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Department of Health and Human Performance, Auburn University, Auburn, Alabama 36849
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ABSTRACT |
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 TOP
 ABSTRACT
 INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES
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The purpose of this study was to determine the effect of
epinephrine on net lactate (La
) uptake at constant
elevated blood La concentration and steady level
metabolic rate (O2 uptake) in the canine
gastrocnemius-plantaris muscle in situ. Infusion of La/lactic acid (pH 3.5) established a mean arterial blood
La concentration of ~10 mM while normal blood-gas and
pH status were maintained as the gastrocnemius-plantaris was stimulated with tetanic trains at a rate of one contraction every 4 s. After steady-state control measures, epinephrine was infused for 35 min at
rates that produced a high physiological concentration with (Pro;
n = 6) and without (Epi; n = 6)
-adrenergic-receptor blockade via propranolol. Net La
uptake values during the control conditions were not significantly different between trials (Epi: 0.756 ± 0.043; Pro: 0.703 ± 0.061 mmol · kg1 · min1).
Steady level O2 uptake averaged ~69.5
ml · kg1 · min1 for
both control conditions and did not significantly change over the
course of the experiments in either set of trials. Epi experiments
resulted in a significantly reduced net La uptake
(0.346 ± 0.088 mmol · kg1 · min1 after 5 min of infusion) compared with control value at all sample times
measured. However, net La uptake was not significantly
different from control at any time during Pro (0.609 ± 0.052 mmol · kg1 · min1 after 5 min of infusion). When the change from the respective control values
for net La uptake was compared across time for both
series of experiments, Epi resulted in a significantly greater change
from control than did Pro. This study suggests that epinephrine can
have a profound effect on net La uptake by contracting
muscle and that these effects are elicited through
-adrenergic-receptor stimulation.
lactate metabolism; exercise; -blockade; canine
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INTRODUCTION |
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TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES
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SKELETAL MUSCLE IS NO
LONGER viewed solely as a producer of lactate (La).
Isotopic tracer studies (2, 23, 42, 43) have provided evidence indicating that both La release into and
La removal from the blood by skeletal muscle are
increased during exercise. In addition, reports have confirmed net
La uptake by exercising skeletal muscle in humans
(7, 32) with an elevated blood La
concentration ([La], where brackets denote
concentration). Studies of canine muscle in situ
(10-13) have shown that, during both rest and
contractions, an elevated blood [La] can reverse an
initial net La output to net La uptake. It
has also been observed that net La uptake by canine
muscle in situ increases in proportion to arterial blood
[La] (10-13, 29). Gladden et al.
(12) have observed that increasing the plasma
[La] causes net La uptake to approach a
plateau in the high range of the [La] studied
(~20-30 mM). In the same preparation, when net La
uptake was measured during steady level conditions with an elevated blood [La] (~10 mM), increases in metabolic rate
produced increases in net La uptake (10).
These studies (10-13, 29), as well as others (2, 23, 32, 42, 43), support the idea that net
La uptake by muscle is dependent on metabolic rate of the
muscle and the blood [La].
In addition to blood [La] and muscle metabolic rate, it
seems likely that circulating epinephrine could play a prominent role in determining the rate of La uptake by skeletal muscle.
The stimulation of muscle glycogenolysis during exercise by epinephrine
is supported by investigations utilizing adrenal demedullation
(31, 33), epinephrine infusion (17, 37, 40),
and -blockade (4, 8). A consequence of enhanced muscle
glycogenolysis is an increase in La production.
Therefore, it is not surprising that net muscle La
output, blood La rate of appearance, and perhaps
La clearance, as well, are influenced by circulating
epinephrine (3, 14, 17, 24, 39-41). In many
instances, -adrenergic-receptor blockade resulted in a decreased
blood [La] as well as a decreased net La
output by muscle (8, 18, 40). In support of these studies, which suggest a causal relationship between muscle and blood
[La] and epinephrine--receptor interaction in
exercising humans, high correlations between arterial
[La] and [epinephrine] have been reported (21,
22, 24, 28). In fact, Mazzeo and Marshall (24) have
even observed the inflection points of blood [La] and
[epinephrine] to occur at the same exercise intensity.
