Intrathecal nicorandil and small-dose morphine can induce spastic paraparesis after a noninjurious interval of spinal cord ischemia in the rat

We investigated the interaction between nicorandil, a K(+)ATP channel opener, and morphine on motor function after a noninjurious interval of spinal cord ischemia in the rat. Spinal ischemia was induced by aortic occlusion for 6 min with a balloon catheter in Sprague-Dawley rats. All animals received intrathecal (IT) injection of morphine (1-60 microg) 1 h after ischemia. In addition to IT injection of morphine, group M (control), group MN (combination of morphine and nicorandil), and group MNG (combination of morphine, nicorandil, and glibenclamide) received IT saline, nicorandil (10 microg), and both glibenclamide (10 microg) and nicorandil (10 microg) after 150 min of reperfusion, respectively. A quantal bioassay for the effect of IT morphine on neurological function after ischemia was performed to calculate 50% effective dose values (ED50) for inducing paraparesis at 3 h of reperfusion. The ED50 in group M and group MN was 15.1 +/- 4.9 microg and 2.9 +/- 1.0 microg of IT morphine, respectively (P < 0.05). In Group MNG, the dose-response curve shifted back to the right and the ED50 for inducing paraparesis was 11.6 +/- 4.7 microg of IT morphine. The present study demonstrates that IT small-dose morphine combined with nicorandil induces spastic paraparesis after noninjurious interval of spinal cord ischemia in the rat.     

Spinal cord protection and opioids

Opioids, when administered in large doses, were reported to produce brain damage primarily in limbic system and association areas in animals. We recently found the result that intrathecal (IT) morphine after a short interval of aortic occlusion in the rodent model induced transient spastic paraparesis via opioid receptor-coupled effects in the spinal cord. Histopathological analysis revealed the possibility that IT morphine could induce degeneration of spinal ventral neurons even after a short lasting of spinal cord ischaemia in rats, and this degeneration was associated with the activation of spinal N-methyl-D-aspartate receptors by elevation of glutamate release in cerebrospinal fluid after IT morphine. Therefore, we would like to emphasize that all anesthesiologists should be aware of the possibility of morphine-induced paraplegia after thoracic aortic surgery and that we should carefully select appropriate analgesic agents from the several available opioids for these patients.     

Exogenous aspartate neurotoxicity in the spinal cord under metabolic stress in vivo

BACKGROUND: Considerable evidence exists that neurotoxicity of excitatory amino acids is related to the neuronal injury, including paraplegia. However, little is known about aspartate neurotoxicity in the spinal cord in vivo. We evaluated the detrimental effects of exogenous aspartate on spinal cord neurons under metabolic stress. METHODS: New Zealand white rabbits underwent an infrarenal aortic isolation. Group A animals (n = 7) received segmental aspartate 50 mmol/L) infusion for 10 minutes. Group B animals (n = 7) received saline as a negative control. Group C animals (n = 5) received segmental aspartate 100 mmol/L) infusion for 5 minutes. Group D animals (n = 7) were pretreated with segmental infusion of (+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]cycloheptan-5,10-imine (MK-801) (6 mg/kg), a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist for 1 minute, followed by segmental infusion of aspartate (50 mmol/L) for 9 minutes. Group E animals (n = 7) received vehicle only, followed by aspartate (50 mmol/L) infusion as a control of group D. Neurologic status was assessed at 12, 24, and 48 hours after operation using the Tarlov score. RESULTS: Group A animals exhibited paraplegia or paraparesis with marked neuronal necrosis. Group B and C animals recovered fully. Group D animals showed significantly better neurologic function (p = 0.0007) compared with group E animals that exhibited paraplegia or paraparesis. CONCLUSIONS: Exogenous aspartate can have detrimental effects on spinal cord neurons under metabolic stress. This model may be useful in assaying neuronal injury mediated by NMDA receptor in vivo.     

