Regional differences in skin blood flow and temperature during total spinal anaesthesia

Kimura, Tetsunori; Goda, Yukiko; Kemmotsu, Osamu; Shimada, Yasuhiro

doi:10.1007/bf03008641

Cited by 12 publications

(3 citation statements)

References 23 publications

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“…32 These studies also contrast with a thermography study in patients with inadvertent total spinal anesthesia which observed vasoconstriction in the upper limb despite profound sensory and motor block of both arms. 33 Like these latter reports, our observations are not consistent with the hypothesis that epidural local anesthetic blockade preferentially blocks sympathetic neural function more than sensory function. Indeed, the current use of dilute epidural local anesthetics to provide effective analgesia with minimal motor block or sympathectomy-related hemodynamic compromise suggests that epidural local anesthetics block sensation more readily than they block sympathetic neural function.…”

Section: Discussioncontrasting

confidence: 99%

Sympathectomy-mediated vasodilatation: a randomized concentration ranging study of epidural bupivacaine

Ginosar

Weiniger

Kurz

et al. 2009

Can J Anesth/J Can Anesth

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Purpose We tested the hypothesis that the development of sympathectomy-mediated vasodilatation is dependent on the concentration rather than the dose of epidural local anesthetic administered. Methods Sixty subjects receiving lumbar epidural bupivacaine were randomised to one of three groups: A: 10 ml 0.5% (50 mg); B: 10 ml 0.25% (25 mg); and C: 40 ml 0.0625% (25 mg). Groups A and B had equal volume but a twofold difference in drug dose, while groups B and C had equal drug dose, but a fourfold difference in drug volume. At baseline and 5, 10, and 20 min following epidural bupivacaine administration, we assessed the following indices of sympathectomy: pulse oximeter perfusion index in the toe and finger, skin temperature in the toe and finger, and mean arterial pressure. We also assessed sensory level (pinprick, cold, and light touch) and motor block. Results There was an increase in the pulse oximeter perfusion index by 20 min of 280%, 303%, and 59% in groups A, B, and, C, respectively. There was a significant sympathectomy-mediated vasodilatation in the toe for both groups A (P = 0.002) and B (P \ 0.001) but not C (P = 0.22). Vasoconstriction in the finger was observed in group A only (P = 0.015) but not in group B (P = 0.09) or group C (P = 0.20). There were similar blood pressure changes and similar sensory changes in all groups. The intensity of motor block increased with increasing drug concentration. Conclusions Our observations suggest that drug concentration is more important than drug dose in determining the degree of sympathectomy following lumbar epidural local anesthesia. RésuméObjectif Nous avons teste´l'hypothe`se selon laquelle l'apparition d'une vasodilatation me´die´e par sympathectomie e´tait lie´e à la concentration plutôt qu'a`la dose d'anesthe´sique local pe´ridural administre´. Méthode Soixante patients recevant de la bupivacaı¨ne pe´ridurale lombaire ont e´te´randomise´s en trois groupes : A : 10 ml 0,5 % (50 mg); B : 10 ml 0,25 % (25 mg); et C : 40 ml 0,0625 % (25 mg). Les groupes A et B ont reçu un volume e´quivalent mais la dose de me´dicament e´tait double´e pour le groupe A, alors que les groupes B et C ont reçu une dose e´gale, mais le volume de me´dicament a e´teq uadruple´pour le groupe C. Nous avons e´value´les indices de sympathectomie suivants aux niveaux de base ainsi qu'a5 , 10 et 20 minutes apre`s l'administration de la bupivacaı¨ne pe´ridurale : indice de perfusion de l'oxyme`tre de pouls a`l'orteil et au doigt, tempe´rature cutane´e à l'orteil et au doigt, et tension arte´rielle moyenne. Nous avons e´galement e´value´le niveau sensoriel (piquˆre a`l'aiguille, froid et toucher le´ger) et le bloc moteur. Résultats Sur la base de l'indice de perfusion de l'oxyme`tre de pouls, nous avons observe´une vasodilatation 123Can J Anesth/J Can Anesth (2009) 56:213-221 DOI 10.1007 me´die´e par sympathectomie significative dans l'orteil pour les groupes A (P = 0,002) et B (P \ 0,001) mais pas dans le groupe C (P = 0,22). La vasoconstriction au doigt a e´teó bserve´e uniquement ...