There is clear evidence suggesting a relationship between circulating
epinephrine and the production and output of La by
skeletal muscle. The increasing blood La level in many of
these studies merely indicates that entry into the blood exceeds
removal. Given the importance of skeletal muscle in the removal of
La during exercise, measurements investigating
epinephrine and La uptake are warranted. Under conditions
that engender skeletal muscle net La uptake, one could
speculate that epinephrine will stimulate endogenous La
production, resulting in inhibition of net La uptake. A
reversal to net La output might even be possible.
However, there have been no systematic investigations of the effect of
epinephrine on net La uptake by skeletal muscle.
Therefore, it was the purpose of the present investigation to examine
the effect of epinephrine on net La uptake by contracting
skeletal muscle.
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METHODS |
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TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES
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Animals. All procedures for this investigation involving animals were reviewed and approved by the Auburn University Institutional Animal Care and Use Committee. For this study, 12 mongrel dogs (14.5-25.0 kg) of either sex were obtained from the Auburn University Laboratory Animal Health Facility at the College of Veterinary Medicine.
Each animal was obtained after an overnight fast. The animal was anesthetized with pentobarbital sodium (30 mg/kg body wt iv injection), intubated, and transported to the laboratory. Additional doses of pentobarbital sodium were given as needed to maintain a deep surgical plane of anesthesia. The animals were ventilated with a respirator (model 613, Harvard Apparatus) to maintain normal blood-gas values. Rectal temperature was maintained at ~37°C with a heating pad placed under the animal.Surgical procedure.
The left gastrocnemius-plantaris muscle group (GP) was surgically
isolated, as previously described (10-13, 38).
Briefly, a medial incision was made through the skin of the left
hindlimb from the midthigh to the ankle. The insertion tendons of the
sartorius, gracilis, semitendinosus, and semimembranosus muscles were
cut with a heated blade (model D550, Weller) and folded back to expose the GP. All branches of the popliteal vein that did not come from the
GP were ligated, and all venous connections from the GP that did not go
directly to the popliteal vein were ligated as well. Therefore, all
venous outflow (
) from the GP was isolated to the popliteal
vein. The popliteal vein was cannulated, and returned to the
animal by means of a reservoir attached to a cannula in the left
jugular vein. was directed from the cannula to the jugular
reservoir by using a venous return line. Blood flow was measured with
an in-line type ultrasonic flow transducer (T106, Transonic Systems)
placed in the venous return tubing. The flowmeter-transducer combination was calibrated with a graduated cylinder and a stopwatch before and during each experiment. Venous blood samples were taken from
a T connector placed in the cannula exiting the left popliteal vein. In
addition, to ensure vascular isolation, all branches of the popliteal
artery that did not go directly into the GP were doubly tied and
ligated. Thus arterial supply to the GP was exclusively by way of the
popliteal artery.
/lactic
acid and epinephrine solutions. The La/lactic acid
infusate consisted of a 725 mM L-(+)-lactic acid (2-hydroxypropionic acid, sarcolactic acid) solution made by diluting a
30% aqueous solution (L-1875, Sigma Chemical) with deionized water.
The pH of the infusate was adjusted to 3.5 at 37°C with saturated
NaOH to maintain normal blood acid-base status during infusion
(13). This solution was infused via a peristaltic pump (model 312, Gilson Minipuls 3) at a rate of 0.245 mmol · kg
body wt1 · min1 for the first 10 min of infusion and then decreased to 0.133 mmol · kg body
wt1 · min1 thereafter. Arterial
[La] was monitored with a portable La
analyzer (Accusport), and the infusate schedule was altered as necessary to maintain an elevated arterial whole blood concentration around 10 mM. The epinephrine infusate was made immediately before infusion by adding 1.5 mg active principle of epinephrine bitartrate (E-4375, Sigma Chemical) to a stock solution containing 60 ml of normal
saline (NaCl 0.9 g/100 ml) with 2.0 mg/ml ascorbic acid (A-1417, Sigma
Chemical) as an antioxidant. In all of the experiments, the same
empirically determined epinephrine infusate schedule was used. The
epinephrine solution was infused via a syringe pump (model
55-1111, Harvard Apparatus) at a rate of 0.32 µg · kg
body wt1 · min1 for 30 s and
then 0.25 µg · kg body
wt1 · min1 for the remainder of the
experiment. In 6 of the 12 experiments, propranolol (P-8688, Sigma
Chemical) was dissolved in a normal saline solution and given in a
bolus dose of 1.0 mg/kg body wt by way of the jugular cannula. Blood
coagulation was prevented by intravenous heparin (2,000 U/kg) given
through the jugular cannula immediately postsurgery before any cannulations.
