title: 'Air hunger' from increased PCO2 persists after complete neuromuscular block in humans.
abstract: The tolerance of totally curarized subjects for prolonged breath hold is viewed by many as evidence that respiratory muscle contraction is essential to generate the sensation of breathlessness. Although conflicting evidence exists, none of it was obtained during total neuromuscular block. We completely paralyzed four normal, unsedated subjects with vecuronium (a non-depolarizing neuromuscular blocker). Subjects were mechanically ventilated with hyperoxic gas mixtures at fixed rate and tidal volume. End-expiratory PCO2 (PETCO2) was varied surreptitiously by changing inspired PCO2. Subjects rated their respiratory discomfort or 'air hunger' every 45 sec. At low PETCO2 (median 35 Torr) they felt little or no air hunger. When PETCO2 was raised (median 44 Torr) all subjects reported severe air hunger. They had reported the same degree of air hunger at essentially the same PETCO2 before paralysis. When questioned afterwards all subjects said the sensation could be described by the terms 'air hunger', 'urge to breathe', and 'shortness of breath', and that is was like breath holding. They reported no fundamental difference in the sensation before and after paralysis. We conclude that respiratory muscle contraction is not important in the genesis of air hunger evoked by hypercapnia.
authors.affiliation: Department of Environmental Science and Physiology, Harvard School of Public Health, Boston, Massachusetts 02115.
authors.forename: R B
authors.initials: RB
authors.lastname: Banzett
authors.forename: R W
authors.initials: RW
authors.lastname: Lansing
authors.forename: R
authors.initials: R
authors.lastname: Brown
authors.forename: G P
authors.initials: GP
authors.lastname: Topulos
authors.forename: D
authors.initials: D
authors.lastname: Yager
authors.forename: S M
authors.initials: SM
authors.lastname: Steele
authors.forename: B
authors.initials: B
authors.lastname: Londoño
authors.forename: S H
authors.initials: SH
authors.lastname: Loring
authors.forename: M B
authors.initials: MB
authors.lastname: Reid
authors.forename: L
authors.initials: L
authors.lastname: Adams
mesh_terms: D000328:Adult; D002245:Carbon Dioxide / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009407:Nerve Block; D009469:Neuromuscular Junction / Q000187:drug effects / Q000502:physiology*; D010101:Oxygen Consumption / Q000502:physiology*; D012119:Respiration / Q000502:physiology*; D012121:Respiration, Artificial; D012132:Respiratory Muscles / Q000187:drug effects / Q000502:physiology*
chemical_list: D002245:Carbon Dioxide