Enflurane suppresses phrenic nerve-diaphragm transmission in vivo

We examined the effects of enflurane on the diaphragmatic function in 15 pentobarbital-anesthetized, mechanically ventilated dogs. They were divided into three groups of five animals each, according to the administered concentration of enflurane. The diaphragmatic function was assessed from transdiaphragmatic pressure (Pdi) and integrated diaphragmatic electromyography (Edi) developed at functional residual capacity against an occluded airway during bilateral supramaximal phrenic nerve stimulation at 0.5, 10, 20, 50 and 100 Hz under quasiisometric condition. After a control measurement, enflurane was administered at a constant end-expired concentration (0, 0.5 and 1 MAC) and the measurement was repeated after 1 hour of exposure. The Pdi amplitude generated by single twitch (0.5 Hz) and during 10, 20 and 50 Hz stimulation was unchanged between the groups. No change in Pdi during 100 Hz stimulation was noted during 0 and 0.5 MAC exposure, while it was reduced by 1 MAC of enflurane. When the values of Pdi were expressed as % of maximum Pdi (%Pdi,max) that developed during control measurement and analyzed in terms of %Pdi,max-stimulus frequency relationship, a significant decrease in %Pdi,max was noted for 100 Hz stimulation in 0.5 and 1 MAC groups compared to the control. Similarly, Edi during 100 Hz stimulation obtained in 0.5 and 1 MAC groups was markedly depressed compared to the control. Edi during 50 Hz stimulation was also decreased at 1 MAC. Relative changes in Edi following enflurane administration were greater than the corresponding changes of Pdi. These results demonstrate that enflurane impairs diaphragmatic function through its inhibitory effects on neuromuscular transmission.