A portion of the calcaneus, with the two tendons of the GP attached,
was cut away for connection to an isometric myograph. The two tendons
were clamped around a short metal rod and connected via a short section
of aluminum pipe (29 mm diameter) and a universal joint coupler to the
myograph load cell (interface SM-250, Narco Biosystems). The universal
joint coupler was used to ensure that the muscle always pulled directly
in line with the load cell, thus preventing the application of torque
to the load cell. The load cell was calibrated with known weights
before each experiment. The GP was covered with saline-soaked gauze and
a thin piece of plastic to prevent drying and cooling. Both the femur
and the tibia were fixed to the base of the myograph using bone nails and connecting rods. A turnbuckle strut was placed parallel to the
muscle between the tibial bone nail and the arm of the myograph to
minimize flexing of the myograph, which would decrease the measured
force production. The sciatic nerve was exposed and isolated near the
GP. The distal stump of the nerve, ~1.5-3.0 cm in length, was
pulled through an epoxy electrode containing two wire loops for stimulation.
To evoke muscle contractions, the nerve was stimulated by supramaximal
square-wave pulses of 4.0- to 6.0-V amplitude and 0.2-ms duration
(Grass S48 stimulator) and isolated from ground by a stimulus isolator
(Grass SIU8TB). Before each experiment, the GP was set to optimal
length by progressively lengthening the muscle as it was stimulated at
a rate of 0.2 Hz until a peak in developed tension (total minus resting
tension) was observed. For the contraction protocol of the experiments,
isometric tetanic contractions were evoked by stimulation with trains
of stimuli (200-ms duration, 50-Hz frequency) at a rate of one
contraction every 4 s. This contraction protocol was used to
elevate metabolic rate to a steady level for a prolonged period of time.
Experimental protocols.
Once surgical isolation of the GP was complete, all cannulas and
equipment were in place, and optimal length was determined, the muscle
was allowed to rest for a minimum of 10 min while blood gases and pH
were measured. When these values were within normal limits,
La/lactic acid infusion commenced. After an equilibration
of the arterial [La] at ~10 mM, the GP was stimulated
to contract submaximally until a steady state in oxygen consumption was
reached and maintained for 15 min (total contraction period ~35 min;
control). Subsequently, there was a 35-min period during which the
[La] was still maintained at ~10 mM and the muscle
continued to contract, but epinephrine was also infused to reach an
arterial level of ~3.5 ng/ml (Epi). Because epinephrine was
determined to influence net La uptake in the contracting
GP, additional experiments were performed. These experiments were
similar in all respects (time, infusion schedules, etc.) to the
aforementioned experiments, except that propranolol was given in a
bolus dose 10 min preceding the infusion of epinephrine (Pro).
Measurements. Outputs from the flowmeter, pressure transducer, and load cell were recorded on a strip chart recorder (Narcotrace 40, Narco Biosystems) for monitoring and analysis. Additionally, output from the load cell was fed into a computerized data-acquisition system (PowerComputing Powerbase 240 Macintosh clone; GW Instruments, Superscope II; IntruNet model 100B A/D converter). Five and thirty minutes into each experimental period (control, Epi, and Pro), muscle force production was measured and averaged over 30 s. Heart rate was periodically monitored by using the arterial pressure tracing.
A minimum of three steady-state arterial and venous (a-v) samples, separated by 5 min, was collected no earlier than 20 min into the contraction protocol before epinephrine infusion. Steady state was defined as a variation in measured variables of <5% over a 5-min interval. During the 35-min contraction period with epinephrine infusion, simultaneous a-v samples were taken at 2, 5, 10, 15, 20, 25, 30, and 35 min after the first observable arterial pressure response to epinephrine. All blood samples were collected anaerobically in 3.0-ml plastic syringes. About 1.0 ml of blood was placed in a spot plate, and 0.4 ml were immediately transferred from the spot plate into each of duplicate test tubes containing 2.0 ml of ice-cold 4.2% perchloric acid. The tubes were vortexed and stored on ice until the end of the experiment. At the end of the experiment, the tubes were centrifuged at 4°C, and the supernatant from each sample was stored at
80°C
until analysis for [La] by a modification of standard
spectrophotometric methods (15).
