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PubMed1998

Structural basis for the inhibition of firefly luciferase by a general anesthetic.

The firefly luciferase enzyme from Photinus pyralis is probably the best-characterized model system for studying anesthetic-protein interactions. It binds a diverse range of general anesthetics over a large potency range, displays a sensitivity to anesthetics that is very similar to that found in animals, and has an anesthetic sensitivity that can be modulated by one of its substrates (ATP). In this paper we describe the properties of bromoform acting as a general anesthetic (in Rana temporaria tadpoles) and as an inhibitor of the firefly luciferase enzyme at high and low ATP concentrations. In addition, we describe the crystal structure of the low-ATP form of the luciferase enzyme in the presence of bromoform at 2.2-A resolution. These results provide a structural basis for understanding the anesthetic inhibition of the enzyme, as well as an explanation for the ATP modulation of its anesthetic sensitivity.

Adenosine Triphosphate↗

PubMed1999

Lack of effect of flurothyl, a non-anesthetic fluorinated ether, on rat brain synaptic plasma membrane calcium-ATPase.

Plasma membrane Ca2+-ATPase (PMCA), a regulator of intracellular calcium, is inhibited by volatile anesthetics and by xenon and nitrous oxide. Response of a cellular system to anesthetics, particularly to volatile agents, raises the question of non-specific, even toxic, side effects unrelated to anesthetic action. Compounds with chemical and physical properties similar to halogenated anesthetics, but which lack anesthetic effect, have been used to address this question. We have compared the effects of halothane and flurothyl, a non-anesthetic fluorinated ether, on PMCA Ca2+ transport across isolated brain synaptic plasma membranes (SPM). Flurothyl, at concentrations predicted by the Meyer-Overton curve to range from 0.4 to 2.6 MAC (minimum alveolar concentration), had no significant on PMCA activity. In contrast halothane, 1.3 MAC, reduced Ca2+ transport 30 to 40%. These findings provide further evidence for a specific effect of inhalation anesthetics on neuronal plasma membrane Ca2+-ATPase.

Anesthetics, Inhalation↗

PubMed2005

Brain imaging in research on anesthetic mechanisms: studies with propofol.

Brain imaging helps to refine our understanding of the anesthetic effect and is providing novel information that result in the formulation of hypotheses. They have shown that anesthetics act on specific structures that have been known to be important for consciousness at large. They have also helped to show that anesthetics act on specific structures regionally, rather than being non-specific, general depressant of the central nervous system (CNS). A constant finding is that the drugs that we use seem to exert their action on specific sites within the CNS. This is true for a wide variety of drugs like midazolam, anesthetic vapors and opiates. The thalamus has consistently shown marked deactivation coincident with the anesthesia-induced loss of consciousness, appearing to be a very important target of anesthetic effect. Additionally, when vibro-tactile or pain stimulation is given, anesthetics significantly effect cortical structures even before loss of consciousness while loss of transmission at the thalamic level seems to coincide with loss of consciousness. Finally, the use of radioligands allow in vivo characterization of anesthetic effects on neurotransmitter systems.

Anesthetics, Intravenous↗

PubMed1996

Corneal anesthetic abuse and Candida keratitis.

PURPOSE: Topical corneal anesthetic abuse is a self-inflicted injury, causing profound corneal morbidity. Superimposed infection is an important complicating factor. The authors report four patients with confirmed topical anesthetic abuse of the cornea, in whom Candida keratitis developed. METHODS: A retrospective review of the medical records of four patients with confirmed topical corneal anesthetic abuse and fungal keratitis. RESULTS: A 21-year-old woman, two 28-year-old women, and a 35-year-old man were included in the study. All these patients sustained a corneal injury, prompting the chronic use of topical anesthetics (0.5% proparacaine hydrochloride in 3 patients, and 0.5% tetracaine hydrochloride and 0.4% benoxinate hydrochloride in the other). Corneal findings included epithelial defects in all patients, focal infiltrate in one patient, and ring-shaped stromal infiltrate in three patients. Topical anesthetic was discontinued, all patients initially were treated empirically with antibacterial agents, and three patients received topical corticosteroids. Subsequent corneal cultures grew Candida spp, Candida albicans specifically in three patients, and local and systemic antifungal therapy was started. Corneas in two patients re-epithelialized; a conjunctival flap was performed on another patient with a descemetocele; and the remaining patient was lost to follow-up, although repeat fungal cultures yielded no growth. CONCLUSIONS: Corneal superinfection with Candida may occur during topical anesthetic abuse. Therapy includes discontinuation of the anesthetic and institution of antifungal therapy.