The effect of gamma-aminobutyric acid (GABA) receptor drugs on morphine-induced spastic paraparesis after a noninjurious interval of spinal cord ischemia in rats

We have previously demonstrated that intrathecal morphine given after a noninjurious interval of spinal cord ischemia induced transient spastic paraparesis in a rodent model. However, the mechanism of this paraparesis is unknown. We hypothesized that morphine inhibits gamma-aminobutyric acid (GABA)ergic interneurons that control the tonus of spinal cord alpha-motoneurons and that inhibition of spinal cord interneurons may cause spastic paraparesis. In this study, we investigate interactions between morphine and GABAergic agonists or antagonists on motor function after spinal cord ischemia and then clarified the mechanism of the spastic paraparesis induced by intrathecal morphine. Spinal cord ischemia was induced by aortic occlusion lasting 6 min. We first determined whether intrathecally administered GABA agonists (muscimol or baclofen) improve the spastic paraparesis in this model. GABA agonists did not improve the paraparesis. Next, we examined the effect of GABA antagonists (bicuculline or 5-aminovaleric acid) and determined the interaction between morphine and GABA antagonists. In an isobolographic analysis, the 50% effective dose decreased below the theoretical additive line, indicating a synergistic interaction between morphine and GABA antagonists. These results indicate that the spastic paraparesis induced by intrathecal morphine may be mediated in part by GABA receptors. IMPLICATIONS: The purpose of this study was to investigate interactions between morphine and GABAergic agonists or antagonists on motor function after spinal cord ischemia and then clarify the mechanism of the spastic paraparesis induced by intrathecal morphine. The spastic paraparesis induced by intrathecal morphine may be mediated in part by GABA receptors.     

Neuroprotective effects of N-methyl-d-aspartate receptor antagonist on aspartate induced neurotoxicity in the spinal cord in vivo

Objective: Much evidence has been gathered to show that neurotoxicity of excitatory amino acids is mainly activated through an N-methyl-d-aspartate (NMDA) receptor cascade. We evaluated the protective effects of NMDA receptor antagonists, MK-801 and CGS19755 on spinal cord neurons using the NMDA receptor mediated neurotoxicity model in vivo. Methods: New Zealand white rabbits underwent an infrarenal aortic isolation. Group A animals (n=7) received segmental aspartate (50 mM) infusion for 10 minutes. Group B animals (n=6) were pretreated with MK-801 (6mg/kg), a noncompetitive NMDA receptor antagonist, that was administrated intravenously for 3 hours beginning 1 hour before the segmental infusion of aspartate (50 mM) of 10 minutes. Group C animals (n=6) received pretreatment with CGS19755 (30mg/kg), a competitive NMDA receptor antagonist, that was administrated in the same fashion as group B, followed by the segmental infusion of aspartate (50 mM). Neurologic status was scored at 12, 24, and 48 hours after operation using the Tarlov score. All the animals were sacrificed for histologic assessment at 48 hours. Results: Group A animals exhibited paraplegia or paraparesis with marked neuronal necrosis. Group B and C animals showed significantly better neurologic function compared with group A (p=0.0013, A vs. B) (p=0.0011, A vs. C). Pathohistological change was not observed in group B and C animals. Conclusions: NMDA receptor antagonists can have protective effects on spinal cord neurons against aspartate induced neurotoxicity. This model may be useful in assaying protective agents in the spinal cord against neuronal injury mediated by NMDA receptors in vivo.     

