Diverse range of fixed positional deformities and bone growth restraint provoked by flaccid paralysis in embryonic chicks.

Pancuronium bromide (PB) is used in neonates and pregnant women to induce limp, flaccid paralysis in order to allow mechanical ventilation during intensive care. Such non-depolarizing neuromuscular blocking drugs are administered to 0.1% of all human births in the UK. In this study, we examined PB effects on skeletal development in chick embryos. PB treatment produced skeletal deformities associated with significant reduction in longitudinal growth of all appendicular elements. This was associated with greater cartilage to bone ratios, indicating a preferential reduction in osteogenesis. PB also increased the incidence of knee joint flexion and tibiotarsal joint hyperextension. In addition to limb, spinal and craniofacial deformities, flaccid immobility appears to convert the normal geometric pattern of weight gain to a simple arithmetic accretion. This novel study highlights the potentially harmful effects of pharmacologically induced flaccid immobility on chick embryonic skeletal development. Whilst in ovo avian development clearly differs from human, our findings may have implications for the fetus, premature and term neonate receiving such non-depolarizing neuromuscular blocking drugs.

Tone burst-evoked otoacoustic emissions in cats with acoustic overstimulation and anoxia.

Transient evoked otoacoustic emissions (TEOAE) produced by a 2 kHz tone burst could be detected in 30 out of 37 ears (81% detectability) in 21 cats. The amplitude of tone burst-evoked TEOAE was saturated at a stimulus level between 45 and 50 dB SPL and the latency time of peak amplitude was 6.23 ms on average (5.53-7.28 ms). The effects of pure tone overstimulation and short-term anoxia on the tone burst-evoked TEOAE in cats were evaluated. A permanent detection threshold shift of the TEOAE was confirmed at 24 h and 1 week after the overstimulation at 125 dB SPL. In these cases, damaged first row outer hair cells and inner hair cells were observed over an average length of 3.3 mm (16% of the entire cochlear length) by scanning electron microscopy. These findings suggested that the TEOAE can detect localized cochlear hair cell damage. A temporary detection threshold shift of the TEOAE was observed after the overstimulation at 105 dB SPL, and the threshold shift recovered in 107.5 min on average. In the short-term anoxia trial, the TEOAE amplitude started to decrease 45-90 s after the anoxia and recovered completely when the duration of anoxia was under 1 min. However, the TEOAE amplitude did not recover pre-anoxia values (it remained below 80% of its initial value) after 5 min when the anoxia was over 2 min. These findings demonstrated that the detection threshold and amplitude of the TEOAE were also affected by metabolic changes of the cochlear hair cells. Tone burst-evoked TEOAE are useful for the evaluation of localized histological and functional damage of the cochlear hair cells.

Activation of brain acetylcholine receptors by neuromuscular blocking drugs. A possible mechanism of neurotoxicity.

BACKGROUND: Neuromuscular blocking drugs cause excitement and seizures when introduced into the central nervous system. We examined the possibility that these drugs produce paradoxical activation of acetylcholine or glutamate receptors, the chief types of brain receptors involved in excitatory neurotransmission. METHODS: Because activation of central glutamate or acetylcholine receptors causes calcium influx into postsynaptic neurons, we measured intracellular calcium concentration ([Ca2+]i) as an index of receptor activation. Changes in [Ca2+]i were compared in brain slices exposed to neuromuscular blocking drugs or acetylcholine and glutamate receptor agonists. [Ca2+]i was measured with the fluorescent dye fura-2. RESULTS: Pancuronium and vecuronium caused sustained increases in [Ca2+]i in approximately the same potency ratio as for seizure activity in vivo (concentrations at which the increase in [Ca2+]i was 95% of maximal: 100 and 400 microM, respectively). Atracurium and laudanosine did not increase [Ca2+]i in cortical slices. Increases in [Ca2+]i caused by both pancuronium and vecuronium were prevented by the non-subtype-specific nicotinic acetylcholine receptor antagonist D-tubocurarine and were reduced 44-73% by atropine. Blockade of glutamate receptors or voltage-gated calcium or sodium channels had no effect on calcium influx. CONCLUSIONS: The results suggest that the acute excitement and seizures caused by introduction of pancuronium and vecuronium into the central nervous system is due to accumulation of cytosolic calcium caused by sustained activation of acetylcholine receptor ion channels.

Comparative haemodynamic alterations induced by pipecuronium and pancuronium.

Haemodynamic effects of pipecuronium bromide (Pi.) and pancuronium bromide (Pa.) were studied on isolated rabbit's heart, guinea pig's tracheal chain as well as the blood pressure in pentobarbital anaesthetized dogs. Pi. induced negative inotropic and chronotropic effects on the isolated rabbit's heart especially in lower concentrations. However, higher concentrations provoked two opposite effects, negative chronotropic and positive inotropic activity. In addition, Pa. in lower concentrations caused positive inotropic and negative chronotropic activity, while higher concentrations induced negative inotropic and chronotropic activity. Cardioinhibitory actions of both tested drugs are not due to either cholinergic or beta 1-adrenergic blocking effect but it may be due to nicotine-like activity. In anaesthetized dogs, i.v. injections of both tested drugs produced a transient decrease in systolic and diastolic pressure in doses above the therapeutic level. This effect may be referred to the partial ganglion blocking effect of both tested drugs.