Administration, Topical↗

PubMed1999

Urinary neopterin and kynurenine in patients submitted to surgical stress with different inhalational anesthetics (halothane or isoflurane).

Measurements were taken of urinary levels of neopterin (NPT) and kynurenine (KYN), using an HPLC method for their simultaneous analysis in patients submitted to anesthetical surgical stress with two different inhalational anesthetics (halothane and isoflurane). We studied twenty-one women affected by uterine fibromyomatosis and submitted to total hysterectomy (mean age of 42.7+/-5.4 years). They showed the same pre-operative evaluation (ASA-1), and underwent the same i.v. anesthetic treatment. Our patients were randomized in two groups: Group A: 11 patients had halothane as an inhalational anesthetic drug for the maintenance of the anesthetic induction (mean time= 1 h). Group B: 10 patients had isoflurane. A significant decrease in urinary NPT and KYN, parallel to serum-NPT, was found 4 h after anesthetic induction. Raised NPT levels appeared 24 h after A.I. with significant increased levels after 7 days. A strong correlation between urinary and serum NPT levels was seen (Rs= 0.74; p < 0.001). Significantly low KYN levels were observed both 4 h and 24 h after A.I.. In addition to the delayed increase of the excretory KYN levels, significantly raised KYN levels in Group B (isoflurane) 48 h after A.I. (10.59+/-14.31 vs 5.99+/-7.17 micromol/mol creat.; p < 0.01) were shown, whereas in Group A (halothane) we observed a progressive increase as compared to the pre-surgery values starting from 72 h after surgery. Our data seem to show that: (a) it is possible to have a biochemical and non invasive monitoring of the anesthetical-surgical stress on MM "priming" activity; (b) the activation of the phagocyte compartment is one of the earlier immunological events after surgery (NPT), but the efficiency of this "priming" appears to be delayed (KYN); (c) isoflurane appears to induce an earlier recovery in MM activation.

Adult↗

PubMed1998

Do anesthetics act by competitive binding to specific receptors? Phase transition of firefly luciferase.

1. Firefly luciferase (FFL) emits a flash of light when mixed with ATP and luciferin in the presence of molecular oxygen. 2. Halothane inhibited FFL at 0.22 mM, while myristic acid inhibited it at 0.68 microM. Under steady-state conditions, myristic acid competed with luciferin. The Lineweaver-Burk plots of anesthetics were nonlinear. 3. The Hill numbers for anesthetics were above 1, while that of myristic acid was below 1 (0.89). Anesthetics interact with FFL cooperatively at multiple sites. The binding site of myristic acid is limited. 4. FFL undergoes a phase transition at 37-40 degrees C. Anesthetics decreased, while myristic acid increased the transition temperature. 5. The contrasting effects of anesthetics and myristic acid are discussed according to Koshland's transition-state model for myristic acid, which involves specific receptors, and Eyring's unfolded-state model for anesthetics, which involves nonspecific conformational change. Fatty acids are receptor-binders and structure-maker of FFL. Anesthetics are non-specific binders and structure-breaker of FFL.

Acylation↗

PubMed1994

Anesthetic modulation of pulmonary vascular regulation.

