Influência de diferentes anestésicos locais no bloqueio neuromuscular produzido pelo atracúrio em ratos

IF 1 Q3 Medicine

Revista brasileira de anestesiologia Pub Date : 2020-05-01 DOI:10.1016/j.bjan.2020.01.004

João Paulo Soares da Silva Trizotti , Angélica de Fátima de Assunção Braga , Vanessa Henriques Carvalho , Franklin Sarmento da Silva Braga

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Abstract

Introduction

The association between Local Anesthetics (LAs) and Neuromuscular Blocking (NMB) drugs in clinical practice, and the possibility of interaction between these drugs has been investigated. LAs act on neuromuscular transmission in a dose‐dependent manner and may potentiate the effects of NMB drugs.

Objective

The aim of this study was to evaluate, in an experimental model, the effect of lidocaine and racemic bupivacaine on neuromuscular transmission and the influence on neuromuscular blockade produced by atracurium.

Methods

Male Wistar rats, weighing from 250 g to 300 g were used. The preparation was set up based on a technique proposed by Bülbring. Groups were formed (n = 5) according to the drug studied: lidocaine 20 μg.mL^‐1 (Group I); racemic bupivacaine 5 μg.mL^‐1 (Group II); atracurium 20 μg.mL^‐1 (Group III); atracurium 20 μg.mL^‐1 in a preparation previously exposed to lidocaine 20 μg.mL^‐1 and racemic bupivacaine 5 μg.mL^‐1, Groups IV and V, respectively. The following parameters were assessed: 1) Amplitude of hemi diaphragmatic response to indirect stimulation before and 60 minutes after addition of the drugs; 2) Membrane Potentials (MP) and Miniature Endplate Potentials (MEPPs).

Results

Lidocaine and racemic bupivacaine alone did not alter the amplitude of muscle response. With previous use of lidocaine and racemic bupivacaine, the neuromuscular blockade (%) induced by atracurium was 86.66 ± 12.48 and 100, respectively, with a significant difference (p = 0.003), in comparison to the blockade produced by atracurium alone (55.7 ± 11.22). These drugs did not alter membrane potential. Lidocaine initially increased the frequency of MEPPs, followed by blockade. With the use of bupivacaine, the blockade was progressive.

Conclusions

Lidocaine and racemic bupivacaine had a presynaptic effect expressed by alterations in MEPPs, which may explain the interaction and potentiation of NMB produced by atracurium.

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不同局部麻醉剂对阿曲库铵对大鼠神经肌肉阻滞作用的影响

引言研究了临床实践中局部麻醉剂（LA）和神经肌肉阻滞（NMB）药物之间的关系，以及这些药物之间相互作用的可能性。LA以剂量依赖的方式作用于神经肌肉传递，并可能增强NMB药物的作用。目的本研究的目的是在实验模型中评估利多卡因和外消旋布比卡因对神经肌肉传递的影响以及阿曲库铵对神经肌肉阻滞的影响。方法雄性Wistar大鼠，体重250～300g。该制剂是根据Bülbring提出的技术进行的。根据研究药物分组（n=5）：利多卡因20μg.mL-1（I组）；外消旋布比卡因5μg.mL-1（第II组）；阿曲库铵20μg.mL-1（第III组）；先前分别暴露于利多卡因20μg.mL-1和外消旋布比卡因5μg.mL-1的制剂中的阿曲库铵，第IV组和第V组。评估了以下参数：1）在药物添加前和添加后60分钟，半膈肌对间接刺激的反应幅度；2）膜电位（MP）和微型端板电位（MEP）。结果单独使用利多卡因和外消旋布比卡因不会改变肌肉反应幅度。在先前使用利多卡因和外消旋布比卡因的情况下，阿曲库铵诱导的神经肌肉阻滞（%）分别为86.66±12.48和100，与单独使用阿曲库胺产生的阻滞（55.7±11.22）相比有显著差异（p=0.003）。这些药物不会改变膜电位。利多卡因最初增加了MEP的频率，随后阻断。随着布比卡因的使用，阻断是渐进的。结论利多卡因和外消旋布比卡因具有突触前效应，表现为MEP的改变，这可能解释了阿曲库铵产生的NMB的相互作用和增强作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Revista brasileira de anestesiologia ANESTHESIOLOGY-

CiteScore

1.50

自引率

0.00%

发文量

审稿时长

21 weeks

期刊介绍： The Brazilian Journal of Anesthesiology is the official journal of the Brazilian Anesthesiology Society. It publishes articles classified into the following categories: -Scientific articles (clinical or experimental trials)- Clinical information (case reports)- Reviews- Letters to the Editor- Editorials. The journal focuses primarily on clinical trials, with scope on clinical practice, aiming at providing applied tools to the anesthesiologist and critical care physician. The Brazilian Journal of Anesthesiology accepts articles exclusively forwarded to it. Articles already published in other journals are not accepted. All articles proposed for publication are previously submitted to the analysis of two or more members of the Editorial Board or other specialized consultants.