Korean Journal of Anesthesiology

The Korean Society of Anesthesiologists (대한마취통증의학회)
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Effects of adenosine receptor agonist on the rocuronium-induced neuromuscular block and sugammadex-induced recovery

  • Kim, Yong Beom (Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University College of Medicine) ;
  • Lee, Sangseok (Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Choi, Hey Ran (Seoul Paik Hospital, Inje University College of Medicine) ;
  • In, Junyong (Ilsan Hospital, Dongguk University College of Medicine) ;
  • Chang, Young Jin (Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University College of Medicine) ;
  • Kim, Ha Jung (Asan Medical Center, Ulsan University College of Medicine) ;
  • Ro, Young Jin (Asan Medical Center, Ulsan University College of Medicine) ;
  • Yang, Hong-Seuk (Asan Medical Center, Ulsan University College of Medicine)
  • Received : 2017.09.11
  • Accepted : 2017.12.10
  • Published : 2018.12.01
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Abstract

Background: Several types of receptors are found at neuromuscular presynaptic membranes. Presynaptic inhibitory $A_1$ and facilitatory $A_{2A}$ receptors mediate different modulatory functions on acetylcholine release. This study investigated whether adenosine $A_1$ receptor agonist contributes to the first twitch tension (T1) of train-of-four (TOF) stimulation depression and TOF fade during rocuronium-induced neuromuscular blockade, and sugammadex-induced recovery. Methods: Phrenic nerve-diaphragm tissues were obtained from 30 adult Sprague-Dawley rats. Each tissue specimen was randomly allocated to either control group or 2-chloroadenosine (CADO, $10{\mu}M$) group. One hour of reaction time was allowed before initiating main experimental data collection. Loading and boost doses of rocuronium were sequentially administered until > 95% depression of the T1 was achieved. After confirming that there was no T1 twitch tension response, 15 min of resting time was allowed, after which sugammadex was administered. Recovery profiles (T1, TOF ratio [TOFR], and recovery index) were collected for 1 h and compared between groups. Results: There were statistically significant differences on amount of rocuronium (actually used during experiment), TOFR changes during concentration-response of rocuronium (P = 0.04), and recovery profiles (P < 0.01) of CADO group comparing with the control group. However, at the initial phase of this experiment, dose-response of rocuronium in each group demonstrated no statistically significant differences (P = 0.12). Conclusions: The adenosine $A_1$ receptor agonist (CADO) influenced the TOFR and the recovery profile. After activating adenosine receptor, sugammadex-induced recovery from rocuronium-induced neuromuscular block was delayed.