After the 1.0 ml of blood was dispensed, as noted above, the syringe
containing the remaining 2.0 ml of blood was capped and stored on ice
for a short time before being analyzed for PO2, PCO2, and pH with a blood-gas analyzer (IL
1304). In addition, samples were analyzed for [Hb] and percent
saturation of Hb with a calibrated CO-oximeter (IL 282) set for dog
blood. Oxygen uptake (
O2) and net
La uptake by the GP were calculated from blood flows and
a-v concentration differences.
An additional 1.5-ml arterial blood sample was collected during
steady-state contractions before epinephrine infusion and at ~5 and
~30 min into epinephrine infusion. This sample was dispensed into a
1.5-ml Eppendorf tube containing 30 µl of a catecholamine preserving
solution (250 mM EGTA; 200 mM reduced glutathione; sodium heparin, 30 U/ml blood), lightly vortexed, and centrifuged. The supernatant was
transferred to Eppendorf tubes and stored at 80°C for later
analysis of plasma [epinephrine] and [norepinephrine]. [Epinephrine] and [norepinephrine] were determined by using the single-isotope derivative method (36). This method is
based on quantitative conversion of epinephrine and norepinephrine to their labeled O-methyl derivatives, isolation of the
derivative by solvent extraction, thin-layer chromatography, and
oxidation to vanillin.
After each experiment, the muscle was removed from the animal,
dissected free of connective tissue, and weighed. The muscle was then
dried in an oven at 80°C to determine its percentage of water.
Statistics. Differences among the variables measured in this study were determined with a two-way (2 conditions × 9 sample times) ANOVA with repeated measures across time (0, 2, 5, 10, 15, 20, 25, 30, 35 min). Appropriate post hoc contrasts were used when necessary to determine where significant differences occurred. A significance level of 0.05 was used for all analyses in this investigation. Data are reported as means ± SE.
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RESULTS |
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TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES
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Table 1 shows mean values for major
variables that were measured in the Epi as well as the Pro experiments.
The mean control data for the two series of experiments were not
different in terms of the major variables measured. There were no
significant differences in O2 between
the two trials at any time. Although steady-state O2 in Pro was numerically lower than in
the other measures, the difference was not statistically significant.
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In accordance with the experimental protocol, epinephrine infusion increased the arterial [epinephrine] in both Epi and Pro. The infusion of epinephrine in this investigation resulted in an increased arterial blood concentration of this amine that is on the high end of the physiological range observed in dogs exercising at moderate intensity (27). These values are also well within the range observed in exercising humans (24, 26) and rats (14, 25) in vivo. Five minutes into epinephrine infusion, the arterial concentration was elevated to 2,985 ± 949 and 3,570 ± 752 pg/ml for the Epi and Pro series, respectively. Steady-state arterial [epinephrine] in both trials were slightly but insignificantly higher than the 5-min values.
As planned, La infusion resulted in an elevated arterial
[La] of ~10 mM in all experiments. During Epi, there
was a slight but significant increase in the arterial
[La] over the course of the experiments. Despite this
slight increase in arterial [La], the a-v
[La] difference decreased significantly from the
control to steady state. To the contrary, Pro resulted in a gradual
rise in the a-v [La], which became significantly
greater than the control after 10 min of epinephrine infusion and
remained elevated for the remainder of the experiment.
The blood flow response to epinephrine infusion as a function
of time is shown in Fig. 1. Infusion of
epinephrine during Epi resulted in a significant rise in
by the second minute of infusion, which reached a peak of 642.9 ± 37.7 ml · kg1 · min1 5 min
into the infusion. After 5 min of Epi, gradually declined to
the elevated steady-state shown in Table 1. Conversely, Pro
significantly decreased during epinephrine infusion. By the
second minute of epinephrine infusion, had significantly decreased to 414.5 ± 28.5 ml · kg1 · min1 from the
control (544 ± 21 ml · kg1 · min1) and
continued to decline slowly to steady state.
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As expected, La infusion and the resulting increase in
arterial [La] elicited a large net La
uptake during the control period in both experimental protocols. The
control net La uptake averaged 0.756 ± 0.043 and
0.703 ± 0.061 mmol · kg1 · min1 for Epi
and Pro, respectively (Table 1). Net La uptake for both
conditions as a function of time is depicted in Fig.