强啡肽对大鼠行为学和脊髓组织学改变的影响及受体机制

目的探明强啡肽(Dyn)对脊髓的损伤效应及其受体机制。方法观测大鼠鞘内注射DynA(1-13)或联合注射Kappa阿片受体拮抗剂nor-BNI或兴奋性氨基酸(EAA)的NMDA受体拮抗剂MK-801后的运动功能和脊髓病理学变化。结果注射30nmolDyn组3d时,Tarlov运动功能评分下降,脊髓前角神经元数目减少,GFAP阳性神经胶质细胞数轻度增生。14d时,Tarlov运动功能评分未恢复,神经胶质细胞增生明显。而鞘内联合注射100nmol nor-BNI、100nmol MK-801后3d时与单纯Dyn组结果相似,14d时Tarlov运动功能评分明显恢复,脊髓前角神经元数目较Dyn组多,GFAP阳性神经胶质细胞增生不明显,nor-BNI组与MK-801组间比较差异不显著。结论Dyn鞘内注射可使大鼠运动功能、脊髓组织损害,而nor-BNI或MK-801有对抗其损害作用。Dyn的病理作用是通过Kappa阿片受体和EAA的NMDA受体两种途径介导的。     

Intrathecal morphine, but not buprenorphine or pentazocine, can induce spastic paraparesis after a noninjurious interval of spinal cord ischemia in the rat

In this study, we sought to determine the effect of intrathecal (IT) pentazocine or buprenorphine on the neurological outcome after a short interval of spinal cord ischemia in rats. Although IT morphine (30 microg) induced spastic paraparesis after 6 min of aortic occlusion, neither pentazocine (150 microg) nor buprenorphine (4 microg) produced neurological dysfunction. Our results indicate that the effect of various opioids on the motor function after a noninjurious interval of spinal cord ischemia is opioid-specific.     

Neuroprotective effects of <Emphasis Type="Italic">N</Emphasis>-methyl-<Emphasis Type="SmallCaps">d</Emphasis>-aspartate receptor antagonist on aspartate induced neurotoxicity in the spinal cord in vivo

Objective: Much evidence has been gathered to show that neurotoxicity of excitatory amino acids is mainly activated through an N-methyl-d-aspartate (NMDA) receptor cascade. We evaluated the protective effects of NMDA receptor antagonists, MK-801 and CGS19755 on spinal cord neurons using the NMDA receptor mediated neurotoxicity model in vivo. Methods: New Zealand white rabbits underwent an infrarenal aortic isolation. Group A animals (n=7) received segmental aspartate (50 mM) infusion for 10 minutes. Group B animals (n=6) were pretreated with MK-801 (6mg/kg), a noncompetitive NMDA receptor antagonist, that was administrated intravenously for 3 hours beginning 1 hour before the segmental infusion of aspartate (50 mM) of 10 minutes. Group C animals (n=6) received pretreatment with CGS19755 (30mg/kg), a competitive NMDA receptor antagonist, that was administrated in the same fashion as group B, followed by the segmental infusion of aspartate (50 mM). Neurologic status was scored at 12, 24, and 48 hours after operation using the Tarlov score. All the animals were sacrificed for histologic assessment at 48 hours. Results: Group A animals exhibited paraplegia or paraparesis with marked neuronal necrosis. Group B and C animals showed significantly better neurologic function compared with group A (p=0.0013, A vs. B) (p=0.0011, A vs. C). Pathohistological change was not observed in group B and C animals. Conclusions: NMDA receptor antagonists can have protective effects on spinal cord neurons against aspartate induced neurotoxicity. This model may be useful in assaying protective agents in the spinal cord against neuronal injury mediated by NMDA receptors in vivo.     

Effects of methylprednisolone and MK-801 on functional recovery after experimental chronic spinal cord injury

