Hypoperfusion in response to epinephrine in local anaesthetics: Investigation of dependence on epinephrine concentration, spread of hypoperfusion and time to maximal cutaneous vasoconstriction

Sheikh, Rafi; Memarzadeh, Khashayar; Torbrand, Christian; Blohmé, Jonas; Malmsjö, Malin

doi:10.1016/j.bjps.2016.10.017

Cited by 16 publications

(16 citation statements)

References 22 publications

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“…However, we observed no change in perfusion following lidocaine infiltration in our recent studies on porcine eyelid flaps and flanks (Sheikh et al. ,).…”

Section: Discussioncontrasting

confidence: 71%

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A waiting time of 7 min is sufficient to reduce bleeding in oculoplastic surgery following the administration of epinephrine together with local anaesthesia

Hult

Sheikh

Nguyen

et al. 2017

Acta Ophthalmologica

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ABSTRACT.Objective: The time taken to reach maximal haemostatic effect following local anaesthesia with epinephrine is generally believed to be <10 min. This is based on clinical experience and indirect measurements of perfusion using methods such as laser Doppler flowmetry and oxygen spectroscopy. However, the only study in which bleeding has been measured quantitatively in an intra-operative setting in humans showed that the full haemostatic effect was not achieved until 30 min after anaesthesia. The aim of this study was to determine the time taken to reach maximum haemostatic effect when using epinephrine for local anaesthesia in oculoplastic surgery. Methods: Intra-operative bleeding following infiltration anaesthesia with either lidocaine 20 mg/ml (2%) or lidocaine + epinephrine 12.5 lg/ml (1:80 000) was measured after 7, 15 and 30 min in the eyelids of 16 patients undergoing upper eyelid blepharoplasty. Results: Bleeding was decreased by 74.6% (with 95% CI, 6.16-87.6%) 7 min after the injection of lidocaine + epinephrine (p = 0.0048) compared with lidocaine without epinephrine. There was no further decrease in bleeding after 15 or 30 min (p = n.s.). Conclusion: The optimal time for skin incision in eyelid surgery is within 7 min of injection of lidocaine with epinephrine. Waiting longer does not lead to a further decrease in bleeding.

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“…However, we observed no change in perfusion following lidocaine infiltration in our recent studies on porcine eyelid flaps and flanks (Sheikh et al. ,).…”

Section: Discussioncontrasting

confidence: 71%

“…In a similar study on porcine flank flaps, using laser Doppler flowmetry and laser speckle contrast imaging, a low level of perfusion was observed after approximately 120 seconds (Sheikh et al. ).…”

Section: Discussionmentioning

confidence: 92%

A waiting time of 7 min is sufficient to reduce bleeding in oculoplastic surgery following the administration of epinephrine together with local anaesthesia

Hult

Sheikh

Nguyen

et al. 2017

Acta Ophthalmologica

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“…There are now a few studies in which LSCI has been used for assessment of microcirculation in pig skin. 5,6,9,17,18 Even if results from these studies might not be translated directly to clinical conditions, we assume that since porcine skin is fairly similar to the human skin, LSCI will measure similar perfusion levels in both species. 19,20 We used a model based on a pedicled flap and not a free flap since the aim of this study was to evaluate the possibility of using LSCI to predict ischemic areas without actually being interested in the cause of the ischemia.…”

Section: Discussionmentioning

confidence: 99%

The use of laser speckle contrast imaging to predict flap necrosis: An experimental study in a porcine flap model

Zötterman

Tesselaar

Farnebo

2019

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Background: We have evaluated the use of Laser Speckle Contrast Imaging (LSCI) in the perioperative planning in reconstructive surgery. The aim of the study was to investigate if LSCI can predict regions with a high risk of developing postoperative necrosis. Our hypothesis was that, perioperatively, such regions have perfusion values below a threshold value and show a negative perfusion trend. Methods: A porcine flap model based on the cranial gluteal artery perforator was used. Images were acquired prior to surgery, immediately after surgery (t=0), after 30 minutes (t=30 min) and after 72 hours (t=72 h). Regions of Interest (ROI) were chosen along the central axis of the flap. Clinical evaluation of the flap was done during each time point. Results: At t=72h a demarcation line could be seen at 15.8±0.4 cm from the proximal border of the flaps. At t=0 perfusion decreased gradually from proximal to distal ROI. At t=30 min perfusion was significantly lower in ROI distal to the final demarcation line compared to t=0 and every flap these ROI had a perfusion >25 PU. At t=72 perfusion in ROI proximal of this line returned to baseline levels, while perfusion in distal ROI remained low. Conclusions: In our model a decrease in perfusion during the first 30 minutes after surgery, and a perfusion <25 PU at t=30 min was a predictor for tissue morbidity 72 hours after surgery, indicating that LSCI is a promising technique for perioperative monitoring in reconstructive surgery.

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“…The use of adrenaline with lignocaine significantly delays absorption and increases the safety profile, as only a lower dose of anesthetic is required . This is caused by alpha adrenergic receptor action leading to vasoconstriction of blood vessels in the mucosa and skin . However, despite these advantages, the use of catecholamine‐type vasoconstrictors, such as adrenaline, has been a controversial issue, especially in patients with cardiac problems, diabetes, and hypertension .…”

Section: Discussionmentioning

confidence: 99%

Effect of clonidine on the efficacy of lignocaine local anesthesia in dentistry: A systematic review and meta‐analysis of randomized, controlled trials

Sivaramakrishnan

Sridharan

2017

J of Invest & Clin Dent

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Alternatives to adrenaline with lignocaine local anesthesia, such as clonidine, have been trialed in various randomized, controlled trials. Therefore, the aim of the present systematic review was to compile the available evidence on using clonidine with lignocaine for dental anesthesia. Electronic databases were searched for eligible studies. A data-extraction form was created, extracted data were analyzed using non-Cochrane mode in RevMan 5.3 software. Heterogeneity between the studies were assessed using the forest plot, I statistics (where >50% was considered to have moderate-to-severe heterogeneity), and χ -test. Random-effects models were used because of moderate heterogeneity. Five studies were included for the final review. While clonidine was found to significantly shorten the onset of local anesthesia when measured subjectively, no significant difference was observed objectively. No significant difference was observed in the duration and postoperative analgesia. Stable hemodynamic parameters within the safe range were observed postoperatively when clonidine was used. Clonidine could be considered as an alternative to adrenaline in cases of contraindications to adrenaline, such as like cardiac abnormalities, hypertension, and diabetes.

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Hypoperfusion in response to epinephrine in local anaesthetics: Investigation of dependence on epinephrine concentration, spread of hypoperfusion and time to maximal cutaneous vasoconstriction

Cited by 16 publications

References 22 publications

A waiting time of 7 min is sufficient to reduce bleeding in oculoplastic surgery following the administration of epinephrine together with local anaesthesia

A waiting time of 7 min is sufficient to reduce bleeding in oculoplastic surgery following the administration of epinephrine together with local anaesthesia

The use of laser speckle contrast imaging to predict flap necrosis: An experimental study in a porcine flap model

Effect of clonidine on the efficacy of lignocaine local anesthesia in dentistry: A systematic review and meta‐analysis of randomized, controlled trials

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