Effect of axillary brachial plexus blockade on baroreflex-induced skin vasomotor responses: assessing the effectiveness of sympathetic blockade.
BACKGROUND
The combination of laser Doppler flowmetry and non-invasive blood pressure monitoring allows the continuous observation of cutaneous vascular resistance (CVR). Continuous recording of unmodulated skin blood flow (SBF) is very sensitive to artefacts, rendering the method unreliable. In contrast, intermittent short lasting challenges of the CVR by cardiovascular autonomic reflexes may provide information about the responsiveness of the sympathetic nervous system in the skin.


METHODS
Eleven patients with below-wrist hand surgery (six males and five females; aged 35.2+/-7.1 years) performed Valsalva maneuver following axillary blockade. Skin blood flow was continuously monitored on the forearm of the side axillary blockade, as well as on the contra-lateral forearm, which was used as the control. The responses were expressed as changes compared with the baseline level derived from a resting period of 30 s. The maximal change in CVR was determined during the late strain phase of the Valsalva maneuver on both sides. For numerical comparison the change in CVR on the axillary blockade and control sides were simultaneously calculated.


RESULTS
During the Valsalva maneuver a significant increase in CVR was observed on the control side with a maximum value during the late strain phase (baseline 0.18+/-0.1 and late strain phase 0.42+/-0.2 relative units; P<0.01). In contrast, only minimal changes were detected on the side of axillary blockade in CVR (baseline 0.17+/-0.8 and late strain 0.16+/-0.2 relative units; P=NS).


CONCLUSIONS
Our findings support the disputed hypothesis that the human skin microvasculature is involved in baroreflex regulation under thermoneutral conditions. The determination of baroreflex stimulus-induced microvascular responses may serve as a feasible method for monitoring the effectiveness of sympathetic blockade.
Department of Medical Intensive Care Unit, Albert Szent-Györgyi Medical University, Szeged, Hungary. szili@card.azr.nl
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Szili-Torok
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Paprika
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Peto
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Babik
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Bari
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Barzo
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Rudas
D000328:Adult; D001340:Autonomic Nerve Block; D017704:Baroreflex / Q000502:physiology*; D001783:Blood Flow Velocity; D001794:Blood Pressure; D001917:Brachial Plexus; D004562:Electrocardiography; D005260:Female; D005542:Forearm; D006225:Hand / Q000601:surgery; D006339:Heart Rate; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012867:Skin / Q000098:blood supply* / Q000294:innervation; D014636:Valsalva Maneuver; D014655:Vascular Resistance