Keywords

References

  1. Slutsky I, Parnas H, Parnas I. Presynaptic effects of muscarine on ACh release at the frog neuromuscular junction. J Physiol 1999; 514: 769-82. https://doi.org/10.1111/j.1469-7793.1999.769ad.x
  2. Tomas J, Santafe MM, Garcia N, Lanuza MA, Tomas M, Besalduch N, et al. Presynaptic membrane receptors in acetylcholine release modulation in the neuromuscular synapse. J Neurosci Res 2014; 92: 543-54. https://doi.org/10.1002/jnr.23346
  3. Kim YB, Lee S, Lee KC, Kim HJ, Ro YJ, Yang HS. Effects of presynaptic muscarinic cholinoreceptor blockade on neuromuscular transmission as assessed by the train-of-four and the tetanic fade response to rocuronium. Clin Exp Pharmacol Physiol 2017; 44: 795-802. https://doi.org/10.1111/1440-1681.12763
  4. Garcia N, Priego M, Obis T, Santafe MM, Tomas M, Besalduch N, et al. Adenosine $A_{1}$ and $A_{2}A$ receptor-mediated modulation of acetylcholine release in the mice neuromuscular junction. Eur J Neurosci 2013; 38: 2229-41. https://doi.org/10.1111/ejn.12220
  5. Oliveira L, Timoteo MA, Correia-de-Sa P. Modulation by adenosine of both muscarinic M1-facilitation and M2-inhibition of [3H]-acetylcholine release from the rat motor nerve terminals. Eur J Neurosci 2002; 15: 1728-36. https://doi.org/10.1046/j.1460-9568.2002.02020.x
  6. Pereira M, Bornia E, Correia-de-Sa P, Alves-Do-Prado W. Presynaptic muscarinic and adenosine receptors are involved in 2 Hz-induced train-of-four fade caused by antinicotinic neuromuscular relaxants in the rat. Clin Exp Pharmacol Physiol 2011; 38: 764-70. https://doi.org/10.1111/j.1440-1681.2011.05588.x
  7. Bornia EC, Correia-de-Sa P, Alves-Do-Prado W. Presynaptic facilitatory adenosine A2A receptors mediate fade induced by neuromuscular relaxants that exhibit anticholinesterase activity. Clin Exp Pharmacol Physiol 2011; 38: 164-9. https://doi.org/10.1111/j.1440-1681.2011.05476.x
  8. Bornia EC, Bando E, Machinski M Jr, Pereira MW, Alves-Do-Prado W. Presynaptic M1, M2, and A1 receptors play roles in tetanic fade induced by pancuronium or cisatracurium. J Anesth 2009; 23: 513-9. https://doi.org/10.1007/s00540-009-0790-z
  9. Viby-Mogensen J. Neuromuscular monitoring. In: Miller's Anesthesia. 7th ed. Edited by Miller RD: Philadelphia, Churchill Livingstone/Elsevier. 2010, pp 1515-31.
  10. Bonsu AK, Viby-Mogensen J, Fernando PU, Muchhal K, Tamilarasan A, Lambourne A. Relationship of post-tetanic count and train-of-four response during intense neuromuscular blockade caused by atracurium. Br J Anaesth 1987; 59: 1089-92. https://doi.org/10.1093/bja/59.9.1089
  11. Viby-Mogensen J, Howardy-Hansen P, Chraemmer-Jorgensen B, Ording H, Engbaek J, Nielsen A. Posttetanic count (PTC): a new method of evaluating an intense nondepolarizing neuromuscular blockade. Anesthesiology 1981; 55: 458-61. https://doi.org/10.1097/00000542-198110000-00024
  12. Beny K, Piriou V, Dussart C, Henaine R, Aulagner G, Armoiry X. Impact of sugammadex on neuromuscular blocking agents use: a multicentric, pharmaco-epidemiologic study in French university hospitals and military hospitals. Ann Fr Anesth Reanim 2013; 32: 838-43. https://doi.org/10.1016/j.annfar.2013.08.004
  13. Pavoni V, Gianesello L, De Scisciolo G, Provvedi E, Horton D, Barbagli R, et al. Reversal of profound and "deep" residual rocuronium-induced neuromuscular blockade by sugammadex: a neurophysiological study. Minerva Anestesiol 2012; 78: 542-9.
  14. Woo T, Kim KS, Shim YH, Kim MK, Yoon SM, Lim YJ, et al. Sugammadex versus neostigmine reversal of moderate rocuronium-induced neuromuscular blockade in Korean patients. Korean J Anesthesiol 2013; 65: 501-7. https://doi.org/10.4097/kjae.2013.65.6.501
