Anesthesia Pharmacology Chapter 4: Autonomic (ANS) Pharmacology: Introduction
ANS Neurotransmitters: Effector Organs
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Adrenergic |
Effects |
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Cholinergic |
Iris: Radial Muscle |
N.E., α-1 receptor |
Contraction (mydriasis) |
----- |
Iris: Sphincter muscle |
----- |
----- |
Contraction (miosis) |
Ciliary Muscle |
N.E., β2 receptor |
Relaxation (far vision) |
Contraction (near vision) |
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Adrenergic |
Effects |
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Cholinergic |
Sino-atrial (SA) Node |
β1; β2 |
Increased rate |
Decrease rate (vagal) |
Atrial muscle |
β1, β2 |
Increased: contractility, conduction velocity |
Decreased: contractility, action potential duration |
Atrio-ventricular (AV) node |
β1, β2 |
Increased: automaticity*, conduction velocity |
Decreased conduction velocity; AV block |
His-Purkinje System |
β1, β2 |
Increased: automaticity, conduction velocity |
------ |
Ventricles |
β1, β2 |
Increased: contractility, conduction velocity, automaticity, ectopic pacemaker |
Small Decrease in contractility |
*An increase in the slope of phase 4 depolarization results in enhanced automaticity.
As a result of the increase in phase 4 slope the cell reaches threshold more often, with a higher heart rate as a result.
Factors that increase phase 4 depolarization include
Mechanical stretch
β-adrenergic stimulation
Hypokalemia
Ischemia can induce abnormal automaticity, i.e. automaticity that occurs in cells not typically exhibiting pacemaker activity.
Acetylcholine is an example of an agent that decreases the slope of phase 4 depolarization and as a result, slows the heart rate.
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Adrenergic Effects |
Cholinergic |
Coronary |
α1,2; β2 |
Constriction; dilatation |
Constriction |
Skin/Mucosa |
α 1, 2 |
Dilatation |
|
Skeletal Muscle |
α; β2 |
Constriction, dilatation |
Dilatation |
Cerebral |
α1 |
Slight Constriction |
Dilatation |
Pulmonary |
α1, β2 |
Constriction; dilatation |
Dilatation |
Abdominal Vicera |
α1, β2 |
Constriction; dilatation |
--------- |
Salivary Glands |
α1,2 |
Constriction |
Dilatation |
Renal |
α 1, 2; β,2 |
Constriction; dilatation |
--------- |
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|
Adrenergic Effects |
Cholinergic |
systemic veins |
α1,2; β2 |
Constriction; dilatation |
----- |
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Adrenergic Effects |
Cholinergic |
Tracheal and bronchial muscle |
β2 |
Relaxation |
Contraction |
Bronchial glands |
α1, β2 |
Decrease secretion; increased secretion |
Stimulation |
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|
Adrenergic Effects |
Cholinergic |
Renin Secretion |
α1; β1 |
Decrease; increased secretion |
------- |
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Adrenergic Effects |
Cholinergic |
Pilomotor muscles |
α1 |
Contraction |
----- |
Sweat glands |
α1 |
localized secretion |
generalized secretion |
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Adrenergic Effects |
Cholinergic |
Adrenal medulla |
-- |
---- |
Secretion of epinephrine and norepinephrine (mainly nicotinic and some muscarinic) |
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Adrenergic Effects |
Cholinergic |
Skeletal Muscle |
β2 |
Increased: contractility; |
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Adrenergic Effects |
Cholinergic |
Liver |
α1; β 2 |
Glycogenolysis and gluconeogenesis |
-------- |
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Adrenergic Effects |
Cholinergic |
Posterior Pituitary |
β 1 |
Antidiuretic hormone secretion (ADH) |
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Based on Table 6-1: Lefkowitz, R.J, Hoffman, B.B and Taylor, P. Neurotransmission: The Autonomic and Somatic Motor Nervous Systems, In, Goodman and Gillman's The Pharmacologial Basis of Therapeutics, (Hardman, J.G, Limbird, L.E, Molinoff, P.B., Ruddon, R.W, and Gilman, A.G.,eds) TheMcGraw-Hill Companies, Inc.,1996, pp.110-111
Characteristics of Autonomic Organ Innervation
Usually, parasympathetic and sympathetic systems are physiological antagonists; that is, if one system facilitates or augments a process the other system inhibits the process.
Since most visceral organs are innervated by both system, the activity of the organ is influenced by both, even though one system may be dominant.
The general pattern of antagonism between sympathetic and parasympathetic systems is not always applicable.
The interaction between sympathetic and parasympathetic systems may be independent or interdependent.
Examples of Antagonistic Interactions between Sympathetic and Parasympathetic Systems (Examples)
Actions of sympathetic and parasympathetic influences on the heart.
Actions of sympathetic and parasympathetic influences on the iris.
Interdependent or Complementary Sympathetic and Parasympathetic Effects
Actions of sympathetic and parasympathetic systems on male sexual organs are complementary.
Independent Effects
Vascular resistance is mainly controlled by sympathetic tone.
Fight or Flight: General Functions of the Autonomic Nervous System
ANS regulates organs/processes not under conscious control including:
Circulation
Digestion
Respiration
Temperature
Sweating
Metabolism
Some endocrine gland secretions
Sympathetic system is most active when the body needs to react to changes in the internal or external environment:
The requirement for sympathetic activity is most critical for:
Temperature regulation
Regulation of glucose levels
Rapid vascular response to hemorrhage
Reacting to oxygen deficiency
During rage or fright the sympathetic system can discharge as a unit affecting multiorgan systems.
Sympathetic fibers show greater ramification.
Sympathetic preganglionic fibers may traverse through many ganglia before terminiating at its post-ganglionic cell.
Synaptic terminal arborization results in a single preganglionic fiber terminating on many post-ganglionic cells.
This anatomical characteristic is the basis for the diffuse nature of sympathic response in the human and other species.
Sympathetic Responses
Heart rate increases.
Blood pressure increases.
Blood is shunted to skeletal muscles.
Blood glucose levels increase.
Bronchioles dilate.
Pupils dilate.
Parasympathetic responses
Slows heart rate.
Protects retina from excessive light.
Lowers blood pressure.
Empties the bowel and bladder.
Increases gastrointestinal motility.
Promotes absorption of nutrients.
Lefkowitz, R.J, Hoffman, B.B and Taylor, P. Neurotrasmission: The Autonomic and Somatic Motor Nervous Systems, In, Goodman and Gillman's The Pharmacologial Basis of Therapeutics, (Hardman, J.G, Limbird, L.E, Molinoff, P.B., Ruddon, R.W, and Gilman, A.G.,eds) TheMcGraw-Hill Companies, Inc.,1996, pp.108.