AMINOPHYLLINE AND HUMAN DIAPHRAGM STRENGTH INVIVO

The transdiaphragmatic pressure (Pdi) twitch response to single shocks from supramaximal bilateral phrenic nerve stimulation was studied before and after acute intravenous infusions of aminophylline [14.9 ± 3.1 (SD) μg/ml] in nine normal subjects. Stimulation was performed with subjects in the sitting position against an occluded airway from end expiration. Baseline gastric pressure and abdominal and rib cage configuration were kept constant. There was no significant difference in peak twitch Pdi from the relaxed diaphragm between control (38.8 ± 3.3 cmH2O) and aminophylline (40.2 ± 5.2 cmH2O) experiments. Other twitch characteristics including contraction time, half-relaxation time, and maximum relaxation rate were also unchanged. The Pdi-twitch amplitude at different levels of voluntary Pdi was measured with the twitch occlusion technique, and this relationship was found to be similar under control conditions and after aminophylline. With this technique, maximum Pdi (Pdi(max)) was clculated at the Pdi at which stimulation would results in no Pdi twitch because all motor units are already maximally activated. No significant change was found in mean calculated Pdi(max) between control (146.9 ± 27.09 cmH2O) and aminophylline (149.2 ± 26.0 cmH2O) experiments. We conclude from this study that the acute administration of aminophylline at therapeutic concentrations does not significantly affect contractility or maximum strength of the normal human diaphragm in vivo.