Document Detail


Tactile stimulation of the oropharynx elicits sympathoexcitation in conscious humans.
MedLine Citation:
PMID:  23599399     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Tactile stimulation of the oropharynx (TSO) elicits the gag reflex and increases heart rate (HR) and mean arterial pressure (MAP) in anesthetized patients. However, the interaction between upper-airway defense reflexes and the sympathetic nervous system has not been investigated in conscious humans. In Experiment 1, beat-by-beat measurements of HR, MAP, muscle sympathetic nerve activity (MSNA), and renal vascular resistance (RVR) were measured during TSO and tactile stimulation of the hard palate (Sham) in the supine posture. In Experiment 2, TSO was performed before (pre) and after (post) inhalation of 4% lidocaine via nebulizer. Rate pressure product (RPP) was determined. Compared with Sham, TSO elicited the gag reflex and increased RPP [absolute change (Δ)36 ± 6 vs. 17 ± 5%], MSNA (Δ122 ± 39 vs. 19 ± 19%), and RVR (Δ55 ± 11 vs. 4 ± 4%). This effect occurred within one to two cardiac cycles of TSO. The ΔMAP (12 ± 3 vs. 6 ± 1 mmHg) and the ΔHR (10 ± 3 vs. 3 ± 3 beats/min) were also greater following TSO compared with Sham. Lidocaine inhalation blocked the gag reflex and attenuated increases in MAP (Δpre: 16 ± 2; Δpost: 5 ± 2 mmHg) and HR (Δpre: 12 ± 3; Δpost: 2 ± 2 beats/min) in response to TSO. When mechanically stimulated, afferents in the oropharynx not only serve to protect the airway but also cause reflex increases in MSNA, RVR, MAP, and HR. An augmented sympathoexcitatory response during intubation and laryngoscopy may contribute to perioperative cardiovascular morbidity and mortality.
Authors:
Matthew D Muller; Jessica L Mast; Jian Cui; Matthew J Heffernan; Patrick M McQuillan; Lawrence I Sinoway
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2013-04-18
Journal Detail:
Title:  Journal of applied physiology (Bethesda, Md. : 1985)     Volume:  115     ISSN:  1522-1601     ISO Abbreviation:  J. Appl. Physiol.     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-07-02     Completed Date:  2013-10-17     Revised Date:  2014-07-01    
Medline Journal Info:
Nlm Unique ID:  8502536     Medline TA:  J Appl Physiol (1985)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  71-7     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthetics, Local / pharmacology
Arterial Pressure
Blood Pressure / physiology
Cold Temperature / diagnostic use
Data Interpretation, Statistical
Female
Heart Rate / physiology
Humans
Hypertension / physiopathology
Lidocaine / pharmacology
Male
Oropharynx / drug effects,  innervation*,  physiology*
Palate, Hard / physiology
Physical Stimulation
Pressure
Reflex / drug effects,  physiology
Renal Circulation / physiology
Sympathetic Nervous System / drug effects,  physiology*
Tachycardia / physiopathology
Vascular Resistance / physiology
Young Adult
Grant Support
ID/Acronym/Agency:
C06 RR016499/RR/NCRR NIH HHS; C06-RR016499/RR/NCRR NIH HHS; P01 HL096570/HL/NHLBI NIH HHS; P01-HL096570/HL/NHLBI NIH HHS; R01-HL070222/HL/NHLBI NIH HHS; UL1 RR033184/RR/NCRR NIH HHS; UL1 TR000127/TR/NCATS NIH HHS; UL1-RR033184/RR/NCRR NIH HHS; UL1-TR000127/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Anesthetics, Local; 98PI200987/Lidocaine
Comments/Corrections

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