the generation of muscle action potentials. In addition, these results raise questions about the validity of statistical methods used to calculate transmitter output.

Action Potentials↗

[A new toy: upswing in curare use in Spanish anesthesia].

The introduction of curare for general anesthesia by Harold Griffith in 1942 was one of the most important moments in the development of anesthesiology. However, several years passed before curare came to be used in Spain. We review the early application of curare and the role played by Robert Macintosh, Professor of Anaesthesia at Oxford, in introducing the drug to Spain.

Anesthesia, General↗

Single-channel currents activated by curare in cultured embryonic rat muscle.

Single cholinergic receptor channel currents activated by curare were recorded in tissue-cultured embryonic rat muscle, directly confirming curare's action as a weak cholinergic agonist. In embryonic muscle, curare, in addition to its classical action as a competitive cholinergic antagonist, produces small sustained depolarizations which can be blocked by alpha-bungarotoxin. The single-channel events are of short duration but otherwise exhibit the major features observed with other cholinergic agonists. The single-channel events are blocked by alpha-bungarotoxin. Two values of unit conductance, 30.4 +/- 3.5 pS and 47 +/- 6 pS, were measured in cells from different cultures. Histograms of open-state duration are well fit by a distribution which is a sum of two exponentials, with time constants of 0.33 +/- 0.08 msec for the fast component and 1.84 +/- 0.43 msec for the slow component.

Action Potentials↗

Morphological changes in long bone development in fetal akinesia deformation sequence: an experimental study in curarized rat fetuses.

In order to investigate the transverse growth of the long bones during intrauterine development in the fetal akinesia deformation sequence (FADS), we studied curarized rat fetuses. Curarization was performed by daily subcutaneous administration of D-Tubocurarine from day 17 of gestation until term. Experimental fetuses were compared with a sham-operated control group. The total area and perimeter, the absolute and relative amount of periosteum and bone trabeculae, the major and minor axes, and the elongation factor were measured from histological cross-sections of the femoral metaphysis and diaphysis using an IBAS 1 image analysis system. Curarized rat fetuses showed growth retardation, a short umbilical cord, and multiple articular contractures, a phenotype consistent with FADS. Alterations in femoral shape and transverse growth that affected the diaphysis were noted in these fetuses. These included a decrease of total cross-section area and reduction of the absolute and relative amounts of bone trabeculae with marked thinning of the periosteum. Femoral cross-sections was rounder than controls. These results evidenced an impairment of the membraneous (periosteal) ossification of long bones produced by immobilization and/or decrease of muscular strength, and support our previous clinical findings of bone hypoplasia and osteopenia in FADS.

Animals↗

The usefulness of electroencephalography in curarized newborns.

Curare and other muscle relaxants are being used with increasing frequency in the management of infants who are mechanically ventilated for severe respiratory distress. Neurological evaluation of these paralyzed newborns is difficult and neonatal convulsions may go unrecognized. The present study includes 5 curarized infants in whom neurological impairment was suspected because of complicated pregnancies and perinatal asphyxia. All showed very abnormal EEGs with ongoing paroxysmal activity in the absence of clinical seizures or a severely depressed record. In two of these infants an improvement in the values of the blood-gases coincided with the administration of diazepam. In curarized infants the electroencephalogram is of importance in the evaluation of the background activity, the detection of convulsive brain activity, and in the management of anticonvulsive therapy.

Alpha Rhythm↗

Cardiovascular and catecholamine responses to static exercise in partially curarized humans.

Neural control of the circulation was evaluated during static exercise in 19 subjects by the determination of heart rate (HR), mean arterial pressure (MAP), cardiac output (CO) and plasma catecholamines. Influence from central command was evaluated during contractions with weakened muscles following partial curarization and reflex influence from metaboreceptors was assessed by post-exercise muscle ischaemia. Static handgrip increased HR and more so MAP and CO and MAP remained elevated during post-exercise muscle ischaemia. With partial curarization plasma catecholamines were also increased (P < 0.05). Two-leg extension increased all variables and during post-exercise muscle ischaemia elevations of HR, MAP and CO were maintained (P < 0.05). With partial curarization HR, MAP and plasma noradrenaline were even greater during the contraction. With the involvement of both legs during static exercise, reflex influence from the muscles elevated blood pressure by way of HR and CO and the importance of central command was detectable for HR and MAP as plasma catecholamines became elevated. However, the results indicate a separation between a central command influence on HR and CO related to an increase in plasma catecholamines during a handgrip, while the reflex influence on blood pressure was directed towards total peripheral resistance.