2. In the Epi series, epinephrine
infusion resulted in a significant decrease in net La
uptake compared with the control at all sample times. In the Pro
series, epinephrine infusion had no significant effect on net
La uptake compared with control conditions.
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Figure 3 illustrates the change in net
La uptake from the control values at every sample time
for both Epi and Pro. The negative values indicate a decrease in net
La uptake compared with control conditions. The change in
net La uptake observed during Epi was significantly
greater than the change observed during Pro for every sample time.
Although the values are not significantly different, the change in net
La uptake over the course of the Epi experiments suggests
a trend toward the control net La uptake values. This
visual trend of net La uptake during Epi is consistent
with the work of Rennie et al. (30), which provides
evidence that suggests that phosphorylase activation at the onset of
contractions is reversed with continued contractions and can be
reactivated with epinephrine (adrenaline) infusion.
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The percentage of muscle tissue that was water at the end of the experiments was similar to that found in previous studies in this preparation (10-12). Percentage of water averaged 75.8 ± 0.6 and 75.7 ± 0.5% after Epi and Pro, respectively.
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DISCUSSION |
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TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES
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The most significant finding of this investigation was that
epinephrine infusion significantly inhibited net La
uptake in the contracting canine GP during exposure to an elevated arterial [La]. In addition, propranolol given in a
bolus dose before epinephrine infusion abolished the decrease in net
La uptake brought about by epinephrine infusion (Fig. 3).
Because the effect of epinephrine infusion on net La
uptake could be abolished by prior administration of propranolol, it
appears that the effect of epinephrine on net La uptake
is related to epinephrine--receptor interaction. To our knowledge,
this is the first investigation to address directly the role of
epinephrine on La uptake by skeletal muscle and to
provide evidence as to whether -receptor activation mediates
alterations in La uptake by skeletal muscle caused by epinephrine.
There is no direct evidence with which to explain the observed decrease
in net La uptake due to Epi in this investigation. On the
basis of previous research examining the effect of epinephrine on net
La output in canine GP (39-41), it is
reasonable to suggest that the decrease in net La uptake
observed in this study was due to a mass action effect resulting from
an increased rate of glycogenolysis and glycolysis and a concomitant
increase in endogenous La production. An increase in
endogenous La production would increase intramuscular
[La]. This increase in the intramuscular
[La], along with the associated decrease in pH, could
inhibit La transport into the muscle (9,
35). In addition, the elevated rate of glycogenolysis could lead
to a decreased flux of La to pyruvate through lactate
dehydrogense and decrease the ability of the muscle to metabolize
exogenous La once it is taken up. Previous studies
investigating the role of epinephrine in skeletal muscle metabolism
have provided evidence that epinephrine activates glycogenolysis
(1, 31, 33, 37). A consequence of epinephrine-mediated
enhancement of glycogenolysis is an increase in La
production and output by skeletal muscle. Furthermore, administration of a -receptor blocking agent has been shown to attenuate the rate
of La production and output by skeletal muscle during
contractions and exercise (8, 18, 40). These results
support the above hypothesis.
An alternate postulate is that epinephrine might directly inhibit
sarcolemmal La transport, thereby decreasing net
La uptake. The major portion of La
transport across the muscle sarcolemmal membrane is facilitated by
protein-linked monocarboxylate transporters. The monocarboxylate transporter displays typical saturation kinetics and has been characterized as being bidirectional, symmetrical, stereospecific, and
facilitating flux along pH and concentration gradients (9, 34,
35). La transport is, therefore, a potentially
significant rate-controlling step in La uptake. This has
led to much debate as to whether La transport,
La utilization by muscle, or a combination of both
control La uptake by skeletal muscle (9).
Presently, there is no evidence with which to confirm or refute the
idea that epinephrine may affect La transport.
There are at least two notable limitations to the present study. First,
there are no control data on resting muscle, and it is possible that
other mechanisms, such as changes in [Ca2+], could alter
La transport and metabolism during contractions compared
with rest. Second, muscle [La] measurements before and
after Epi would have been informative and might have been able to
confirm our hypothesis of a mass action effect of endogenous
La production on net La uptake. It should
be noted, however, that a steady state of net La uptake
was essential for the purposes of this study. Our previous experience
(unpublished observations) with this muscle preparation strongly
suggests that the steady state of net La uptake is very
sensitive to manipulations such as biopsy sampling.