These results provide compelling evidence that general anesthesia can alter neural, hymoral, and local mechanisms of pulmonary vascular regulation. A clear strength of these studies is that we have assessed these various mechanisms of pulmonary vascular regulation in the conscious state, and then again in the same animal during general anesthesia. Our studies in chronically instrumented conscious dogs have documented that regulation of the pulmonary vascular P/Q relationship is multifactorial, and that these vascular mechanisms are interactive. These results in conscious animals serve as a database to assess the specific effects of general anesthesia on pulmonary vascular regulation. A striking finding in these studies is that different anesthetics can have differential effects on neural, humoral, and local mechanisms of pulmonary vascular regulation. Without this fundamental information, it is difficult to interpret previous experimental studies that have utilized background anesthetics. Moreover, this information is essential for the adequate clinical management of patients in the perioperative period. These in vivo studies have allowed us to identify the overall effects of general anesthetics on the integrative response of the intact organism to these diverse pulmonary vasoregulatory pathways. Our next objective is to elucidate the cellular mechanisms that mediate the effects of general anesthetics on these various mechanisms of pulmonary vasoregulation. To that end, we are now performing in vivo studies utilizing isolated pulmonary arterial rings to elucidate abnormalities in the various signal transduction pathways that could be responsible for the effects of general anesthetics. We propose to identify the loci of dysfunction in the signal transduction pathways that mediate the pulmonary vascular effects of general anesthetics on cAMP-, cGMP-, and K+ATP channel-mediated pulmonary vasodilation, as well as alpha 1- and angiotensin-mediated pulmonary vasoconstriction. These combined in vivo and in vitro approaches are complementary and can be used to delineate the effects and mechanisms of action of general anesthetics on pulmonary vasoregulation.

Anesthetics↗

PubMed1998

Local anesthetic efficacy for oral surgery: Comparison of diphenhydramine and prilocaine.

OBJECTIVE: Diphenhydramine has been suggested as an alternative local anesthetic agent for patients claiming allergy to local anesthetics. The present study attempted to determine the local anesthetic efficacy of diphenhydramine for oral surgery. STUDY DESIGN: Seventeen patients claiming allergy to local anesthetics were given diphenhydramine as anesthetic alternative and compared with seven nonallergic control patients treated with prilocaine. After determining an average value of vitality score of neighboring and contralateral teeth by electrical pulp stimulation, molar and premolar teeth were extracted and postextraction vitality scores determined. Visual analogue scale, anesthesia onset times, and the incidence of pulpal and soft tissue anesthesia were analyzed nonparametrically by means of Mann-Whitney U tests. RESULTS: The mean onset time of pulp anesthesia with diphenhydramine (range, 4 to 7.5 minutes), excluding one failure, was not significantly different from that of prilocaine; (range, 4 to 13 minutes). The duration of anesthesia was significantly longer and the visual analogue scale lower in the group receiving prilocaine in comparison with the group receiving diphenhydramine. CONCLUSION: In the small group studied, diphenhydramine administration provided adequate anesthesia before oral surgery; it may be useful as an anesthetic alternative in patients with histories of allergy to local anesthetics.

Adolescent↗

PubMed1995

Distribution of general anesthetics in phospholipid bilayers determined using 2H NMR and 1H-1H NOE spectroscopy.

The effect of the general anesthetics halothane, enflurane, and isoflurane on hydrocarbon chain packing in palmitoyl(d31)oleoylphosphatidylcholine membranes in the liquid crystalline phase was investigated using 2H NMR. Upon the addition of the anesthetics, the first five methylene units near the interface generally show a very small increase in segmental order, while segments deeper within the bilayer show a small decrease in segmental order. From the 2H NMR results, the chain length for the perdeuterated palmitoyl chain in the absence of anesthetic was found to be 12.35 A. Upon the addition of halothane, enflurane, or isoflurane, the acyl chain undergoes slight contractions of 0.11, 0.20, or 0.16 A, respectively, at 50 mol % anesthetic. A simple model was used to estimate the relative amounts of anesthetic located near the interface and deeper in the bilayer hydrocarbon region, and only a slight preference for an interfacial location was observed. Intermolecular 1H-1H nuclear Overhauser effects (NOEs) were measured between phospholipid and halothane protons. These NOEs are consistent with the intramembrane location of the anesthetics suggested by the 2H NMR data. In addition, the NOE data indicate that anesthetics prefer the interfacial and hydrocarbon regions of the membrane and are not found in high concentrations in the phospholipid headgroup.