STUDY DESIGN: An experimental study was conducted to evaluate the effects of methylprednisolone and MK-801 after the compressive injury of spinal cord in rats. OBJECTIVES: To investigate the effect of methylprednisolone and non-competitive NMDA antagonist MK-801 in long-term functional outcome after spinal cord injury (SCI). METHODS: A randomized group A of Sprague-Dawley rats were treated with MK-801 (1.0 mg/kg, n=10; Group A) after a compression injury. A group of methylprednisolone (MP)-treated (30 mg/kg, n=10; Group B) and non-treated animals (n=9; Group C) were included for comparison. The functional motor outcome such as inclined plane (IP), toe spreading reflex (TSR), and modified Tarlov scale (TS) were measured in each animal at regular time points up to 8 weeks post-treatment. Histologically the injury site was scored in four groups and immunohistochemically Wallerian Degeneration (WD), astrocytosis and expression of beta-amyloid protein was identified. RESULTS: In examining the IP data, no significant difference was recognized between the group means (P-value>0.5). For the TSR, there were no differences in the group responses. For the TS, the differences were not statistically significant. Only group B showed significance in cavitation scores compared to group A (P>0.0094), WD was significantly different than group C (P>0.03), astrocytosis was significantly higher than group A (P>0.001) and modest presence of beta-amyloid protein. CONCLUSION: Our data indicate that one time bolus administration of MK-801 lacks any significant effect on axonal function in chronically injured rats. Daily bolus administration of MP at 30 mg/kg also did not ensure a better functional outcome. Immunohistochemically we have been able to show significant differences in WD, astrocytosis and small insignificant changes in beta-amyloid protein.     

糖皮质激素受体在慢性吗啡耐受大鼠脊髓背角神经元凋亡中的作用

目的 评价糖皮质激素受体在慢性吗啡耐受大鼠脊髓背角神经元凋亡中的作用.方法 鞘内置管成功的健康雄性SD大鼠20只,体重300～350 g,随机分为4组(n=5):对照组(C组)、慢性吗啡耐受组(M组)、吗啡+糖皮质激素受体拮抗剂组(MR组)和吗啡+糖皮质激素受体激动剂组(MD组)分别于8:00和20:00鞘内注射生理盐水10μl、吗啡10μg、吗啡10μg+RU38486 2μg、吗啡10μg+地塞米松4μg,连续6 d.于每天8:00给药后30 min行甩尾实验,给药第7天处死大鼠,取L3～L5脊髓行TUNEL染色,光镜下观察脊髓背角神经元的凋亡情况,计算凋亡率.结果 地塞米松、RU38486分别对慢性吗啡耐受的形成起促进、抑制作用.与C组比较,M组和MD组脊髓背角神经元凋亡率升高(P＜0.05);与M组比较,MR组脊髓背角神经元凋亡率降低,MD组脊髓背角神经元凋亡率升高(P＜0.05).结论 糖皮质激素受体参与了慢性吗啡耐受形成中大鼠脊髓背角神经元凋亡的过程.     

Glutamate neurotoxicity during spinal cord ischemia —Neuroprotective effects of glutamate receptor antagonists—

Evidence is accumulating that glutamate, a major neurotransmitter, exerts potent neurotoxic activity during ischemia. In our laboratory, a delayed-onset paraplegia model using rabbits has been developed and described. The severity of the ischemic event in this model, i.e., extracellular glutamate overload, is believed to influence the etiology of this borderline lesion. We hypothesized that glutamate receptor antagonists (MK-801, NBQX) would attenuate the delayed neuronal dysfunction that follows spinal cord ischemia. Infrarenal aortic segments from 18 New Zealand white rabbits were isolated for 5 minutes and infused at a rate of 2 ml/min. Group I (n=6) received normothermic L-glutamate (20 mM). Group II (n=6) received 3 mg of MK-801 and normothermic L-glutamate (20 mM). Group III (n=6) received 3 mg of NBQX and normothermic L-glutamate (20 mM). Neurologic function was assessed at 6, 24, and 48 hours after surgery according to the modified Tarlov scale. After 48 hours, the rabbits were euthanized and spinal cords were harvested for histologic examination. The neurologic function of three rabbits in group I showed acure paraplegia and the other three showed delayed-onset paraplegia, whereas all group II animals had nearly intact neurologic function and all group III animals showed mild neurologic disturbance. Histologic examination of spinal cords from rabbits in group I showed evidence of moderate spinal cord injury with necrosis of central gray matter and adjacent white matter and axonal swelling, whereas spinal cords from group II showed small and localized spinal cord injuries and those from group III revealed no evidence of cord injury. These results indicate that MK-801 and NBQX exert different neuroprotective effects related to different mechanisms of glutamate neurotoxicity mediated by the NMDA receptor and non-NMDA receptor, which initiate a deleterious cascade of biochemical events that ultimately results in delayed-onset paraplegia.     

