The role of nicotinic acetylcholine receptors in the mechanisms of anesthesia

Brain Res Bull. 2002 Jan 15;57(2):133-50. doi: 10.1016/s0361-9230(01)00740-7.


Nicotinic acetylcholine receptors are members of the ligand-gated ion channel superfamily, that includes also gamma-amino-butiric-acid(A), glycine, and 5-hydroxytryptamine(3) receptors. Functional nicotinic acetylcholine receptors result from the association of five subunits each contributing to the pore lining. The major neuronal nicotinic acetylcholine receptors are heterologous pentamers of alpha4beta2 subunits (brain), or alpha3beta4 subunits (autonomic ganglia). Another class of neuronal receptors that are found both in the central and peripheral nervous system is the homomeric alpha7 receptor. The muscle receptor subtypes comprise of alphabetadeltagamma (embryonal) or alphabetadeltaepsilon (adult) subunits. Although nicotinic acetylcholine receptors are not directly involved in the hypnotic component of anesthesia, it is possible that modulation of central nicotinic transmission by volatile agents contributes to analgesia. The main effect of anesthetic agents on nicotinic acetylcholine receptors is inhibitory. Volatile anesthetics and ketamine are the most potent inhibitors both at alpha4beta2 and alpha3beta4 receptors with clinically relevant IC(50) values. Neuronal nicotinic acetylcholine receptors are more sensitive to anesthetics than their muscle counterparts, with the exception of the alpha7 receptor. Several intravenous anesthetics such as barbiturates, etomidate, and propofol exert also an inhibitory effect on the nicotinic acetylcholine receptors, but only at concentrations higher than those necessary for anesthesia. Usual clinical concentrations of curare cause competitive inhibition of muscle nicotinic acetylcholine receptors while higher concentrations may induce open channel blockade. Neuronal nAChRs like alpha4beta2 and alpha3beta4 are inhibited by atracurium, a curare derivative, but at low concentrations the alpha4beta2 receptor is activated. Inhibition of sympathetic transmission by clinically relevant concentrations of some anesthetic agents is probably one of the factors involved in arterial hypotension during anesthesia.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acetylcholine / physiology
  • Analgesics / pharmacology
  • Analgesics / therapeutic use
  • Anesthesia*
  • Anesthetics / classification
  • Anesthetics / pharmacology*
  • Anesthetics, Inhalation / pharmacology
  • Animals
  • Binding, Competitive
  • Central Nervous System / drug effects
  • Central Nervous System / physiology
  • Consciousness / drug effects
  • Coturnix
  • Drug Synergism
  • Humans
  • Ion Channel Gating / drug effects
  • Ketamine / pharmacology
  • Mice
  • Models, Molecular
  • Muscle Proteins / chemistry
  • Muscle Proteins / drug effects
  • Muscle Proteins / physiology*
  • Muscle Relaxants, Central / pharmacology
  • Nerve Tissue Proteins / chemistry
  • Nerve Tissue Proteins / drug effects
  • Nerve Tissue Proteins / physiology*
  • Neuromuscular Junction / drug effects
  • Neuromuscular Junction / physiology
  • Pain / drug therapy
  • Pain / physiopathology
  • Peripheral Nervous System / drug effects
  • Peripheral Nervous System / physiology
  • Protein Subunits
  • Rats
  • Receptors, Nicotinic / chemistry
  • Receptors, Nicotinic / classification
  • Receptors, Nicotinic / drug effects
  • Receptors, Nicotinic / physiology*
  • Recombinant Fusion Proteins / physiology
  • Synaptic Transmission / drug effects


  • Analgesics
  • Anesthetics
  • Anesthetics, Inhalation
  • Muscle Proteins
  • Muscle Relaxants, Central
  • Nerve Tissue Proteins
  • Protein Subunits
  • Receptors, Nicotinic
  • Recombinant Fusion Proteins
  • Ketamine
  • Acetylcholine