Anesthetics, General↗

PubMed1987

Temperature dependence and mechanism of local anesthetic effects on mitochondrial adenosinetriphosphatase.

Chloroform-released ATPase prepared from beef heart mitochondria is inhibited by tetracaine and dibucaine over the entire temperature range in which the enzyme is active. The temperature of maximal activity is at 60 degrees C in the absence of anesthetic and is shifted upward by 2-3 degrees C by the addition of 0.3 mM dibucaine. Local anesthetics protect ATPase from irreversible cold inactivation. The kinetics of this protective effect are analyzed by a thermodynamic model in which the associated/dissociated subunit equilibrium is shifted toward the associated state by the preferential binding of anesthetic to the associated state. The accessibility of buried sulhydryl groups to reaction with 5,5'-dithiobis(2-nitrobenzoic acid) is increased by local anesthetics; this is interpreted to mean that the anesthetics increase the conformational flexibility of the protein. It is proposed that the hydrophobic moieties of local anesthetics and related compounds bind to numerous hydrophobic sites or crevices on ATPase; this binding induces a perturbation of the protein conformation, which in turn causes a decrease of enzyme activity. This model is sufficiently general to encompass the diversity of molecules which have similar anesthetic-like effects, and since it relates to common fundamental features of protein structure, it may also be the mechanism of the nonspecific effects of these molecules on other proteins.

Adenosine Triphosphatases↗

PubMed1998

Differential effects of general anesthetics on the quaternary structure of the Ca-ATPases of cardiac and skeletal sarcoplasmic reticulum.

The effects of the general anesthetics hexanol, halothane, and diethyl ether on Ca-ATPase activity and on the oligomeric state of the Ca-ATPase of sarcoplasmic reticulum (SR) from cardiac and skeletal muscle were investigated. The effects of these general anesthetics on Ca-ATPase activity were similar in cardiac and skeletal SR and were characterized by stimulation of Ca-ATPase activity at lower concentrations of anesthetics and inhibition at higher concentrations. The distribution of the Ca-ATPase among its oligomeric states was estimated from the time-resolved phosphorescence anisotropy (TPA) decay of SR in which Ca-ATPase was covalently labeled with erythrosin isothiocyanate (ERITC) or with erythrosin iodoacetamide (ERIA). In contrast to the similar responses of Ca-ATPase activity, there were marked differences in the responses to general anesthetics of the TPA decay between cardiac and skeletal SR. In cardiac SR hexanol, halothane, and diethyl ether caused pronounced increases in the limiting anisotropy at very long times (r infinity), which indicate increases in the fraction of oligomers too large to rotate on the millisecond time scale of the experiments. In skeletal SR, by contrast, there were no significant changes in r infinity in response to the three general anesthetics. This difference between cardiac and skeletal SR in response to general anesthetics is not due to the presence of phospholamban in cardiac SR, since SR from AT-1 cells, which have the SERCA2a isoform of Ca-ATPase, but only trace levels of phospholamban, have increases in r infinity in response to the general anesthetics that resemble those in cardiac SR. Experiments with cardiac SR labeled with ERIA give similar results, showing that the results with ERITC are not an artifact of the labeling procedure. Increasing the ionic strength with LiCl diminished the proportion of large immobile oligomers of cardiac Ca-ATPase under control conditions but enhanced the formation of large oligomers in response to hexanol.

Anesthetics, General↗

PubMed1997

Performance of an electrochemical carbon monoxide monitor in the presence of anesthetic gases.

