Effect of topical and subcutaneous epinephrine in combination with topical thrombin in blood loss during immediate near-total burn wound excision in pediatric burned patients

Barret, Juan P.; Dziewulski, Peter; Wolf, Steven E.; Desai, M. H.; Nichols, Ray J.; Herndon, David N.

doi:10.1016/s0305-4179(99)00038-8

Cited by 53 publications

(40 citation statements)

References 8 publications

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“…19 However, the pilot study was based on the retrospective review of routine anesthesia records, which may not have actually reflected the actual minute by minute hemodynamic changes that occurred. 25 Our finding that HR is minimally affected by the use of subcutaneous and topical epinephrine is in agreement with the observations in most of the aforementioned studies 7,8,10,14,23,24 as well as those of our pilot study. 19 There are a number of factors that may explain the absence of a significant increase in HR.…”

Section: Discussionsupporting

confidence: 91%

What Are the Acute Cardiovascular Effects of Subcutaneous and Topical Epinephrine for Hemostasis During Burn Surgery?

Cartotto

Kadikar

Musgrave

et al. 2003

The Journal of Burn Care &Amp; Rehabilitation

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Although subcutaneous and topical epinephrine are widely used for hemostasis during burn surgery, the acute systemic cardiovascular effects of the epinephrine are neither well documented nor completely understood. The purpose of this work was to prospectively study the acute cardiovascular responses to epinephrine (epi) administered subcutaneously and topically during burn surgery. Consecutive patients who received subcutaneous and topical epi during burn surgery were monitored prior to the administration of epi, at 2-minute intervals during subcutaneous epi infiltration, and then after epi infiltration (during which time, topical epi was applied). This period of monitoring lasted up to 20 minutes and was referred to as an epinephrine event (EE). A total of 100 EEs from 38 operations in 24 patients (mean +/- SD: age 43 +/- 16 years, mean % TBSA burn 23 +/- 17%) were studied. The mean dose of subcutaneous epi was 30 +/- 30 microg/kg. Although all patients received topical epi, it was impossible to document the topical dose. There was no significant increase in heart rate from baseline, and no arrhythmias occurred. Mean arterial pressure (MAP) did acutely increase significantly by 17.0 +/- 14.1% from baseline (P =.009) and increased more than 10% from baseline in 64/100 EEs. However, the increase in MAP was independent of the dose of epi (r =.053). The increase in MAP was not clinically significant, did not require intervention, and did not appear to be related to the type of wound that received epi (donor site vs burn wound), or the depth of anesthesia, analgesia, or sedation. On the basis of these findings, the use of subcutaneous and topical epi appears to be safe and produces minimal acute cardiovascular effects.

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Section: Discussionsupporting

confidence: 91%

What Are the Acute Cardiovascular Effects of Subcutaneous and Topical Epinephrine for Hemostasis During Burn Surgery?

Cartotto

Kadikar

Musgrave

et al. 2003

The Journal of Burn Care &Amp; Rehabilitation

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“…Pain and pruritus were assessed using analog scales. [1][2][3][4][5][6][7][8][9] Donor site healing was assessed to 90% healing every day for inpatients and twice weekly for outpatients. A follow-up evaluation of scar quality (Vancouver Scar Scale, perfusion, elasticity, thickness, sensation, pain, and pruritus; Table 1) was performed at least 3 months after donor site healing.…”

Section: Methodsmentioning

confidence: 99%

Effect of Subcutaneous Epinephrine/Saline/Local Anesthetic Versus Saline-Only Injection on Split-Thickness Skin Graft Donor Site Perfusion, Healing, and Pain

