Background: Abundant in vitro and animal model data suggest the postsynapti
c gamma -aminobutyric acid receptor type A (GABA(A)-R) is an important targ
et for volatile general anesthetics, but the relevance of these models Is u
ntested in humans. Because benzodiazepines have also been shown to act via
a specific GABA(A)-R site, they provide sensitive probes for the GABA(A)-R.
Availability of the C-11-labeled benzodiazepine ligand, flumazenil, allowe
d us to quantitatively test in humans whether the volatile anesthetic isofl
urane affects GABA(A)-Rs in vivo in a dose-dependent manner.
Methods: C-11-flumazenil positron emission tomography scans were obtained i
n 12 healthy subjects while awake (control condition) and anesthetized with
either 1.0 or 1.5 minimum alveolar concentration isoflurane (n = 7 and 5,
respectively; isoflurane conditions). Regions of interest included areas of
high, intermediate, and low GABA(A)-benzodiazepine site density. For each
subject and experimental condition, the binding of C-11-flumazenil, express
ed as distribution volume (which linearly correlates to maximal binding sit
e density and apparent ligand affinity), was obtained by curve fitting usin
g a two-compartment model.
Results: The ratio of distribution volume increased significantly In each e
xamined region during the Isoflurane conditions compared with control condi
tions (P < 0.01, one-tailed t test). Furthermore, the increases in ratio of
distribution volume during the 1.5-minimum alveolar concentration isoflura
ne condition were significantly greater than those measured during 1.0 mini
mum alveolar concentration isoflurane Inhalation (P < 0.002, one-tailed t t
est).
Conclusions: Isoflurane exposure appeared to enhance receptor-specific C-11
-flumazenil binding in a dose-dependent manner. The results suggest the pos
sibility that a conformational change of the GABA(A)-R is Involved in the m
echanism of action of isoflurane in the living human brain.