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Implications for burn shock resuscitation of a new in vivo human vascular microdosing technique (microdialysis) for dermal administration of noradrenaline
Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Intensive Care UHL.
Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL.
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Dermatology and Venerology in Östergötland.
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2012 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 38, no 7, 975-983 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: Skin has a large dynamic capacity for alterations in blood flow, and is therefore often used for recruitment of blood during states of hypoperfusion such as during burn shock resuscitation. However, little is known about the blood flow and metabolic consequences seen in the dermis secondary to the use vasoactive drugs (i.e. noradrenaline) for circulatory support. The aims of this study were therefore: to develop an in vivo, human microdosing model based on dermal microdialysis; and in this model to investigate effects on blood flow and metabolism by local application of noradrenaline and nitroglycerin by the microdialysis system simulating drug induced circulatory support. less thanbrgreater than less thanbrgreater thanMethod: Nine healthy volunteers had microdialysis catheters placed intradermally in the volar surface of the lower arm. The catheters were perfused with noradrenaline 3 or 30 mmol/L and after an equilibrium period all catheters were perfused with nitroglycerine (2.2 mmol/L). Dermal blood flow was measured by the urea clearance technique and by laser Doppler imaging. Simultaneously changes in dermal glucose, lactate, and pyruvate concentrations were recorded. less thanbrgreater than less thanbrgreater thanResults: Noradrenaline and nitroglycerine delivered to the dermis by the microdialysis probes induced large time- and dose-dependent changes in all variables. We particularly noted that tissue glucose concentrations responded rapidly to hypoperfusion but remained higher than zero. Furthermore, vasoconstriction remained after the noradrenaline administration implicating vasospasm and an attenuated dermal autoregulatory capacity. The changes in glucose and lactate by vasoconstriction (noradrenaline) remained until vasodilatation was actively induced by nitroglycerine. less thanbrgreater than less thanbrgreater thanConclusion: These findings, i.e., compromised dermal blood flow and metabolism are particularly interesting from the burn shock resuscitation perspective where noradrenaline is commonly used for circulatory support. The importance and clinical value of the results obtained in this in vivo dermal model in healthy volunteers needs to be further explored in burn-injured patients.

Place, publisher, year, edition, pages
Elsevier , 2012. Vol. 38, no 7, 975-983 p.
Keyword [en]
Burn resuscitation, Burn shock, Glucose, Glucose homeostasis, Insuline resistance, Lactate, Microdialysis, Puruvate, Skin, Tissue blood flow, Tissue ischemia, Wound healing
National Category
Medical and Health Sciences
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URN: urn:nbn:se:liu:diva-85852DOI: 10.1016/j.burns.2012.05.012ISI: 000310410300004OAI: oai:DiVA.org:liu-85852DiVA: diva2:573283
Available from: 2012-11-30 Created: 2012-11-30 Last updated: 2017-12-07

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Samuelsson, AndersFarnebo, SimonMagnusson, BeatriceAnderson, ChrisTesselaar, ErikZettersten, ErikSjöberg, Folke
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AnesthesiologyFaculty of Health SciencesDepartment of Intensive Care UHLSurgeryDepartment of Plastic Surgery, Hand surgery UHLDepartment of Clinical and Experimental MedicineDermatology and VenerologyDepartment of Dermatology and Venerology in ÖstergötlandBurn CenterDepartment of Anaesthesiology and Surgery UHL
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