Isolation of novel biflavonoids from Cardiocrinum giganteum seeds and characterization of their antitussive activities.

ETHNOPHARMACOLOGICAL RELEVANCE: Seeds of Cardiocrinum giganteum var. yunnanense (Leichtlin ex Elwes) Stearn (Liliaceae), also known as Doulingzi, have been used as a folk substitute for conventional antitussive herb "Madouling" (Aristolochia species) to treat chronic bronchitis and pertussis. The active antitussive phytochemicals in C. giganteum seeds are not known. AIM OF THE STUDY: The present work aims at isolating the active phytochemicals in C. giganteum seeds and confirming their antitussive effects. MATERIALS AND METHODS: Active chemicals were isolated from C. giganteum seeds ethanol extract and identified their structures. Antitussive effects were evaluated with the cough frequency of guinea pigs exposed to citric acid. Electrical stimulation of the superior laryngeal nerve in guinea pigs was performed to differentiate the acting site of potential antitussives. RESULTS: Two racemic biflavonoids (CGY-1 and CGY-2) were isolated from C. giganteum seeds. CGY-1 was identified as (S)-2″R,3″R- and (R)-2″S,3″S-dihydro-3″-hydroxyamentoflavone-7- methyl ether, which are new compounds and firstly isolated from C. giganteum seeds. Racemic CGY-2 was identified as (S)-2″R,3″R- and (R)-2″S,3″S-dihydro-3″-hydroxyamentoflavone. Both CGY-1 and CGY-2 could significantly inhibit coughs induced by inhalation of citric acid. Further, they acted on the peripheral reflex pathway to inhibit cough after electrical stimulation of the superior laryngeal nerve in guinea pigs. CONCLUSIONS: These chemicals isolated from C. giganteum seeds showed good antitussive effects. The data provide scientific evidence to support the traditional use of C. giganteum seeds as an antitussive herbal medicine.

Does topical anesthesia using aerosolized lidocaine inhibit the superior laryngeal nerve reflex?

OBJECTIVE: This study was designed to evaluate the effectiveness of topical lidocaine in attenuating the laryngeal reflex and blunting hemodynamic response by inhibition of the superior laryngeal nerve in laryngeal microsurgery, which would be helpful in preventing potential complications. STUDY DESIGN: A prospective, randomized, double-blind study. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Fifty-four patients requiring glottic and supraglottic laryngeal microsurgery were randomly assigned to 1 of 2 groups, with equal numbers. Before surgery, 10% lidocaine was topically applied to the laryngeal surface of the epiglottis and vocal folds under direct vision in the study group and saline aerosol was applied in the control group. Heart rates, arterial blood pressure, and SPO2 were recorded at baseline, after induction, immediately before and after intubation, during the surgery, and upon extubation. Laryngospasm, agitation, and coughing were recorded during the recovery period. RESULTS: Heart rates, arterial pressure, and SPO2 did not differ significantly from baseline to postintubation period among the groups. SPO2 values measured similar in the remaining study. Heart rates and blood pressures were slightly decreased in the study group after lidocaine administration, but only blood pressure at pre- and post-extubation was significantly decreased in the study group (P < .05). Also laryngospasm and coughing were not statistically different between the 2 groups. There was an obvious gap between the 2 groups for agitation. Study group agitation was noted significantly lower (P < .05). CONCLUSION: These findings indicate that preoperative topical lidocaine application may be helpful in attenuating airway-circulatory reflexes in laryngeal microscopic surgery.

Antitussive and central respiratory depressant effects of Stemona tuberosa.

AIMS OF THE STUDY: Stemona alkaloids with distinctly different chemical skeletons are recently reported as the active components in the antitussive herb Baibu derived from the root-tubers of Stemona tuberosa. This study aims to determine if alkaloids of this herb contribute equally to the antitussive functions, act on the same sites of cough reflex, and play any role in inducing central respiratory depressant effects. MATERIALS AND METHODS: Antitussive potency of four major alkaloids was evaluated on guinea pigs with citric acid aerosol to induce cough. The action sites of the alkaloids on cough reflex pathway were tested with electrical stimulation of the superior laryngeal nerve in guinea pigs. The central respiratory effects of croomine were also tested on guinea pigs. RESULTS: Croomine, neotuberostemonine and stemoninine showed similar antitussive potency, while tuberostemonine showed much weaker antitussive potency. Neotuberostemonine, tuberostemonine and stemoninine acted on the peripheral cough reflex pathway, while croomine acted on the central part. Croomine also showed obvious central respiratory depressant effects. CONCLUSIONS: The four major Stemona alkaloids in Stemona tuberosa do not contribute equally to antitussive potency in guinea pigs. Neotuberostemonine, tuberostemonine and stemoninine target on peripheral cough reflex pathway. Croomine acts on central sites in the cough reflex pathway and demonstrates central respiratory depressant effects, which can partly account for the adverse reactions reported for the herb.

The descending motorcortical pathway to the laryngeal motoneurons in the squirrel monkey.