Role of norepinephrine and excitatory amino acids in edema of the spinal cord after experimental compression injury in rats

The role of norepinephrine and excitatory amino acids in edema of the spinal cord after an acute experimental compression injury was studied in rats. Control rats received the compression injury only. Intraspinal norepinephrine was depleted in one rat group by injection of 6-hydroxydopamine (6-OHDA) into the subarachnoid space to selectively destroy catecholamine neurons and in a third group MK-801 was administered intravenously to block receptors for N-methyl-d-aspartate (NMDA), an excitatory amino acid. Recovery from motor paralysis and suppression of edema of the spinal cord were then compared in the three groups. Significant recovery from motor paralysis was found 12 h after injury in the 6-OHDA-treated rats, compared with the controls, and 24 h after injury in the MK-801-treated rats. Edema of the spinal cord was significantly suppressed for up to 24 h after injury in the 6-OHDA-treated rats. The MK-801-treated rats showed no significant suppression of the edema until 24 h after the spinal cord injury. It was concluded that norepinephrine is primarily involved in the formation of vasogenic edemas, which develop in the early stages after an injury, whereas excitatory amino acids affect the formation of cytotoxic edemas, which develop at a relatively later stage. Received for publication on March 26, 1997; accepted on July 8, 1997     

Dextromethorphan potentiates morphine antinociception at the spinal level in rats

PURPOSE: Morphine is an effective analgesic, but adverse effects limit its clinical use in higher doses. The non-opioid antitussive, dextromethorphan (DM), can potentiate the analgesic effect of morphine and decrease the dose of morphine in acute postoperative pain, but the underlying mechanism remains unclear. We previously observed that DM increases the serum concentration of morphine in rats. Therefore, we investigated the effects of drugs administered at the spinal level to exclude possible pharmacokinetic interactions. As DM has widespread binding sites in the central nervous system [such as N-methyl-D-aspartate (NMDA) receptors, sigma receptors and alpha(3)ss(4) nicotinic receptors], we investigated whether the potentiation of morphine antinociception by DM at the spinal level is related to NMDA receptors. METHODS: We used MK-801 as a tool to block the NMDA channel first, and then studied the interaction between intrathecal (i.t.) morphine and DM. The tail-flick test was used to examine the antinociceptive effects of different combinations of morphine and other drugs in rats. RESULTS: DM (2-20 microg) or MK-801 (5-15 microg) showed no significant antinociceptive effect by themselves. The antinociceptive effect of morphine (0.5 microg, i.t.) was significantly enhanced by DM and reached the maximal potentiation (43.7%-50.4%) at doses of 2 to 10 microg. Pretreatment with MK-801 (5 or 10 microg, i.t.) significantly potentiated morphine antinociception by 49.9% or 38.7%, respectively. When rats were pretreated with MK-801, DM could not further enhance morphine antinociception (45.7% vs 50.5% and 43.3%). CONCLUSION: Our results suggest that spinal NMDA receptors play an important role in the effect of DM to potentiate morphine antinociception.     

吗啡耐受大鼠脊髓NR2B与mGluR5的相互作用

目的 评价吗啡耐受大鼠脊髓含2B亚基的NMDA受体(NR2B)和代谢型谷氨酸受体5(mGluR5)的相互作用.方法 雄性SD大鼠,体重220～280 g,取鞘内置管成功的大鼠16只,随机分为2组(n=8).对照组(C组)鞘内注射生理盐水10 μl;吗啡组(M组)鞘内注射吗啡10 μg(10 μl).每日给药2次,连续7 d.于给药前和给药后30 min采用热水缩尾法测定痛阈,计算最大镇痛效应百分比(MPE).最后1次痛阈测定结束后第2天,处死大鼠,取L4-5,脊髓背角,采用Western blot法测定NR2B和mGluRS蛋白表达水平;应用免疫共沉淀技术,NR2B抗体沉淀提取蛋白,Western blot法检测沉淀物.结果 与C组比较,给药1～5 d时M组MPE升高(P<0.01),给药7 d时差异无统计学意义(P>0.05).与C组比较,M组NR2B蛋白表达差异无统计学意义(P>0.05),mGluRS蛋白表达上调(P<0.01).免疫共沉淀法证实NR2B与mGluR5存在相互作用.结论 吗啡耐受大鼠脊髓NR2B与mGluR5存在相互作用.     

