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Professor Malin Malmsjö, MD, PhD. Photo.

Malin Malmsjö

Professor

Professor Malin Malmsjö, MD, PhD. Photo.

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

Author

  • Rafi Sheikh
  • Khashayar Memarzadeh
  • Christian Torbrand
  • Jonas Blohmé
  • Malin Malmsjö

Summary, in English

Objectives: The present study aimed to examine hypoperfusion in response to epinephrine following the administration of a local anaesthetic. The . concentration of epinephrine that causes maximal hypoperfusion, the . spread of hypoperfusion in the tissue and the . time to the stabilization of hypoperfusion were investigated. Methods: Blood perfusion was monitored using laser Doppler velocimetry and laser speckle contrast imaging of random-pattern advancement flaps (1 × 4 cm) or intact skin on the pig flank. Epinephrine was either injected cumulatively (0.1, 1.0, 10 or 100 μg/ml) after injecting 20 mg/ml lidocaine, to determine the concentration response, or given as a single dose (12.5 μg/ml epinephrine. +. 20 mg/ml lidocaine). Control experiments were performed with saline or lidocaine (without epinephrine). Results: Increasing concentrations of epinephrine resulted in a gradual decrease in skin perfusion, approaching a minimum after injecting 10 μg/ml. The area of hypoperfusion was 12 mm in radius, and the time from the injection to the stabilization of hypoperfusion was approximately 120 s. After the administration of 10 μg/ml epinephrine in flaps with small pedicle, 25% blood perfusion still remained. Conclusions: Local anaesthetic with an epinephrine concentration of approximately 10 μg/ml appears to be adequate for vasoconstriction before surgery. Incisions were required to be delayed only for 2 min following local anaesthetic with epinephrine in pigs. The remaining 25% blood perfusion observed after the administration of epinephrine supports the use of epinephrine in flaps with a small pedicle. Obviously, these experimental findings must be clinically assessed before being considered for infiltration anaesthesia during plastic surgery procedures.

Department/s

  • Ophthalmology, Lund
  • Ophthalmology Imaging Research Group
  • Urology

Publishing year

2017

Language

English

Pages

322-329

Publication/Series

Journal of Plastic, Reconstructive and Aesthetic Surgery

Volume

70

Issue

3

Document type

Journal article

Publisher

Elsevier

Topic

  • Surgery

Keywords

  • Epinephrine
  • Laser Doppler velocimetry
  • Laser speckle contrast imaging
  • Lidocaine
  • Local anesthetic
  • Perfusion

Status

Published

Project

  • Flap monitoring during oculoplastic reconstructive surgery using new non-invasive imaging techniques
  • Perfusion Monitoring During Oculoplastic Reconstructive Surgery - Opportunities for Optimization of Surgical Techniques
  • Identifying periorbital tumor margins using new non-invasive imaging techniques

Research group

  • Ophthalmology Imaging Research Group
  • Urology

ISBN/ISSN/Other

  • ISSN: 1748-6815