Improvement of Superficial and Deep Cutaneous Microcirculation Due to Axillary Plexus Anesthesia Impaired by Smoking

Abstract

Background: Understanding microvascular physiology is key to any reconstructive procedure. Current concepts in anesthesia increasingly involve regional peripheral nerve blockade during microvascular reconstructive procedures. Whereas favorable effects on perfusion due to these techniques have been reported earlier, little evidence focusing on its effects in most peripheral vascular compartments is available. Methods: A total of 30 patients who were to receive axillary plexus blockade (APB) were included. Microcirculatory assessment of the dependent extremity was conducted utilizing combined laser-Doppler flowmetry and white light spectroscopy. Two probes (1–2 and 7–8 mm penetration depth) were used to assess changes in microcirculation. Results: APB resulted in significant changes to both superficial and deep cutaneous microcirculation. Changes in blood flow were most prominent in superficial layers with a maximum increase of +617% compared to baseline values. Significantly lower values of +292% were observed in deep measurements. Consecutively, a significant enhancement in tissue oxygen saturation was observed. Further analysis revealed a significant impairment of perfusion characteristics due to reported nicotine consumption (max Bf: +936% vs. +176%). Conclusion: Cutaneous microcirculation is strongly affected by APB, with significant differences regarding microvascular anatomy and vascular physiology. Smoking significantly diminishes the elicited improvements in perfusion. Our findings could influence reconstructive strategies as well as dependent perioperative anesthetic management.

Indications, anaesthesia and postoperative protocol for replantation and revascularization in the hand in Nordic countries

“…All the centres performed replantation surgery under continuous plexus anaesthesia. It enables optimal blood pressure for distal tissue perfusion, and it can directly promote peripheral vasodilatation ( Bosselmann et al., 2021 ). The peripheral vasodilatation is particularly important in children, because they seem to have a tendency to develop vasospasm peripheral vessels ( Duteille et al., 2003 ).…”

Microcurrent Reverses Cigarette Smoke-Induced Angiogenesis Impairment in Human Keratinocytes In Vitro

“…Tobacco use is linked to over 60 diseases [ 3 ], and it has long been common knowledge that tobacco use has a wide range of adverse effects on the circulatory system [ 42 ]. The microcirculation of the skin is also affected by cigarette smoke exposure [ 43 , 44 ]. Cyril et al demonstrated that the vasodilatory response of the skin microvasculature is significantly impaired in people who have smoked for years [ 45 ], and an in vivo study by Sophie-Élise et al also showed that angiogenesis was impaired considerably in mice exposed to cigarette smoke following surgically induced hindlimb ischemia.…”