Other results of the present investigation support the notion that mean
is not typically an important factor in determining the rate of
net La uptake. was significantly elevated above
the control level by the second minute of the Epi experiments and
peaked at a flow rate ~27% higher than the control 5 min into Epi
before declining slightly to the steady-state value. The Epi
steady-state still remained significantly greater than
the control . Despite this elevated , net
La uptake was significantly decreased at all
sample times. In contrast, net La uptake remained
unchanged from the control values during the Pro experiments, even
though flow rate was significantly decreased to ~66% of the control
flow by minute 2 of epinephrine infusion, and
continued to decline throughout the remainder of the trial. These
findings are consistent with those of Gladden et al. (11), who observed no significant effect on net La uptake when
was increased up to ~165% of the normal spontaneous blood
flow in the isolated GP. Under these experimental conditions, it seems
reasonable to conclude that mean blood flow, within the physiological
range for this preparation, plays a minor role in determining net
La uptake. On the basis of the present investigation, as
well as previous findings (9-12), it can be proposed
that the changes in metabolic rate of the muscle, arterial
[La], membrane transport, and transmembrane pH gradient
play a much more significant role than blood flow in regulating net
La uptake.
In the present study, if all of the La taken up were
oxidized as a fuel, the net La uptake would have
accounted for 74.5 ± 0.1% of the total
O2 during control conditions and
56.3 ± 0.1% during Epi steady state. During the Pro experiments,
net La uptake could have accounted for 69.8 ± 0.1%
of the total O2 during control
conditions and 74.4 ± 0.1% during Pro steady state (for
calculations, see Ref. 10). Recent experiments in our
laboratory examining the metabolic fate of La taken up by
the contracting GP have provided evidence that La
oxidation is indeed the primary fate of
[14C]La during submaximal contractions
(~20% peak O2 for this preparation); arterial [La] was similar to the levels used in the
present study (20). During this metabolic fate study
(20), La oxidation accounted for ~83% of
the La that was taken up. Previous studies in dogs
(5, 19), rats (6), and humans (16,
23) have also provided evidence that La oxidation
is prevalent during steady-state exercise. On the basis of this
evidence and the calculations above, we assume that oxidation was the
primary fate of La taken up by the contracting GP in our experiments.
To assess the role of epinephrine--receptor interaction in the
determination of net La uptake, propranolol was
administered in 6 of the 12 experiments in this investigation. As a
marker of -blockade, heart rate was monitored during the Pro
experiments. The dose of propranolol given in this investigation
resulted in a significant decrease in heart rate, from 165 ± 6 beats/min for control to 146 ± 6 beats/min after administration
of propranolol. During Pro, epinephrine infusion had no effect on heart
rate at any sample time. Along with the finding that propranolol
abolished the decrease in net La uptake observed during
Epi, heart rate data suggest that full -blockade was achieved by the
administered dose of propranolol used in these experiments.
In conclusion, the results of the present investigation suggest that
epinephrine has a profound effect on net La uptake by
contracting skeletal muscle in situ exposed to an elevated blood
[La]. -Adrenergic blockade via propranolol abolished
the decrease in net La uptake brought about by
epinephrine infusion. Therefore, under the conditions studied in the
present investigation (10 mM arterial [La], high
[epinephrine], and one tetanic contraction per 4 s), the evidence suggests that epinephrine reduces the ability of skeletal muscle to remove La from the blood. Furthermore, the
effect of epinephrine is apparently mediated by -adrenergic receptors.
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ACKNOWLEDGEMENTS |
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We appreciate the criticism of the original manuscript by Drs. David Pascoe, Dean Schwartz, Robert Judd, and Robert Keith. We are also grateful to Dr. Robert Judd for use of the syringe pump.
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FOOTNOTES |
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This project was supported by National Institute of Arthritis and Musculoskeletal and Skin Diseases Grant 1R01-AR-40342.
Address for reprint requests and other correspondence: J. J. Hamann, VA Medical Center, Anesthesia Research 151, 5000 West National Ave., Milwaukee, WI 53295 (E-mail: hamannj{at}mcw.edu).
The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
Received 18 October 2000; accepted in final form 10 August 2001.
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REFERENCES |
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TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES
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