OBJECTIVE: The passage of volatile anesthetic agents through accidentally dried CO2 absorbents in anesthesia circuits can result in the chemical breakdown of anesthetics with production of greater than 10000 ppm carbon monoxide (CO). This study was designed to evaluate a portable CO monitor in the presence of volatile anesthetic agents. METHODS: Two portable CO monitors employing electrochemical sensors were tested to determine the effects of anesthetic agents, gas sample flow rates, and high CO concentrations on their electrochemical sensor. The portable CO monitors were exposed to gas mixtures of 0 to 500 ppm CO in either 70% nitrous oxide, 1 MAC concentrations of contemporary volatile anesthetics, or reacted isoflurane or desflurane (containing CO and CHF3) in oxygen. The CO measurements from the electrochemical sensors were compared to simultaneously obtained samples measured by gas chromatography (GC). Data were analyzed by linear regression. RESULTS: Overall correlation between the portable CO monitors and the GC resulted in an r2 value >0.98 for all anesthetic agents. Sequestered samples produced an exponential decay of measured CO with time, whereas stable measurements were maintained during continuous flow across the sensor. Increasing flow rates resulted in higher CO readings. Exposing the CO sensor to 3000 and 19000 ppm CO resulted in maximum reported concentrations of approximately 1250 ppm, with a prolonged recovery. CONCLUSIONS: Decrease in measured concentration of the sequestered samples suggests destruction of the sample by the sensor, whereas a diffusion limitation is suggested by the dependency of measured value upon flow. Any value over 500 ppm must be assumed to represent dangerous concentrations of CO because of the non-linear response of these monitors at very high CO concentrations. These portable electrochemical CO monitors are adequate to measure CO concentrations up to 500 ppm in the presence of typical clinical concentrations of anesthetics.

Anesthesia, Closed-Circuit↗

PubMed1999

Topical use of local anesthetics in neonates.

INTRODUCTION: Various local anesthetics as in lidocaine ointment, amethocaine cream and EMLA cream are used topically for minor invasive interventions, such as venipuncture, both in children and adults. Since neonates have a nervous system that, albeit immature, enables them to feel pain, analgesia for these procedures is also indicated. Several studies in neonates have been carried out to establish effectiveness and safety of topically applied local anesthetics. These studies are reviewed in order to assess effectiveness and safety. METHODS: A Medline search was made in order to review all studies on effectiveness and safety of topical use of local anesthetics in neonates. Effectivity or safety studies using local anesthetics for circumcision were rejected. RESULTS: Seven studies on effectiveness were found: Three studies examined lidocaine ointment and four examined EMLA cream. Effectiveness of lidocaine ointment was questionable in two studies and negative in one. Effectiveness of EMLA cream was positive in two studies and negative in the other two. Four studies were found on safety of EMLA cream. All studies indicated that use of EMLA cream was safe. DISCUSSION: The poor effectiveness found in the reviewed studies is possibly due to too long an application time, a lipophilic carrier used and difficulties in assessing pain. The time of application is often based upon studies in children. Since the skin of neonates acts more as a mucosa than as mature skin the local anesthetics are able to cross this barrier more rapidly. Also a high bloodflow in the heel enhances the uptake of the drug. The application time in neonates should therefore be reduced compared to children. The use of a lipophilic carrier should be avoided since a lipophilic carrier impedes the local anesthetic to be absorbed, leading to reduced effect. Various methods of pain assessment were being used. Since not all methods used are validated it is difficult to obtain an objective end point. CONCLUSION AND RECOMMENDATION: The articles reviewed are non conclusive in their results of effective analgesia. Due to a lipophilic base form and a hydrophilic matrix EMLA cream is most effective. An application time of 30 minutes is recommended. In spite of the present precautions due to fear of methemoglobinemia, use of EMLA cream proved to be safe when used once a day. Since the clinical situation often requires more than one application a day, more research is needed to establish a safe and effective local anesthetic which can be applied topically several times a day in the neonate.

Administration, Topical↗

PubMed2002

Increased synthesis of nitric oxide in rat brain cortex due to halogenated volatile anesthetics confirmed by EPR spectroscopy.

