Neural control of human skin blood flow

doi:10.1016/0165-1838(90)90128-6

Journal of the Autonomic Nervous System

Volume 30, Supplement, July 1990, Pages S185-S190

Journal of the Auton...

https://doi.org/10.1016/0165-1838(90)90128-6 Get rights and content

Abstract

The paper reviews recent studies on neural control of skin blood flow, with special emphasis on the interaction between vasoconstrictor and vasodilator mechanisms. Intraneural electrical stimulation, mental stress, arousal and deep breaths have been found to cause cutaneous reflex vasodilatation in cold and vasoconstriction in warm subjects. The vasoconstrictions are probably due to increases of sympathetic vasoconstrictor nerve traffic, but whether vasodilatation is due to inhibition of vasoconstrictor nerve traffic or active (= impulse-induced) vasodilatation is unclear. The latter alternative is a possibility since electrical stimulation of the lumbar sympathetic chain may result in skin vasodilatation, suggesting that active vasodilatation is present in the skin of the human foot. Body cooling, which causes a reflex increase of cutaneous sympathetic vasoconstrictor activity, leads to reduction of cutaneous axon reflex vasodilatation. This may be due to competition between vasoconstrictor and vasodilator mechanisms at the blood vessel level.

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Cited by (70)

Responses to hyperthermia. Optimizing heat dissipation by convection and evaporation: Neural control of skin blood flow and sweating in humans
2016, Autonomic Neuroscience: Basic and Clinical
Under normothermic, resting conditions, humans dissipate heat from the body at a rate approximately equal to heat production. Small discrepancies between heat production and heat elimination would, over time, lead to significant changes in heat storage and body temperature. When heat production or environmental temperature is high the challenge of maintaining heat balance is much greater. This matching of heat elimination with heat production is a function of the skin circulation facilitating heat transport to the body surface and sweating, enabling evaporative heat loss.
These processes are manifestations of the autonomic control of cutaneous vasomotor and sudomotor functions and form the basis of this review. We focus on these systems in the responses to hyperthermia. In particular, the cutaneous vascular responses to heat stress and the current understanding of the neurovascular mechanisms involved. The available research regarding cutaneous active vasodilation and vasoconstriction is highlighted, with emphasis on active vasodilation as a major responder to heat stress. Involvement of the vasoconstrictor and active vasodilator controls of the skin circulation in the context of heat stress and nonthermoregulatory reflexes (blood pressure, exercise) are also considered. Autonomic involvement in the cutaneous vascular responses to direct heating and cooling of the skin are also discussed. We examine the autonomic control of sweating, including cholinergic and noncholinergic mechanisms, the local control of sweating, thermoregulatory and nonthermoregulatory reflex control and the possible relationship between sudomotor and cutaneous vasodilator function. Finally, we comment on the clinical relevance of these control schemes in conditions of autonomic dysfunction.
Relation between blood flow and tissue blood oxygenation in human fingertip skin
2015, Microvascular Research
Tissue blood flow (BF) is thought to be involved in the regulation of tissue blood oxygenation (StO₂). The purpose of the present study was to show the relation between BF and StO₂ by measuring them simultaneously under different conditions.
Twenty-one healthy subjects (age 21–30 years) participated in this study. We measured BF and StO₂ in a small area of skin (fingertip, palm, forearm) simultaneously using a laser Doppler flowmeter and a tissue oxygenation monitor. Three measurements were made at rest while performing mental arithmetic and during constriction of the ipsilateral upper arm.
At rest, BF and StO₂ were higher in the fingertip than in the palm or forearm (p < 0.01). Performing mental arithmetic produced significant decreases in BF, oxygenated hemoglobin, and StO₂ in the fingertip (p < 0.05). Constriction of the ipsilateral upper arm produced significant decreases in BF and StO₂ (p < 0.05) and an increase in oxygenated hemoglobin (p < 0.05). Both procedures produced significant increases in deoxygenated hemoglobin (p < 0.05), which was in antiphase to the decrease in StO₂.
BF decrease produced a significantly decreased StO₂ in fingertip skin. The results show that simultaneous measurement of BF and StO₂ is beneficial for showing the close relation between them.
Preoperative anxiety in surgical patients - Experience of a single unit
2012, Acta Anaesthesiologica Taiwanica