Developmental toxicity of nondepolarizing muscle relaxants in cultured rat embryos.

Evidence of developmental toxicity of clinically used nondepolarizing muscle relaxants was sought in rat embryos grown in culture. Embryos were explanted at 8 AM on day 9 of gestation (presomite stage, plug day = day 0), and were cultured in rotating bottles with medium containing various concentrations of d-tubocurarine, pancuronium, atracurium, and vecuronium. At 10 AM on day 11 of gestation (forelimb bud stage), culture was terminated and embryos were examined for general morphology. Treatment with tested agents resulted in dose-dependent developmental toxicity; namely, growth retardation seen as decreased crown-rump length, decreased number of somite pairs, and morphologic abnormalities. However, the concentrations that caused toxicity were at least 30-fold greater than serum concentrations clinically achieved in the mother. We conclude that these muscle relaxants have a low potential for causing developmental toxicity during organogenesis.

Vecuronium and porcine malignant hyperthermia.

Vecuronium was studied in eight malignant hyperthermia (MH) susceptible pigs for its potential to either trigger or prevent MH. Two sets of experiments were performed in the same animals: 1-hr total neuromuscular blockade by vecuronium infusion with thiopental anesthesia in the absence of invasive monitoring and halothane; and 1-hr infusion of vecuronium with thiopental anesthesia with invasive monitoring in the absence of and then, followed by 30-min infusion in the presence of halothane, followed in turn by exposure to halothane alone. One-hour infusion of vecuronium in the absence of halothane and invasive monitoring did not trigger MH in any animal. During the second set of experiments, MH, evidenced by rising rectal temperature, elevated end-tidal PCO2, mixed venous oxygen desaturation and muscle rigor, occurred in one animal during vecuronium alone, in four animals during vecuronium infusion and simultaneous exposure to halothane, and in three animals during exposure to halothane alone after recovery from vecuronium neuromuscular blockade. In view of the results of control experiments, the development of MH during vecuronium neuromuscular blockade before exposure to halothane was attributed to surgical stress rather than to vecuronium itself. It is concluded that vecuronium is not a trigger to MH in susceptible pigs.

Cardiac vagolytic action of some neuromuscular blockers.

Cardiac vagolytic effect of four commonly used neuromuscular blockers, (viz. D-tubocurarine, decamethonium, pancuronium and gallamine) was compared in midcollicular decerebrate rats. The intravenous doses of neuromuscular blockers used (d-tubocurarine: 0.1 mg/kg; decamethonium: 2 mg/kg; pancuronium: 0.1 mg/kg; gallamine: 20 mg/kg) were sufficient to produce the paralysis of respiratory muscles. Bradycardia was induced by electrical stimulation of the vagus or by injecting dimethyl-phenyl-piperazinium (DMPP; a ganglionic stimulant). It was observed that d-tubocurarine and decamethonium were devoid of cardiac vagolytic action. On the other hand, pancuronium and gallamine inhibited significantly the bradycardia induced by electrical stimulation of the vagus or injection of DMPP; gallamine was found to have greater vagolytic action. The pressor responses to DMPP were not attenuated by pancuronium and gallamine indicating that in the dose administered, these agents did not block the ganglia. Bradycardia induced by the administration of acetylcholine in the left atrium was also attenuated by pancuronium and gallamine suggesting that the drugs produce cardiac vagolytic action by acting on the post-synaptic cholinergic receptors of the heart.

A novel class of antitumour agents. I. Chemistry and animal experiments.

Newly synthesized tertiary amino steroids, among them 2 beta,16 beta-dipiperidino-5 alpha-androstane-3 alpha,17 beta-diol dipivalate (DAP), were tested in three animal species as to their antitumour activity against transplantable tumours. The acute toxicity of DAP was similar to that of cyclophosphamide and considerably lower than vinblastine. Rats with Walker ascites, treated intraperitoneally with DAP, survived up to one year without ascites; untreated animals died within 10 days of transplantation. Intragastric and intraperitoneal application of DAP caused side effects suggesting a local toxicity.

A novel class of antitumour agents. II. In vitro testing.

Suspensions of Walker and HeLa cells, rat fibroblasts and human stimulated lymphocytes were incubated over various periods with the synthetic amino steroid, 2 beta,16 beta-dipiperidino-5 alpha-androstane-3 alpha,17 beta-diol dipivalate (DAP). The acute cell destroying effect was found to be exponentially time and dose dependent within a certain range. With lower nontoxic doses, decreases in the mitotic and labelling indices were observed, and clotted mitotic figures occurred. The effects were essentially the same for all experimental cell types; chromosome alterations were not seen.