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Section: Discussioncontrasting

confidence: 99%

Sympathectomy-mediated vasodilatation: a randomized concentration ranging study of epidural bupivacaine

Ginosar

Weiniger

Kurz

et al. 2009

Can J Anesth/J Can Anesth

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“…Baseline could possibly have an important influence on the ‘possibility’ of temperature increase (which could be less in areas already warm, such as the trunk). This is a possible explanation for the results found by Kimura et al 7 in total spinal anaesthesia.…”

Section: Discussionmentioning

confidence: 74%

The relation between skin temperature increase and sensory block height in spinal anaesthesia using infrared thermography

Haren

Driessen

Kadic

et al. 2010

Acta Anaesthesiol Scand

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The varying baseline temperatures across the trunk, the limited sympathetic block-induced increase in skin temperature at the trunk and the difficult control of influences from the surroundings partly obscured the extent of the skin temperature increase and its correlation to sensory block height. These factors have to be controlled to improve the use of infrared cameras as an easy bedside tool for predicting the cranial extent of (sympathetic blockade during) spinal anaesthesia.

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“…After total sympathetic blockade, patients were noted to have a decrease in skin blood flow, as measured by laser Doppler flowmetry. 25 It has also been demonstrated that the sympathetic denervation of the microcirculation which occurs in island flaps leads to opening of arteriovenous shunts that partially bypass the subdermal plexus, resulting in decreased skin blood flow. 10 Although our study population is not large and most of the data come from the TRAM-flap group, the study does reveal an important trend in cutaneous blood-flow patterns in free flaps, as determined by continuous laser Doppler measurements.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Blood-Flow Patterns in Free Flaps Determined by Laser Doppler Flowmetry

Place¹,

Witt²,

Hendricks³

1996

J reconstr Microsurg

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Accurate monitoring of tissue perfusion in microvascular surgery is paramount to flap survival. Many methods have been proposed for monitoring of flaps, but none have achieved widespread acceptance. The laser Doppler has been shown to be beneficial in monitoring flap perfusion. Trends have been noted in laser Doppler measurements over time in free TRAM, free latissimus dorsi, and free iliac-crest osteomyocutaneous flaps. TRAM flaps demonstrated a slow increase in the laser Doppler index (LDI), with a peak increase in skin blood flow of over 600 percent at 52 to 80 hr postoperatively (LDI 6.77 +/- 3.51), and then a gradual decline to previous baseline. Latissimus dorsi flaps also demonstrated a slow increase until about 80 hr postoperatively (LDI 9.8 +/- 10.65), indicating an increase in skin blood flow of almost 900 percent. Iliac-crest osteomyocutaneous free flaps had a slow increase in blood flow until approximately 70 hr postoperatively, when the LDI (5.5) increased, representing an increase in skin blood flow of over 500 percent. These changes in skin blood flow over time, seen with continuous laser Doppler measurements, depict the dynamic nature of skin blood flow and allow predictive patterns to be established, instead of single normal values, by which to gauge adequate flap perfusion.

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Regional differences in skin blood flow and temperature during total spinal anaesthesia

Cited by 12 publications

References 23 publications

Sympathectomy-mediated vasodilatation: a randomized concentration ranging study of epidural bupivacaine

Sympathectomy-mediated vasodilatation: a randomized concentration ranging study of epidural bupivacaine

The relation between skin temperature increase and sensory block height in spinal anaesthesia using infrared thermography

Cutaneous Blood-Flow Patterns in Free Flaps Determined by Laser Doppler Flowmetry

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