BACKGROUND: Halogenated volatile anesthetics (HVAs) are considered to be inhibitors of nitric oxide synthase (NOS). On other hand, NO mediates the vasodilation produced by HVAs. Thus, both increase and decrease of NO concentration in brain tissues are possible during anesthesia. Previously, we have observed an increase of NO content in rat brain cortex under halothane anesthesia. The goal of this study was to determine whether the observed phenomenon was general for this anesthetic group, if it was specific for brain cortex, and if the NO increase was due changes in NOS activity. METHODS: NO scavengers were injected to adult rats 30 min prior to anesthesia. Rats were anesthetized by inhalation of an O2 mixture with volatile anesthetics (1.5% for halothane; 1% for isoflurane, 2% for sevoflurane). After 30 min of anesthesia, rats were decapitated and brain cortex, cerebellum, liver, heart, kidneys and testes were dissected, frozen in liquid nitrogen and subjected to EPR spectroscopy. Nitric oxide content was determined quantitatively based on the intensity of the NO-Fe-DETC complex spectrum and its comparison with the calibration curve. RESULTS: In rats anesthetized with HVAs, we observed a greater than twofold increase of NO content in brain cortex as compared to the nonanesthetized animals. No significant changes were detected in other organs. The NOS inhibitor N(omega)-nitro-L-arginine abolished the increase of NO content in brain produced by volatile anesthetics. CONCLUSION: The action of volatile anesthetics is coupled with an increase of NO content in the cortex dependent on NOS activity.

Adenosine Triphosphate↗

PubMed1999

Recognition of local anesthetics by alphabeta+ T cells.

Patients with drug allergy show a specific immune response to drugs. Chemically nonreactive drugs like, for example, local anesthetics are directly recognized by alphabeta+ T cells in an HLA-DR restricted way, as neither drug metabolism nor protein processing is required for T cell stimulation. In this study we identified some of the structural requirements that determine cross-reactivity of T cells to local anesthetics, with the aim to improve the molecular basis for the selection of alternatives in individuals sensitized to a certain local anesthetic and to better understand presentation and T cell recognition of these drugs. Fifty-five clones (52 lidocaine specific, three mepivacaine specific from two allergic donors) were analyzed. Stimulatory compounds induced a down-regulation of the T cell receptor, demonstrating that these non-peptide antigens are recognized by the T cell receptor itself. A consistent cross-reactivity between lidocaine and mepivacaine was found, as all except one lidocaine specific clone proliferated to both drugs tested. Sixteen chemically related local anesthetics (including ester local anesthetics, OH- and desalkylated metabolites) were used to identify structural requirements for T cell recognition. Each of the four clones examined in detail was uniquely sensitive to changes in the structures of the local anesthetic: clone SFT24, i.e., did not recognize any of the tested OH- or desalkylated metabolites, while the clone OFB2 proliferated to all OH-metabolites and other differently modified molecules. The broadly reactive clone OFB2 allowed us to propose a model, suggesting that the structure of the amine side chain of local anesthetics is essential for recognition by the T cell receptor.

Anesthetics, Local↗

PubMed2001

Topical anesthetics update: EMLA and beyond.

BACKGROUND: Topical anesthetics remain a powerful, new advance for pain relief prior to cutaneous procedures. They are frequently used by dermatologists to decrease the pain associated with laser pulses, surgical procedures, or soft tissue augmentation. EMLA is the most commonly used agent, however, several new topical anesthetic agents have been released recently that claim increased efficacy and a faster onset of action. OBJECTIVE: We review and compare the efficacy of several commonly used topical anesthetics and provide a look into the future. CONCLUSION: EMLA remains the most widely used topical anesthetic given its proven efficacy and safety by several clinical trials. There has been a recent release of several new topical anesthetic agents with some demonstrating efficacy after a 30-minute application time. A reservoir of anesthetic is located and stored in the upper skin layers during application, providing additional anesthetic benefit 30 minutes after removal. As the options for the practitioner continue to grow, the demand for faster onset, comparative efficacy, and safety trials will continue to be of paramount importance.

