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Selective Anesthetic Inhibition of Brain Nitric Oxide Synthase.

Tobin, Joseph R. M.D.; Martin, Lynn D. M.D.; Breslow, Michael J. M.D.; Traystman, Richard J. Ph.D.

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Background: It has been postulated that nitric oxide (NO) is a neurotransmitter involved in consciousness, analgesia, and anesthesia. Halothane has been shown to attenuate NO-mediated cyclic guanosine monophosphate accumulation in neurons, and a variety of anesthetic agents attenuate endothelium-mediated vasodilation, suggesting an Interaction of anesthetic agents and the NO-cyclic guanosine monophosphate pathway. However, the exact site of anesthetic inhibitory action in this multistep pathway is unclear. The current study examines effects of volatile and Intravenous anesthetic agents on the enzyme nitric oxide synthase (NOS) in brain.
Methods: NOS activity was determined by in vitro conversion of [14C]arginine to [14C]citrulline. Wistar rats were decapitated and cerebellum quickly harvested and homogenized. Brain extracts were then examined for NOS activity in the absence and presence of the volatile anesthetics halothane and isoflurane, and the intravenous agents fentanyl, midazolam, ketamine, and pentobarbltal. Dose-response curves of NOS activity versus anesthetic concentration were constructed. Effects of anesthetics on NOS activity were evaluated by analysis of variance.
Results: Control activities were 57.5 +/- 4.5 pmol [middle dot] mg protein-1 min-1 in the volatile anesthetic experiments and 51.5 +/- 6.5 pmol [middle dot] mg protein-1 [middle dot] min-1 in the intravenous anesthetic experiments. NOS activity was not affected by ketamine (<=I x x 10-4 M), pentobarbital (<=5 x 10-5 M), fentanyl (<=1 x 10-5 M), and midazolam (<=1 x 10-5 m). Halothane decreased NOS activity to 36.7 +/- 2.5 (64% of control, P < 0.01 from control), 23.8 +/- 4.3 (41%, P < 0.01 from control and <0.05 from 0.5% halothane), 25.2 +/- 3.8 (44%, P < 0.01 from control and <0.05 from 0.5% halothane), and 19.7 +/- 2.8 (34%, P < 0.01 from control and <0.05 from 0.5% halothane) pmol [middle dot] mg protein-1 [middle dot] min-1 at 0.5,1.0,2.0, and 3.0% vapor. Isoflurane decreased NOS activity to 48.9 +/- 6.1 (85% of control), 46.0 +/- 3.2 (80%, P < 0.05 from control), 40.3 +/- 5.1 (70%, P < 0.05 from control), and 34.2 +/- 4.0 (60%, P < 0.05 from control and 0.5% and 1.0% isoflurane) pmol [middle dot] mg protein-1 [middle dot] min-1 at 0.5,1.0,1.5, 2.0% vapor, respectively.
Conclusions: Volatile anesthetics inhibit brain NOS activity in an in vitro system, but the Intravenous agents examined have no effect at clinically relevant concentrations. This inhibition suggests a protein-anesthetic interaction between halothane, isoflurane, and NOS. In contrast, intravenous agents appear to have no direct effect on NOS activity. Whether intravenous agents alter signal transduction or regulatory pathways that activate NOS is unknown.
(C) 1994 American Society of Anesthesiologists, Inc.
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