Adult↗

5-Hydroxytryptamine causes depression of twitch height in the partially curarized rat phrenic nerve hemidiaphragm preparation.

5-Hydroxytryptamine (5-HT) has significant effects on the skeletal neuromuscular junction. We have evaluated the potential neuromodulatory effects of 5-HT on the rat hemidiaphragm using a non-fatiguing pattern of stimulation (0.3 Hz) in a partially curarized preparation using tubocurarine (EC50 = 560 (range 400-650) nmol litre-1). 5-HT was added to the partially curarized preparation in the following concentrations: 0, 12.5, 25, 50, 100, 200 and 400 nmol litre-1 and the twitch response was recorded at each concentration. These measurements were expressed as a ratio of control values, plotted against time and the area under the curve (AUC) calculated. The AUC values for test and control hemidiaphragms were compared by paired t test analysis accepting a 5% significance level. The mean AUC for test (3327 mm2) and control (4102 mm2) preparations were significantly different (P = 0.003). We have shown that the addition of low concentrations of 5-HT to the indirectly stimulated partially curarized rat diaphragm preparation caused depression of twitch height.

Animals↗

Changes in the perception of inspiratory resistive loads during partial curarization.

1. The ability of normal subjects to estimate the magnitude of resistive loads and to detect resistive loads was determined using standard psychophysical techniques. The experiments were repeated during maintained partial neuromuscular blockade with D-tubocurarine. 2. During curarization the ability to detect the presence of a small inspiratory resistive load was not significantly impaired. This finding is consistent with the view that changes in the usual breath-by-breath relation between pressure and flow mediate detection. 3. The size of resistive loads was over-estimated during partial curarization. Subjects thus placed more reliance on sensing the increased motor command required during curarization than on alternative peripheral signals related to pressure, flow or resistance. 4. The exponent for the power function relating the perceived magnitude of a resistive load to its actual size (Stevens, 1957) was reduced during partial neuromuscular blockade. 5. These results suggest that detection of resistive loads depends upon sensing apparent information arising from an unexpected pressure-flow disturbance but that estimation of the size of an added load depends, in part, on sensing the outgoing motor command.

Adult↗

Transfer following operant conditioning in the curarized dog.

Dogs were trained to press a pedal to avoid shock. They were then operantly reinforced for making or for refraining from making a series of electromyographic responses while almost completely curarized. Tests after recovery from curarization showed that operant conditioning under curare influenced the original pedal-press response.

Animals↗

A study of sensitivity to curare in myasthenic disorders using a regionaltechnique.

A study of curare sensitivity has been made in ocular myasthenia, myasthenia gravis, and the myasthenic syndrome sometimes associated with carcinoma, using a regional technique. Sensitivity is greater than in normal subjects. The injection of 0-125 mg d-tubocurarine resulted in a neuromuscular transmission block in all but a few of those cases with ocular myasthenia and in all cases of generalized myasthenia. Furthermore, the block persisted for longer than in normal subjects after the release of the tourniquet. This sensitivity to curare was not directly related to myasthenic weakness. The reasons for this are discussed and an explanation for such curare sensitivity is suggested.

Action Potentials↗

Cardiovascular effects of intravenous pentazocine and cyclazocine in conscious, curarized-conscious, and anesthetized dogs.

