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<p><b>New page</b></p><div><span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">'''Sympathetic blockade and hyperbaric oxygen exposure improved transcutaneous oxygen tension in healthy volunteers.''' </span><br />
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical Bottom Line:''' </span><br />
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1.The combination of sympathetic block and hyperbaric oxygen administration improved PtcO2 more than either administered alone in healthy volunteers. </span><br />
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Appraised by:''' Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital </span><br />
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Sydney; Saturday, 10 July 1999 </span><br />
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical Scenario:''' A patient with peripheral vascular disease presented with a problem wound. '''Three-part Question:''' In patients receiving hyperbaric oxygen, does the administration of a sympathetic block result in improved oxygenation of the tissues? </span><br />
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Search Terms:''' hyperbaric oxygenation, sympathetic block </span><br />
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study:''' </span><br />
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Double-blinded concealed randomised cross-over trial with intention-to-treat. </span><br />
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Healthy volunteers. </span><br />
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Control group''' (N = 10; 10 analysed): One injection of 20mls of isotonic saline surrounding the brachial plexus via the axillary route prior to placement in the hyperbaric chamber. Exposure was at 2ATA, breathing 100% oxygen for 60 minutes. </span><br />
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Experimental group''' (N = 10; 10 analysed): As above, but injection was of 20mls of 1% lignocaine. </span><br />
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Evidence:''' </span><br />
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{| <br />
| <span style'''"font-family: Arial,Helvetica,sans-serif; font-size: 110%;">'''<span style'''"color: black;">Non-Event Outcomes</span>'''</span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: Arial,Helvetica,sans-serif; font-size: 110%; text-align: center;">'''<span style'''"color: black;">Time to outcome</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: Arial,Helvetica,sans-serif; font-size: 110%; text-align: center;">'''<span style'''"color: black;">Saline group</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: Arial,Helvetica,sans-serif; font-size: 110%; text-align: center;">'''<span style'''"color: black;">Lignocaine group</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: Arial,Helvetica,sans-serif; font-size: 110%; text-align: center;">'''<span style'''"color: black;">P-value</span>'''</span></span> <br />
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| <span style'''"font-family: Arial,Helvetica,sans-serif; font-size: 110%;">'''<span style'''"color: black;">Increase in PtcO2 on compression (mmHg)</span>'''</span> || <span style'''"display: block; text-align: center;"><span style'''"color: #000000; display: block; font-family: Arial,Helvetica,sans-serif; font-size: 110%; text-align: center;">1 hour</span></span> || <span style'''"display: block; text-align: center;"><span style'''"color: #000000; display: block; font-family: Arial,Helvetica,sans-serif; font-size: 110%; text-align: center;">130</span></span> || <span style'''"display: block; text-align: center;"><span style'''"color: #000000; display: block; font-family: Arial,Helvetica,sans-serif; font-size: 110%; text-align: center;">350</span></span> || <span style'''"display: block; text-align: center;"><span style'''"color: #000000; display: block; font-family: Arial,Helvetica,sans-serif; font-size: 110%; text-align: center;"><0.05</span></span><br><span style="display: block; text-align: center;"><br></span> <br />
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| <span style'''"font-family: Arial,Helvetica,sans-serif; font-size: 110%;">'''<span style'''"color: black;">Absolute PtcO2 at 2ATA (mmHg)</span>'''</span> || <span style'''"display: block; text-align: center;"><span style'''"color: #000000; display: block; font-family: Arial,Helvetica,sans-serif; font-size: 110%; text-align: center;">1 hour</span></span> || <span style'''"display: block; text-align: center;"><span style'''"color: #000000; display: block; font-family: Arial,Helvetica,sans-serif; font-size: 110%; text-align: center;">171</span></span> || <span style'''"display: block; text-align: center;"><span style'''"color: #000000; display: block; font-family: Arial,Helvetica,sans-serif; font-size: 110%; text-align: center;">410</span></span> || <span style'''"display: block; text-align: center;"><span style'''"color: #000000; display: block; font-family: Arial,Helvetica,sans-serif; font-size: 110%; text-align: center;"><0.05</span></span> <br />
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Comments:''' </span><br />
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. A rise in skin temperature (1C) and axillary blood flow (23%) was noted in the lignocaine group prior to compression. </span><br />
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2. The injection of placebo solution may have had some effect on PtcO2 response on compression due to reduction in axillary blood flow (reduced from 24 to 17ml/s). </span><br />
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">3. It is not known if the response shown would be reproduced in patients with abnormal peripheral vessels. </span><br />
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Expiry date:''' January 2022</span><br />
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''References:''' </span><br />
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. Thomas PS, Hakim TS, Trang LQ, Hosain SI, Camporesi EM. The synergistic effect of sympathectomy and hyperbaric oxygen exposure on transcutaneous PO2 in healthy volunteers. Anesthesia and Analgesia 1999; 88:67-71. </span><br />
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