  15. Fuchs-Buder T, Meistelman C, Raft J. Sugammadex: clinical development and practical use. Korean J Anesthesiol 2013; 65: 495-500. https://doi.org/10.4097/kjae.2013.65.6.495
  16. Santafe MM, Priego M, Obis T, Garcia N, Tomas M, Lanuza MA, et al. Adenosine receptors and muscarinic receptors cooperate in acetylcholine release modulation in the neuromuscular synapse. Eur J Neurosci 2015; 42: 1775-87. https://doi.org/10.1111/ejn.12922
  17. Adamek S, Shakirzyanova AV, Malomouzh AI, Naumenko NV, Vyskocil F. Interaction of glutamate- and adenosine-induced decrease of acetylcholine quantal release at frog neuromuscular junction. Physiol Res 2010; 59: 803-10.
  18. Pousinha PA, Correia AM, Sebastiao AM, Ribeiro JA. Predominance of adenosine excitatory over inhibitory effects on transmission at the neuromuscular junction of infant rats. J Pharmacol Exp Ther 2010; 332: 153-63. https://doi.org/10.1124/jpet.109.157255
  19. Mathoot RA, Soudijn W, Breimer DD, Ijzerman AP, Danhof M. Pharmacokinetic-haemodynamic relationships of 2-chloroadenosine at adenosine A1 and A2a receptors in vivo. Br J Pharmacol 1996; 118: 369-77. https://doi.org/10.1111/j.1476-5381.1996.tb15412.x
  20. Alnouri MW, Jepards S, Casari A, Schiedel AC, Hinz S, Muller CE. Selectivity is species-dependent: Characterization of standard agonists and antagonists at human, rat, and mouse adenosine receptors. Purinergic Signal 2015; 11: 389-407. https://doi.org/10.1007/s11302-015-9460-9
  21. Tas PW, Eisemann C, Roewer N. Indirect activation of adenosine A1 receptors in cultured rat hippocampal neurons by volatile anaesthetics. Eur J Anaesthesiol 2005; 22: 694-702. https://doi.org/10.1017/S0265021505001158
  22. Stone TW, Hollins C, Lloyd H. Methylxanthines modulate adenosine release from slices of cerebral cortex. Brain Res 1981; 207: 421-31. https://doi.org/10.1016/0006-8993(81)90374-7
  23. Turan A, Memis D, Karamanlioglu B, Colak A, Pamukcu Z, Turan N. Effect of aminophylline on recovery from sevoflurane anaesthesia. Eur J Anaesthesiol 2002; 19: 452-4. https://doi.org/10.1097/00003643-200206000-00009
  24. Fredholm BB, IJzerman AP, Jacobson KA, Linden J, Muller CE. International Union of Basic and Clinical Pharmacology. LXXXI. Nomenclature and classification of adenosine receptors--an update. Pharmacol Rev 2011; 63: 1-34. https://doi.org/10.1124/pr.110.003285
  25. Turan A, Kasuya Y, Govinda R, Obal D, Rauch S, Dalton JE, et al. The effect of aminophylline on loss of consciousness, bispectral index, propofol requirement, and minimum alveolar concentration of desflurane in volunteers. Anesth Analg 2010; 110: 449-54. https://doi.org/10.1213/ANE.0b013e3181c6be7e
  26. Bock M, Klippel K, Nitsche B, Bach A, Martin E, Motsch J. Rocuronium potency and recovery characteristics during steady-state desflurane, sevoflurane, isoflurane or propofol anaesthesia. Br J Anaesth 2000; 84: 43-7. https://doi.org/10.1093/oxfordjournals.bja.a013380
  27. Wessler I, Kirkpatrick CJ, Racke K. The cholinergic 'pitfall': acetylcholine, a universal cell molecule in biological systems, including humans. Clin Exp Pharmacol Physiol 1999; 26: 198-205. https://doi.org/10.1046/j.1440-1681.1999.03016.x
  28. Reyes R, Jaimovich E. Functional muscarinic receptors in cultured skeletal muscle. Arch Biochem Biophys 1996; 331: 41-7. https://doi.org/10.1006/abbi.1996.0280
  29. Duclert A, Changeux JP. Acetylcholine receptor gene expression at the developing neuromuscular junction. Physiol Rev 1995; 75: 339-68. https://doi.org/10.1152/physrev.1995.75.2.339
  30. Santafe MM, Lanuza MA, Garcia N, Tomas J. Muscarinic autoreceptors modulate transmitter release through protein kinase C and protein kinase A in the rat motor nerve terminal. Eur J Neurosci 2006; 23: 2048-56. https://doi.org/10.1111/j.1460-9568.2006.04753.x

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