The motor cortex of primates contains an area ("larynx area") which, when stimulated unilaterally, produces bilateral vocal fold adduction. In order to identify the pathway along which the cortical larynx area exerts its control on the laryngeal motoneurons, we have blocked excitatory neurotransmission in each of the main projection fields of the cortical larynx area and tested for the elicitability of vocal fold movements from this area in the squirrel monkey. Blocking was carried out by injection of the glutamate antagonist kynurenic acid. We found that injection into the dorsal reticular nucleus of the caudal medulla ipsilateral to the stimulation site blocked vocal fold movements bilaterally; injections invading major parts of the nucleus ambiguus blocked vocal fold movements exclusively ipsilateral to the injection site; and injections centered on the parvocellular reticular formation bordering the nucleus ambiguus blocked exclusively contralateral vocal fold movements. We conclude from this that the corticobulbar laryngeal control pathway synapses in the ipsilateral dorsal reticular nucleus and then divides into one component running directly to the ipsilateral nucleus ambiguus and a second component crossing to the contralateral nucleus ambiguus after having synapsed in the ipsilateral peri-ambigual reticular formation.

Effects of perineural capsaicin treatment on cardiopulmonary reflexes elicited by laryngeal instillations of capsaicin and distilled water in sevoflurane-anesthetized dogs.

The aim of this study was to determine the effect of perineural capsaicin (CAPS) treatment on cardiopulmonary reflexes elicited by topical laryngeal instillation of CAPS and distilled water (DW) in sevoflurane-anesthetized dogs. Cardiopulmonary reflexes elicited by CAPS (10 microg/ml, 10 ml) were attenuated by perineural CAPS treatment to the superior laryngeal nerves (SLNs) (P<0.05), whereas those by DW (10 ml) remained unaffected (P>0.05). The reflex responses to DW that remained even after the perineural CAPS treatment were eliminated by laryngeal anesthesia with lidocaine. These results suggest that cardiopulmonary reflexes from the laryngeal mucosa elicited by CAPS instillation can be blocked by perineural CAPS treatment to the SLNs, which may result from inhibition of the laryngeal CAPS-sensitive C-fiber afferents.

Effects of perineural capsaicin treatment on compound action potentials of superior laryngeal nerve afferents in sevoflurane-anesthetized dogs.

Effects of perineural capsaicin (CAPS) treatment on compound action potentials of the superior laryngeal nerve (SLN) afferents were studied in 6 sevoflurane-anesthetized dogs. Perineural CAPS (100 microg/ml) to the bilateral SLNs reduced (P<0.01) the peak and integral amplitudes of the C-wave of the compound action potential. By contrast, the perineural CAPS had no effect on the A-wave component (P>0.05). Removal of the perineural CAPS recovered the C-wave to pretreatment level. The perineural CAPS treatment selectively blocks C-wave compound action potentials of the SLN afferents, providing a useful tool for studies of laryngeal C-fibers in respiratory physiology.

Anesthesia for the superior laryngeal nerves and tartaric acid-induced cough.

OBJECTIVE: The internal branch of the superior laryngeal nerve (ibSLN) conveys impulses for the laryngeal cough reflex, which protects the laryngeal aditus and prevents the development of aspiration pneumonia. The purpose of this study was to determine the effect of bilateral anesthesia of the ibSLN on the cough reflex after inhalation of a nebulized chemoirritant solution of tartaric acid. DESIGN: Prospective, clinical investigation. SETTING: Outpatient. PARTICIPANTS: Nine healthy volunteers. INTERVENTIONS: Bilateral injections of 2% lidocaine solution without epinephrine into the paraglottic space containing the ibSLN. MAIN OUTCOME MEASURES: The tidal volume after inhalation of a nebulized 20% tartaric acid solution and forced vital capacity (FVC) were measured before and after injection. Data were analyzed using the Wilcoxon signed ranks, Mann-Whitney, and sign tests. RESULTS: Complete anesthesia of the ibSLN abolished the laryngeal cough reflex. Postinjection tidal volumes were significantly lower than preinjection volumes (p<.01). The decrease in tidal volumes for six subjects with complete bilateral anesthesia was significantly larger than the decrease in tidal volumes for three subjects with partial anesthesia (p<.05). FVC in both the six subjects with complete bilateral anesthesia and the three subjects with partial anesthesia did not significantly change from preinjection to postinjection. None of the subjects in this study had complications or adverse respiratory sequelae. CONCLUSION: Tartaric acid-induced cough may be useful in assessing the integrity of the laryngeal cough reflex after anesthesia or in patients with neurologic injury who are at risk of developing aspiration pneumonia. It may also be useful in making the decision whether to resume oral feeding.

Superior laryngeal nerve blockade and inspiratory resistive load detection in normal subjects.

The site for detection of added inspiratory resistive loads is unknown, but recent evidence suggests that the airways may play an important role. The aim of this study was to discern whether the larynx has an important independent role in conscious detection of added inspiratory resistive loads. A randomized double-blind placebo-controlled study of the effect of superior laryngeal nerve blockade on inspiratory resistive load-detection threshold was carried out in 12 normal subjects (7 women; mean age 27.5 yr; range 18-45 yr). Baseline (preinjection) detection thresholds were similar on the lidocaine [0.58 +/- 0.16 (SE) cmH2O.l-1.s] and saline (0.53 +/- 0.12 cmH2O.l-1.s; P = 0.28) days. There was no significant difference in load-detection thresholds after injection between lidocaine (0.60 +/- 0.15 cmH2O.l-1.s) and saline (0.55 +/- 0.10 cmH2O.l-1.s; P = 0.68). Thus, the larynx does not appear to be an important independent airway site for conscious inspiratory resistive load detection.