转基因细胞移植对损伤脊髓天门冬氨酸受体的影响

[目的]研究腺病毒介导的脑源性神经生长因子(brainderivedneurotrophinfactor,AxCABDNF)转基因细胞移植和大剂量甲基强的松龙对大鼠损伤脊髓组织N甲基D天门冬氨酸(NMDA)受体的影响。将成年大鼠分为4组,A组单纯脊髓损伤组;B组脊髓损伤+AxCABDNF基因转染的成肌细胞移植组;C组脊髓损伤+甲基强的松龙组;D组脊髓损伤+细胞移植+甲基强的松龙组。应用后1、3、7、14d,采用[3H]标记的地卓西平马来酸盐([3H]MK801)放射性配基分析法检测大鼠损伤后脊髓NMDA受体的变化。[结果]发现各组[3H]MK801放射性配基分析最大结合容量都有不同程度的减少,其减少程度顺序是A组>B组>C组>D组。表明应用甲基强的松龙(MP)和BDNF转基因细胞移植可以通过影响脊髓NMDA受体减轻脊髓继发性损伤。     

慢性吗啡耐受大鼠脊髓神经元兴奋性氨基酸转运体3表达的变化

目的 观察慢性吗啡耐受大鼠脊髓神经元兴奋性氨基酸转运体3(EAAT3)表达的变化.方法 成年雄性SD大鼠45只,随机分为5组(n=9),除假手术组(S组)外,生理盐水组(NS组)、吗啡组(M组)、氯胺酮组(K组)和吗啡+氯胺酮组(M+K组)均进行鞘内置管,鞘内置管后3 d进行鞘内给药,Ns组鞘内注射生理盐水40 μl,M组给予吗啡20μg,K组给予氯胺酮30μg,M+K组给予吗啡20μg+氯胺酮30μg,2次/d,连续7 d.分别在给药前、给药1、3、5、7 d及停药后1 d时测定50%缩爪阈值(PWT)与辐射热缩爪潜伏期(PWL),最后一次测定痛阈后处死大鼠,分别采用免疫印迹分析和免疫组化法检测脊髓EAAT3的表达水平.结果 与S组比较,M组给药1、3 d时PWT升高,给药7 d及停药后1 d时PWT降低,给药1、3、5 d时PWL延长,停药后1 d时PWL缩短;M+K组给药1、3、5、7 d及停药后1 d时PWT升高,PWL延长,M组和M+K组脊髓EAAT3表达下调(P<0.05);与M组比较,M+K组给药3、5、7 d及停药后1 d时PWT升高,给药5、7 d时及停药后1 d时PWL延长.脊髓EAAT3表达上调(P<0.05).EAAT3主要分布于脊髓背角Ⅰ-Ⅱ层的感觉神经元.结论 脊髓背角神经元EAAT3表达下调参与了大鼠慢性吗啡耐受的形成,吗啡下调EAAT3表达的部分机制与激活N-甲基-D天冬氨酸受体有关.     