Blome-Eberwein

Abboud

Lozano

et al. 2013

Journal of Burn Care & Research

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The technique for split-thickness skin graft harvest varies among surgeons. Even though there is scientific evidence that the subcutaneous injection of modified tumescent solution reduces blood loss during burn surgery, the technique has not been unanimously adapted because of, in part, fear of healing retardation. This study prospectively examines the effect of tumescent injection on donor site perfusion, healing, and pain. Ten burn patients in need of grafting with a need for two distinctly different donor sites were included. During the grafting procedure, the two donor areas were randomly assigned to receive either modified tumescent solution or warm sterile saline solution subcutaneously before skin graft harvest with a dermatome. Perfusion, pain, pruritus, and donor site healing were measured, and a follow-up evaluation on scar quality was performed. Baseline perfusion on day 1 was significantly less in the donor site injected with modified tumescent solution (62.26 vs 95.71 perfusion units; P = .031), whereas the response to heat was similar in both sites. The physiologic response to injury (hyperemia) on days 2 and 3 was not suppressed in the modified tumescent group. Pain reported on day 1 was 2.38/10 in the tumescent site and 3.38/10 in the saline site (P = .21). On all other days, measurements showed no difference between the two sites. Donor sites healed in an average of 16.1 days with modified tumescent solution and in 16.4 days with saline. Late follow-up showed no difference in scar quality. The subcutaneous injection of modified tumescent solution before split-thickness donor site harvest has no adverse effect on donor site perfusion past day 1 or donor site healing. The addition of a local anesthetic may decrease pain for 24 hours postoperatively, but the difference in this study group was not significant. This technique should be universally recommended.

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“…Demographic/Formula Steadman and Pegg (1992) Blood loss (mL) = %TBSA to be excised Â 387 Blood loss (mL) = %TBSA to be excised Â 0.092 Â BV (mL) Budny et al Adults (1993) Blood loss (mL) = %TBSA to be excised Â 269 Blood loss (mL) = %TBSA to be excised Â 0.059 Â BV (mL) Children Blood loss (mL) = %TBSA to be excised Â 0.084 Â BV (mL) Brown et al Children (1995) Blood loss (mL) = %TBSA to be excised Â 2.43 Â weight(kg) Barret et al Children (1999) Blood loss (mL) = cm 2 to be excised Â 0.51 Hart et al Children (2001) Blood loss (mL) = cm 2 to be excised Â 0.53 tightening blood vessels to the skin and hence reducing the blood that could be lost there through surgery. Both pre-excisional subdermal injection of adrenaline by the tumescent technique and post-excisional compression of wounds with adrenaline soaked compresses have been examined (Barret et al, 1999;Robertson et al, 2001). Barret et al (1999) found no significant reduction in bleeding between a group of 21 patients who received topical and subcutaneous adrenaline and a control group who received saline.…”

Section: Formulamentioning

confidence: 99%

Burn surgery and blood loss – a review

Brazier

Sheena

Jeffery

2011

Trauma

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Objectives: Blood loss has long been recognised as a significant problem in burn surgery. Efforts have been made in the past to quantify this loss and determine what factors influence it the most. Several researchers have been able to produce and validate formulae that predict the volume of blood loss during excisional surgery. Accurately determining this allows appropriate volumes of blood to be ordered, reducing risk to patients and saving scarce resources. This article reviews the literature on blood loss in burns surgery, including influencing factors, methods of prediction and effective management. Methods: A literature review was conducted to examine methods used to measure, calculate and reduce blood loss in burn surgery. The validity of these methods and the limitations on accuracy will be discussed. Alternative methods shall also be considered. Results: Most current methods of estimating blood loss attempt to determine the volume of erythrocytes required to return haemoglobin concentrations to their pre-operative level. Various formulae have been developed to calculate this volume. Conclusions: Several authors have produced formulae that predict the volume of blood loss to a significant degree of accuracy. Different techniques have been shown to significantly reduce blood loss. In other areas of surgery, thromboelastometry has been used to identify the levels of specific blood component defects. The use of this method in burns surgery could, in the future, help develop a protocol for operative blood transfusion.

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Effect of topical and subcutaneous epinephrine in combination with topical thrombin in blood loss during immediate near-total burn wound excision in pediatric burned patients

Cited by 53 publications

References 8 publications

What Are the Acute Cardiovascular Effects of Subcutaneous and Topical Epinephrine for Hemostasis During Burn Surgery?

What Are the Acute Cardiovascular Effects of Subcutaneous and Topical Epinephrine for Hemostasis During Burn Surgery?

Effect of Subcutaneous Epinephrine/Saline/Local Anesthetic Versus Saline-Only Injection on Split-Thickness Skin Graft Donor Site Perfusion, Healing, and Pain

Burn surgery and blood loss – a review

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