Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2017 May;24(4):10.1111/micc.12350.
doi: 10.1111/micc.12350.

β-Adrenergic blockade does not impair the skin blood flow sensitivity to local heating in burned and nonburned skin under neutral and hot environments in children

Eric Rivas  1   2 , Serina J McEntire  3 , David N Herndon  1   2 , Ronald P Mlcak  1   2 , Oscar E Suman  1   2
Affiliations
Randomized Controlled Trial

β-Adrenergic blockade does not impair the skin blood flow sensitivity to local heating in burned and nonburned skin under neutral and hot environments in children

Eric Rivas et al. Microcirculation. 2017 May.

Abstract

Objective: We tested the hypothesis that propranolol, a drug given to burn patients to reduce hypermetabolism/cardiac stress, may inhibit heat dissipation by changing the sensitivity of skin blood flow (SkBF) to local heating under neutral and hot conditions.

Methods: In a randomized double-blind study, a placebo was given to eight burned children, while propranolol was given to 13 burned children with similar characteristics (mean±SD: 11.9±3 years, 147±20 cm, 45±23 kg, 56±12% Total body surface area burned). Nonburned children (n=13, 11.4±3 years, 152±15 cm, 52±13 kg) served as healthy controls. A progressive local heating protocol characterized SkBF responses in burned and unburned skin and nonburned control skin under the two environmental conditions (23 and 34°C) via laser Doppler flowmetry.

Results: Resting SkBF was greater in burned and unburned skin compared to the nonburned control (main effect: skin, P<.0001; 57±32 burned; 38±36 unburned vs 9±8 control %SkBFmax ). No difference was found for maximal SkBF capacity to local heating between groups. Additionally, dose-response curves for the sensitivity of SkBF to local heating were not different among burned or unburned skin, and nonburned control skin (EC50 , P>.05) under either condition.

Conclusion: Therapeutic propranolol does not negatively affect SkBF under neutral or hot environmental conditions and further compromise temperature regulation in burned children.

Keywords: burn injury; laser Doppler flowmetry; microcirculation; pediatrics; skin blood flow perfusion; temperature regulation.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Absolute resting (A, C) and maximal (B, D) skin blood flow perfusion (SkBF, arbitrary units) of burned (A, B) and unburned (C, D) skin of burned children under thermal neutral and hot conditions with placebo (white circle), propranolol (black circle) and compared to non-burned healthy children (control, black/white box). All data presented as ±SD. Burned placebo n= 8, burned propranolol n= 13, non-burned controls n =13. *, indicates significantly different compared to control non-burned children; +, indicates significant difference compared to neutral condition. Dashed line indicates control means.
Figure 2
Figure 2
Comparison of skin blood flow (as a percentage of maximal skin blood flow, %SkBFmax) responses between burned (black circle/bar) and unburned skin (white circle/bar) of burned children and non-burned healthy children (control: black/white box/diagonal bar) skin during the progressive local skin heating under thermal neutral (A) and hot (B) environmental conditions with placebo. The associated area under the curve are located to the right of each. All data presented as ±SD.*, indicates significantly different than control non-burned healthy children in the dosage/%SkBF graphs; +, indicates significantly different than unburned skin. Burned and unburned placebo n= 8, non-burned controls n =13.
Figure 3
Figure 3
Comparison of skin blood flow (as a percentage of maximal skin blood flow, %SkBFmax) responses for burned (A) and unburned skin (B) of burned children during the progressive local skin heating under for placebo (white circle/bar) and propranolol (black circle/bar) under neutral and hot conditions. Each were compared to non-burn healthy children’s skin (control: black/white box, diagonal bars). The area under the curves for the dose response of progressive local skin temperature on skin blood are located below of each. All data presented as ±SD. Burned placebo n = 8, burned propranolol n = 13, non-burned healthy controls n = 13. * indicates significantly different than control non-burned children in the dosage/%SkBF graphs.
Figure 4
Figure 4
The dose-response curves on the sensitivity of progressive local heating on changes on skin blood flow perfusion in unburned skin (A) and burned skin (B) under thermal neutral and hot conditions with placebo (white circle) or propranolol (black circle) compared to non-burned healthy children (controls, white box) under similar environmental conditions. Dotted line indicates the half maximal response to the dose effect observed (EC50). Burned placebo n = 8, burned propranolol n = 13, non-burned controls n = 13.
Figure 5
Figure 5
The relationship between the area under the curve progressive SkBF dose-response and absolute body surface area of burned (black circle), 3rd degree burned (grey circle), and unburned (black star) during the placebo administration (n =8) under a thermal neutral environmental condition. Dotted lines indicate 95% confidence band.
See this image and copyright information in PMC

References

    1. Alduchov OA, Eskridge RE. Improved magnus form approximation of saturation vapor pressure. J Appl Meteorol. 1996;35:601–609.
    1. Ali A, Herndon DN, Mamachen A, Hasan S, Andersen CR, Grogans RJ, Brewer JL, Lee JO, Heffernan J, Suman OE, Finnerty CC. Propranolol attenuates hemorrhage and accelerates wound healing in severely burned adults. Critical care. 2015;19:217. - PMC - PubMed
    1. Bell C, Seals DR, Monroe MB, Day DS, Shapiro LF, Johnson DG, Jones PP. Tonic sympathetic support of metabolic rate is attenuated with age, sedentary lifestyle, and female sex in healthy adults. The Journal of clinical endocrinology and metabolism. 2001;86:4440–4444. - PubMed
    1. Birke G, Carlson LA, von Euler US, Liljedahl SO, Plantin LO. Studies on burns. XII. Lipid metabolism, catecholamine excretion, basal metabolic rate, and water loss during treatment of burns with warm dry air. Acta chirurgica Scandinavica. 1972;138:321–333. - PubMed
    1. Bittel J, Marichy J, Henane R, Banssillon V. Comparison of indirect calorimetry and direct heat flow discs results in measuring R+C heat loss in burned patients. Aviation, space, and environmental medicine. 1977;48:637–639. - PubMed

Publication types

LinkOut - more resources