Protective use of N-methyl-D-aspartate receptor antagonists as a spinoplegia against excitatory amino acid neurotoxicity

OBJECTIVE: Paraplegia remains a serious complication of thoracic and thoracoabdominal aortic operations. To avoid this dreadful complication, N-methyl-D-aspartate (NMDA) receptor antagonists have been examined in the ischemic or excitotoxic neuronal injury model. In the present study, we evaluated the protective efficacy of NMDA receptor antagonists that were infused segmentally after aortic clamping, as a spinoplegia, to reduce aspartate neurotoxicity in the spinal cord. METHODS: Infrarenal aortic isolation was performed in New Zealand white rabbits. Group A animals (n = 7) were pretreated with the segmental infusion of MK-801, a noncompetitive NMDA receptor antagonist, followed by segmental aspartate (50 mmol) infusion for 10 minutes. Group B animals (n = 6) received pretreatment with CGS19755, a competitive NMDA receptor antagonist, followed by the same aspartate infusion as group A. Group C animals (n = 7) received vehicle only, followed by aspartate infusion as a control group. In addition, group D animals (n = 6) were pretreated with MK-801 that was administrated intravenously 1 hour before aspartate infusion. Neurologic status was assessed at 12, 24, and 48 hours after operation by using the Tarlov score. The spinal cords were procured at 48 hours for histopathologic analysis to determine the extent of excitotoxic neuronal injury. RESULTS: Most of the animals in groups A and D revealed full recovery or mild motor disturbance. Group B and C animals exhibited paraplegia or paraparesis with marked neuronal necrosis. In the Tarlov score at 48 hours, group A animals represented better neurologic function than group C (P < .01) and similar motor function to group D animals. Severe histopathologic change was not observed in groups A and D. Animals in groups A and D showed a greater number of motor neurons than animals in groups B and C (P < .01). The difference could be due to chance between group A and D animals (P = .08). CONCLUSIONS: These results showed that the segmental infusion of noncompetitive NMDA receptor antagonist as an intraoperative spinoplegia could have a protective effect on the spinal cord neurons against excitotoxic neuronal injury in vivo. On the other hand, efficacy of the use of competitive antagonist was suggested to be limited in this model, probably because of the insurmountable obstacle of the blood-brain barrier. CLINICAL RELEVANCE: Paraplegia is a devastating complication during surgical repair of the thoracic and thoracoabdominal aortas. Excitatory amino acids neurotoxicity through the N-methyl-D-aspartate (NMDA) receptor is no doubt the pathologic hallmark of ischemic and postischemic spinal cord injury. Systemic administration of either a competitive or noncompetitive NMDA antagonist has been reported to have neuroprotective effect, in terms of preoperative treatment, with dose-related central sympathomimetic and sedative effects. Local administration, particularly of a noncompetitive NMDA antagonist, infused segmentally after aortic clamping could therefore be a potent intraoperative pharmacologic strategy to minimize the effective dose that retains NMDA antagonism without undesirable adverse effects. Our ability to reproduce this model could facilitate pharmacologic prevention or provide a new surgical technique as a spinoplegia for NMDA receptor-mediated neuronal injury.     

Morphine tolerance increases [3H]MK-801 binding affinity and constitutive neuronal nitric oxide synthase expression in rat spinal cord

N-Methyl-D-aspartate (NMDA) receptor antagonists and nitricoxide synthase (NOS) inhibitors inhibit morphine tolerance.In the present study, a lumbar subarachnoid polyethylene (PE₁₀)catheter was implanted for drug administration to study alterationsin NMDA receptor activity and NOS protein expression in a morphine-tolerantrat spinal model. Antinociceptive tolerance was induced by intrathecal(i.t.) morphine infusion (10 µg h^–1) for 5 days.Co-administered (+)-5-methyl-10,11-dihydro-⁵H-dibenzo[a,d]cyclohepten-5,10-iminemaleate (MK-801) (10 µg h^–1 i.t.) with morphinewas used to inhibit the development of morphine tolerance. Lumbarspinal cord segments were removed and prepared for [³H]MK-801binding assays and NOS western blotting. The binding affinityof [³H]MK-801 was higher in spinal cords of morphine-tolerantrats (mean (SEM) K_D=0.41 (0.09) nM) than in control rats (1.50(0.13) nM). There was no difference in B_max. Western blot analysisshowed that constitutive expression of neuronal NOS (nNOS) proteinin the morphine-tolerant group was twice that in the controlgroup. This up-regulation was partially prevented by MK-801.The results suggest that morphine tolerance affects NMDA receptorbinding activity and increases nNOS expression in the rat spinalcord. Br J Anaesth 2000; 85: 587–91 ^* Corresponding author     