Anesthetics, Local↗

PubMed1999

Differential depressant effects of general anesthetics on the cardiovascular response to cocaine in mice.

In recent years, murine models have gained increasing importance for studies of cardiovascular physiology and pharmacology, largely due to the development of transgenic strains with specific alterations in phenotype. Differential effects of general anesthetic agents on the cardiovascular responses to cocaine have been reported in larger mammals; therefore, we studied the effects of commonly used anesthetics on heart function and on blood pressure responses to cocaine in Swiss Webster mice. We positioned a polyethylene catheter (PE-10) in the right carotid artery or left ventricle of mice anesthetized with equivalent anesthetic dose of either ketamine-xylazine (KX, 40 mg/kg + 5 mg/kg), pentobarbital (PEN, 40 mg/kg) or alpha-chloralose-urethane (CU, 80 mg/kg + 100 mg/kg). Cocaine (0.3 mg/kg, 1 mg/kg and 3 mg/kg) was administrated via the left jugular vein by bolus injection. In the KX group, the basal mean arterial pressure (MAP) and systolic left ventricular pressure (LVP) were 110 +/- 12 and 120 +/- 13 mmHg, respectively, close to conscious values. However, PEN and CU significantly decreased the basal parameters (P < 0.01 compared to the KX group). The lowest dose of cocaine (0.3 mg/kg) elicited minimal changes. Significant responses were obtained with a 1-mg/kg dose of cocaine (P < 0.01 compared to baseline). However, at 3 mg/kg, a toxic effect of cocaine appeared in all three anesthetic groups. Compared to published conscious animal data, anesthetic agents attenuated the cardiovascular effects of cocaine. Taken together, our results indicate that minimally effective doses of general anesthetics may significantly alter the basal hemodynamic state and the responses to sympathomimetic agents in the murine model, as has been reported in larger mammalian species. We concluded that anesthesia with ketamine-xylazine provides baseline hemodynamic values close to reported values in conscious animals, but also attenuates the hemodynamic response to cocaine.

Anesthetics, General↗

PubMed2000

[Local anesthetics from ester to isomer].

The use of chemical substances to prevent or treat local pain had its origin in South America. It was known that central nervous system stimulation occurred among the natives of Peru who chewed the leaves of an indigenous plant (Erythroxylon coca). Circumoral numbness was believed to have occurred as a by-product of this custom. Attempts to isolate the active principle from these leaves finally resulted in the isolation of the alkaloid, cocaine, by Niemann in 1860. The clinical usefulness of cocaine was not appreciated until 1884, when Koller reported upon topical anesthesia of the eye. The chemical identification of cocaine as a benzoic acid ester led to the synthesis of numerous compounds which were basically benzoic ester derivates. In 1905, Einhorn reported the synthesis of procaine. Tetracaine, the most potent ester of the benzoic acid series appeared in 1930. A major breakthrough in the chemistry of local anesthetic agents occurred in 1943 when Loefgren synthesized lidocaine, since it was not an ester but an amide derivate of diethylamino acetic acid. Concerning structure-activity relationships, local anesthetic agents, in general, possess the chemical arrangement of: aromatic portion--intermediate chain--amine portion. Changes in the aromatic or amine portion of a local anesthetic substance will alter its lipid/water distribution coefficient and its protein-binding characteristics which, in turn, will markedly alter the anesthetic profile. The toxic effects of long-acting local anesthetics on brain and heart, firstly reported by Albright, provided the initial stimulus to develop new amide-type local anesthetics. The first of these drugs, which has come into clinical practice was ropivacaine, the S-enantiomer of two possible optical isomers. It is structurally related to bupivacaine and mepivacaine, exerting a different pharmacodynamic profile, specifically on cardiac electrophysiology (less arrhythmogenic than bupivacaine). Studies on the anesthetic activities and toxicity of the individual enantiomers of bupivacaine and mepivacaine generally indicate, that the S-enantiomers are longer-acting and less toxic than the R-enantiomers.

Anesthetics, Local↗