The cardiovascular effects of intravenous pentazocine and cyclazocine in dogs were studied under conscious, curarized-conscious (paralyzed by gallamine), and anesthetized states. In the conscious state, blood pressure and heart rate were dose-dependently increased by pentazocine (1, 2, 3 mg/kg) and to a lesser extent by cyclazocine (0.3 mg/kg). In all subsequent experiments on dogs, the results were obtained using 3 mg/kg pentazocine and 0.3 mg/kg cyclazocine. Pentazocine accelerated breathing, peaking at about 10 min, whereas cyclazocine reduced breathing to a minimum in 1 min, followed by a gradual recovery thereafter. In the curarized-conscious state, the blood pressure response to pentazocine was biphasic, namely an initial decrease followed by an increase; chronotrophic activity was stimulated. Pretreatment with either ganglionic or alpha andrenergic blocking agents not only significantly antagonized the pressory responses to the drug but also potentiated the initial decreases in blood pressure and unmasked a bradycardic component, but these parameters were not altered by 0.3 mg/kg naxalone. In open-chest anesthetized dogs, blood pressure, heart rate, contractility, and mean peripheral vascular resistance were simultaneously decreased by both pentazocine and cyclazocine, initially accompanied by increases in aortic blood flow. During the later stages of drug action, only the blood pressure and contractility were increased above control levels (biphasic effect). A comparison of blood pressure and heart rate responses to pentazocine in dogs kept under differing experimental conditions revealed that conscious dogs were more sensitive than curarized conscious and anesthetized animals to pentazocine action. In isolated guinea pig atria, the effect of adrenaline (0.1, 0.3, or 1 mg/mL) on the spontaneous breathing rate was significantly augmented by 10 mg/mL pentazocine (p < 0.02 for 0.3 g/mL; p < 0.01 for 0.1 g/mL adrenaline). In dogs, however, adrenaline (1 mg/kg)-induced increases in heart contractility, aortic blood flow, and blood pressure remained almost unaltered in the presence of pentazocine. We concluded that the abovementioned cardiovascular responses to pentazocine and cyclazocine are a consequence of the sum of the two following opposing effects: (i) an indirect reflex activation of sympathetic neuromediation in the periphery, and (ii) a direct membrane effect on the heart leading to bradycardia and a depression in myocardial contractility.

Anesthesia↗

Curare and the efferent vestibular system. An electrophysiological study in the frog.

In the frog we have studied the action of d-tubocurarine on the spontaneous discharge recorded from the whole horizontal semicircular canal (HC) nerve and from single HC afferent fibres. Gross activity was recorded in isolated head preparations. In each case, the spontaneous frequency was measured 6 min before and 16 min after a drop of D-tubocurarine (0.1 microliter, 5.10(-6)M) dissolved in Ringer or after a similar drop of Ringer was injected into the perilymph near the HC ampulla. Curare elicited a significant increase of the discharge frequency in about 60% of the preparations and a decrease in 6-8% of the cases, whether the contralateral eighth nerve was cut or not, while Ringer had no effect. After severing of the ipsilateral eighth nerve anterior branch, curare had no significant effect on the mean resting rate (calculated from 25 preparations), while in a few cases it evoked an increase or a decrease of the discharge frequency. Single afferent discharges were recorded in intact frogs. The mean frequency calculated from about 200 afferent fibres was 21.4 +/- 1.7 spikes/s after curare treatment, while it was only 15.6 +/- 1.3 spikes/s after Ringer injection; these two values are highly significantly different. From these results we conclude that the ampullary receptors are tonically subject to an inhibitory influence probably due to the tonic activity of the cholinergic efferent vestibular system. Moreover, the activity of the hair cells is probably also controlled by another, as yet unknown cholinergic mechanism.

Afferent Pathways↗

[Comparative study of the neuromuscular effects of 3 curare-like agents in children].

The authors studied the effect of three curare-like agents in 92 children anesthetised with halothane (1 to 2 p. 100). The method used was to give increasing doses of d-tubocurarine, metocurine and pancuronium bromide by injection until a block of approximately 95 p. 100 of the contraction of the thumb was obtained. This was checked by electrostimulation. Each of the three groups of children who were treated with one of the three curare-like agents were subdivided according to age and dose-response curves were obtained. The time required to recover 10 and 25 p. 100 of a control contraction was also studied. The authors conclude that from the point-of-view of activity, metocurine and pancuronium are respectively twice and five times more powerful than d-tubocurarine. The recovery time for pancuronium is twice as short as that for metocurine and d-tubocurarine. Furthermore, even though they are more resistant than adults, children recover more quickly than them. There is no difference in sensitivity in children that could be related to age, and this was so in the three curare-like agents studied. However, individual differences were more marked in neo-natal infants of less than 10 days than in other groups.

Age Factors↗