人参皂甙Rg1对炎性痛大鼠吗啡耐受时脊髓背角细胞凋亡的影响

目的 探讨人参皂甙Rg1对炎性痛大鼠吗啡耐受时脊髓背角细胞凋亡的影响.方法 雄性SD大鼠,体重280～320 g,采用右踝关节腔内注射完全弗氏佐剂的方法制备炎性痛模型.取模型制备成功的24只大鼠,采用随机数字表法,将其随机分为4组(n=6):生理盐水对照组(C组)、吗啡耐受组(M组)、人参皂甙Rg1组(G组)及吗啡复合人参皂甙Rg1组(MG组).致炎后3d时M组、G组及MG组分别鞘内注射吗啡10 μg、人参皂甙Rg1 100μg及吗啡10μg+人参皂甙Rg1 100 μg,C组给予等容量生理盐水,吗啡2次/d,人参皂甙Rg1 1次/d,连续7d.分别于致炎前(T1)、鞘内给药前1d(T2)、给药1、3、5、7 d(T3-6)时测定机械缩足阈值(PWT).最后一次测定痛阈后处死大鼠,取L3-5节段脊髓组织,采用TUNEL染色法测定细胞凋亡情况,计算脊髓背角细胞凋亡率.结果 与T1时比较,4组T2-6时PWT降低(P＜0.01);与T2时比较,M组T3.4时PWT升高,G组和MG组T3～6时PWT升高(P＜0.05);与C组比较,M组和MG组PWT和脊髓背角细胞凋亡率升高(P＜0.05),G组上述指标差异无统计学意义(P＞0.05);与M组比较,MG组PWT升高,脊髓背角细胞凋亡率降低(P＜0.05).结论 人参皂甙Rg1预防吗啡耐受形成的机制与降低炎性痛大鼠脊髓背角细胞凋亡有关.     

Intrathecal administration of morphine,but not small dose,induced spastic paraparesis after a noninjurious interval of aortic occlusion in rats

We sought to investigate the dose-response relationship for the effect of intrathecal morphine on the transient spastic paraparesis after short-lasting spinal ischemia in rats. Spinal ischemia was induced by aortic occlusion for 6 min with a balloon catheter in rats previously implanted with an intrathecal catheter for drug delivery. After ischemia, the animals were allowed to recover, and 3, 10, or 30 microg of morphine or saline was injected intrathecally at 30 min after reperfusion. In a separate group, the quantal bioassay for the effect of intrathecal morphine on neurological function after ischemia was performed to calculate 50% effective dose values for inducing paraparesis at 2 h of reperfusion. Subsequently, histopathology of the spinal cord was assessed at 48 h of reperfusion. Intrathecal injection of 30 or 10 micro g of morphine, but 3 micro g of neither morphine nor saline, caused a progressive development of hindlimb spasticity. The 50% effective dose values for inducing paraparesis were 16.1 +/- 1.5 microg in assessing behavioral analysis at 2 h after intrathecal morphine. Histopathological analysis of spinal cords in the 30- microg group revealed the presence of dark-staining alpha-motoneurons in lumbosacral segments. We conclude that spinal administration of a large dose of morphine after transient aortic occlusion may be associated with a potential risk of paraparesis and the corresponding development of neurological dysfunction. Careful attention should be paid when intrathecal morphine is used for pain control after thoracoabdominal aortic aneurysm repair. IMPLICATIONS: Spinal administration of large-dose morphine after transient aortic occlusion may be associated with a potential risk of irreversible spinal neuronal degeneration and the corresponding development of neurological dysfunction.