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The Hypoxic Ischemic Encephalopathy Model of Perinatal Ischemia
08:47

The Hypoxic Ischemic Encephalopathy Model of Perinatal Ischemia

Published on: November 19, 2008

Perinatal neuroprotection by muscle relaxants against hypoxic-ischemic lesions: is it a possible hypothesis?

Vincenzo Fodale1, Caterina Praticò, Maria Rosa Signer

  • 1Anesthesiology and Intensive Care Unit, Department of Neuroscience, Psychiatric and Anesthesiological Sciences, Messina University School of Medicine, Policlinico Universitario G. Martino, Messina, Italy. vfodale@unime.it

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
|October 6, 2005
PubMed

Insights

Laudanosine, a metabolite of neuromuscular blockers used in cesarean sections, shows potential neuroprotection against perinatal brain injury. This finding suggests a therapeutic role for these drugs in preventing neurological disabilities.

Area of Science:

  • Neuroscience
  • Obstetrics
  • Pharmacology

Background:

  • Neurological disabilities from perinatal hypoxia-ischemia (HIPP) are increasing.
  • Glutamate-induced excitotoxicity via N-methyl-D-aspartate (NMDA) receptors contributes to HIPP brain damage.
  • Laudanosine, a metabolite of atracurium and cisatracurium, is present in fetuses during cesarean sections.

Purpose of the Study:

  • To investigate the potential neuroprotective role of laudanosine against HIPP-induced brain injury.
  • To explore the mechanism of laudanosine's action on NMDA excitotoxicity.
  • To assess the clinical relevance of laudanosine in obstetric anesthesia.

Main Methods:

  • Investigated laudanosine's effect on NMDA excitotoxicity in a neonatal model.
  • Measured laudanosine concentrations in umbilical veins during cesarean sections.
  • Examined laudanosine's interaction with alpha4beta2 nicotinic acetylcholine receptors (nAChRs).

Main Results:

  • Laudanosine activated alpha4beta2 nAChRs at nanomolar concentrations.
  • Activation of alpha4beta2 nAChRs conferred neuroprotection against NMDA excitotoxicity.
  • Clinical data indicate fetal laudanosine levels are within a range that can activate these receptors.

Conclusions:

  • Laudanosine demonstrates a potential neuroprotective effect against perinatal brain lesions.
  • The neuromuscular blocking drugs atracurium and cisatracurium may offer therapeutic benefits in obstetric anesthesia.
  • Further research into laudanosine for preventing HIPP-related neurological disabilities is warranted.

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