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Ganglia-stimulating and ganglion-blocking substances

Ganglioblokiruyuschie substances have the ability to block n-holinoretseptory vegetative nerve nodes and in this regard, inhibit the transmission of nervous excitation from preganglionic to postganglionic fibers of the autonomic nerves. Vegetative nerve nodes also become insensitive to the stimulating effect of various cholinergic stimuli (acetylcholine, nicotine, lobeline, cytisine, etc.). Modern ganglioblokatory block both sympathetic and parasympathetic nodes, but different drugs may have different activities in relation to different groups of ganglia.
Ganglioblokatory also exert a depressing effect on the carotid glomeruli and chromaffin adrenal tissue. In large doses, n-cholinergic receptors of neuromuscular synapses and CNS can be blocked.
Interrupting the conduction of nerve impulses through vegetative nervous nodes, ganglion blockers alter the functions of organs provided with autonomic innervation. In this case, the blood pressure decreases, which is mainly due to a decrease in the intake of vasoconstrictor impulses to the blood vessels and the expansion of the peripheral vascular bed (primarily arterioles); Inhibition of impulses along the cholinergic nerve fibers leads to disruption of accommodation, bronchial dilatation, decreased motility of the gastrointestinal tract, suppression of glandular secretion, increased heart rate, decreased bladder tone. Oppression of the chromaffin tissue of the adrenal gland leads to a decrease in the release of adrenergic substances and a weakening of reflex pressor reactions.
The first ganglion blocker, which received practical application in medicine in the early 50's, was hexamethonium (hexonium). Then a number of other gangliablocks were obtained; Some of them, like hexamethonium, are quaternary ammonium compounds (benzohexonium, pentamine, hygronium, etc.), and some are tertiary amines (pachycarpine, pyrilene, etc.).
The main difference between non-quaternary compounds and quaternary compounds is that the former are better absorbed from the gastrointestinal tract; Quaternary compounds are worse absorbed, difficult to penetrate the blood-brain barrier, but they are more active with parenteral administration.
Initially, ganglion blockers were widely used in diseases associated with the violation of nervous regulation, when a decrease in the supply to the organs of nerve impulses can give the desired therapeutic effect, including with arterial hypertension, spasm of peripheral vessels (endarteritis, intermittent claudication, etc.), diencephalic syndrome , Causalgia, peptic ulcer of stomach and duodenum, bronchial asthma, hyperhidrosis, etc.
Over time, it turned out, however, that the use of ganglion blockers is not always effective enough and is often accompanied by side effects: orthostatic hypotension, tachycardia, intestinal atony and bladder, etc. In connection with the emergence of new, more effective, selectively acting drugs, the use of ganglion blockers has become more limited.
Nevertheless, in some cases ganglion blockers are used with significant effect. So, they are successfully used for relief of hypertensive crises. They also use them in the treatment of pulmonary edema (against the background of high blood pressure).
In anesthetic practice, ganglion blockers are used to prevent vegetative reflexes associated with the operation, and to obtain controlled hypotension during surgery, as well as for pulmonary edema. Correct application of ganglion blocking agents usually reduces the risk of shock and facilitates the course of the postoperative period. At operations on a brain the danger of development of its edema decreases.
The use of ganglion blockers in general anesthesia reduces the required amount of narcotic substance.
Different ganglion blockers have different duration of action.
In the treatment of diseases of internal organs, drugs that have a long-lasting effect (benzohexonium, dimecoline, etc.) are usually used, while ganglion blockers with short action (hygronium, Imichin) prefer to use controlled hypotension in operations.
When using ganglioblokatorov it is necessary to take into account that in connection with the oppression of reflex mechanisms that maintain a constant level of arterial pressure, orthostatic collapse may develop. In order to avoid this complication, it is recommended that patients are in a prone position prior to administration (especially with parenteral administration) and for 2 to 2, 5 hours after the ganglion blocker injection.
At the beginning of treatment it is recommended to check the patient's reaction to small doses of the drug: half the average dose is administered and the patient's condition is monitored. It should be borne in mind that with increased arterial pressure, the hypotensive effect is more severe.
In cases of collapse, it is necessary to lift the patient's legs, introduce mezaton, fetanol or ephedrine in small doses, cordiamine, caffeine.
With the use of ganglioblokatorov also possible general weakness, dizziness, increased heart rate, dry mouth, dilated pupils, injection of vessels sclera. These phenomena usually pass independently.
With the introduction of large doses or prolonged use, atony of the bladder with anuria and atony of the intestine (before the paralytic obstruction of the intestine) are possible. With these complications, it is appropriate to administer proserin, talantamine, or other cholinomimetic or anticholinesterase drugs. In connection with the slowing of the blood flow, caution should be exercised with a tendency to thrombosis.
With the application of ganglion blocking substances, the pupils expand, which can lead to a partial closure of the filtering zone of the angle of the anterior chamber of the eye and a deterioration in the outflow of fluid from the eye chambers. At zakratougolnoy glaucoma can therefore occur increase in intraocular pressure, in connection with which patients suffering from this form of glaucoma, ganglion blockers are contraindicated. With open-angle glaucoma, a decrease in intraocular pressure may be observed, which is due to a decrease in the production of watery moisture under the influence of ganglion blockers.
Ganglia blockers are contraindicated in acute myocardial infarction, severe hypotension, shock, kidney and liver damage, thrombosis, degenerative changes in the CNS. Caution is needed when appointing ganglioblokatorov elderly.
Treatment ganglioblokatorami should be conducted under close supervision.

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Subgroup Means acting on peripheral cholinergic processes include drugs: