OBJECTIVE: To compare the systemic effects in burn and non-burn patients undergoing skin grafting with or without the use of topical epinephrine to control bleeding. BACKGROUND: The effects of topical epinephrine on haemodynamics and bleeding are principally documented with burn patients. No reports are available on the effects of topical epinephrine on non-burn patients especially on markers of tissue perfusion. MATERIAL AND METHODS: A prospective study where topical epinephrine was used on burn and non-burn patients and five patients served as controls without epinephrine usage. Catecholamine concentrations were measured and to estimate the systemic effects of epinephrine, serum lactate and pyruvate concentrations were analyzed and perioperative haemodynamic changes recorded. RESULTS: Compared to the baseline values, there was a significant increase in the heart rate, serum epinephrine and lactate concentrations and LP-ratios in the burn patients and an increase in the epinephrine concentrations in the non-burn patients at 1 and 2 h. Epinephrine and lactate concentrations and LP-ratios were also higher in the burn patients compared to the other groups. Altogether, there were no changes in the control group. CONCLUSION: This study showed that the use of topical epinephrine has systemic effects on haemodynamics and serum epinephrine concentrations. Increased epinephrine concentrations in burn patients suggest increased absorption properties in these patients. The increased lactate concentrations and LP-ratios suggest tissue ischaemia, likely in skin.
OBJECTIVE: To compare the systemic effects in burn and non-burn patients undergoing skin grafting with or without the use of topical epinephrine to control bleeding. BACKGROUND: The effects of topical epinephrine on haemodynamics and bleeding are principally documented with burn patients. No reports are available on the effects of topical epinephrine on non-burn patients especially on markers of tissue perfusion. MATERIAL AND METHODS: A prospective study where topical epinephrine was used on burn and non-burn patients and five patients served as controls without epinephrine usage. Catecholamine concentrations were measured and to estimate the systemic effects of epinephrine, serum lactate and pyruvate concentrations were analyzed and perioperative haemodynamic changes recorded. RESULTS: Compared to the baseline values, there was a significant increase in the heart rate, serum epinephrine and lactate concentrations and LP-ratios in the burn patients and an increase in the epinephrine concentrations in the non-burn patients at 1 and 2 h. Epinephrine and lactate concentrations and LP-ratios were also higher in the burn patients compared to the other groups. Altogether, there were no changes in the control group. CONCLUSION: This study showed that the use of topical epinephrine has systemic effects on haemodynamics and serum epinephrine concentrations. Increased epinephrine concentrations in burn patients suggest increased absorption properties in these patients. The increased lactate concentrations and LP-ratios suggest tissue ischaemia, likely in skin.
Authors: Or Kalchiem-Dekel; Aldo Iacono; Edward M Pickering; Ashutosh Sachdeva; Nirav G Shah; Mark Sperry; Bich-Chieu Tran; Robert M Reed Journal: BMJ Open Date: 2019-03-23 Impact factor: 2.692