Preoperative anxiety has a significant effect on the outcome of anesthesia and surgery. At present, there is no published data on the preoperative anxiety levels in Sri Lankan patients. In the West, several validated questionnaires such as The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and State Trait Anxiety Inventory (STAI) are used. To measure the preoperative anxiety levels in patients using APAIS and to analyze the factors affecting anxiety and the role played by the anesthetist in allaying anxiety.
One hundred patients scheduled for elective surgery were prospectively studied using the APAIS. The internal consistency was checked using Cronbach's alpha.
The ages varied 25 to 72 years (mean = 48.7 years, SD = 13.6). Reliability of the APAIS was high; Cronbach's alpha = 0.864 in the overall component and 0.84, 0.73 and 0.97 in the anxiety related to surgery, anesthesia and in the information desire components, respectively.
Females were more anxious than males (p = 0.02) and those who had never sustained surgery were more anxious than those who previously had surgery (p = 0.05).
An anesthetist's visit and premedication reduced total anxiety scores (Z = −3.07, p = 0.002) and anesthesia related anxiety scores (Z = −3.45, p = 0.001).
The prevalence of anxiety is high among Sri Lankan patients. Females are more anxious than males and those who have never had surgery are more anxious than those who have had surgery. The anesthetist's visit could reduce anxiety. Sinhala version of the APAIS is highly reliable in assessing the preoperative anxiety levels.
Nepalese patients' anxiety and concerns before surgery
2011, Journal of Clinical Anesthesia
Citation Excerpt :
Preoperative anxiety is associated with problems such as difficult venous access [1], delayed jaw relaxation and coughing during induction of anesthesia [2], autonomic fluctuations [3], and increased anesthetic requirement [4,5].
To determine the changes in anxiety level and need for information at three different time points before surgery.
Prospective observational study.
Ward (T₁), preoperative holding area (T₂), and operating room (T₃) of a university hospital.
201 adult, ASA physical status 1 and 2 patients scheduled for elective operations.
Level of anxiety and need for information about surgery and/or anesthesia were assessed with the Amsterdam Preoperative Anxiety and Information Scale (APAIS) three times before the start of surgery: in the ward, the preoperative holding area, and the operating room.
The psychometric characteristics of the APAIS were similar to its original Dutch version. The frequency of patients with high preoperative anxiety peaked at the preoperative holding area. The median score on need for information decreased from T₁ [4; interquartile range (IR) 2-5] to T₂ (3; IR 2-4) (P < 0.005) and T₃ (3; IR 2-4) (P < 0.01). While the mean anxiety scores for anesthesia were significantly (P < 0.001) higher than for the surgical procedure at all three time points, when patients were still in the ward their need for information about their surgical procedure was significantly (P < 0.05) greater than it was for the anesthesia. Patients who were more desirous of information also were more anxious (P < 0.001). Predictors of high anxiety were female gender [odds ratio (OR) 4; 95% confidence interval (CI) 1.09-14.94] and need for general anesthesia (OR 7.1; 95% CI 0.93-54.98). The characteristics, general anesthesia (OR 3.3; 95% CI 1.1-10.0), younger age (≤30 yrs; OR 2.9; 95% CI 1.3-6.4), education (>12 yrs; OR 2.6; 95% CI 1.2-5.4), and no previous surgery (OR 2.6; 95% CI 1.2-5.5), correlated with greater need for information.
The frequency of anxious patients is variable at different time points before surgery. The factors correlating with anxiety before surgery are nonmodifiable. Providing information to those individuals is the only modifiable option.
Activation of central sympathetic networks during innocuous and noxious somatosensory stimulation
2011, NeuroImage
Citation Excerpt :
Cutaneous blood flow in the glabrous skin (of the left index finger) was measured during fMRI experiments using an MRI-suitable laser Doppler flowmeter (LDI, Moore Instruments, UK). The fingertip was selected for investigation because it is known that the abundant arteriovenous anastomoses of this area are under strict sympathetic vasoconstrictor control (Jänig and Habler, 2003; Wallin, 1990). Therefore, changes mediated by central sympathetic outflow are very prominent, and vasomotor reflexes are extensive.
Although pain is accompanied by autonomic nervous system responses, the cerebral circuits involved in the autonomic pain dimension remain elusive. Therefore, we used functional magnetic resonance imaging (fMRI) and investigated brain processing associated with cutaneous sympathetic vasoconstrictor reflexes during noxious stimulation. When a classical fMRI analysis based on the applied block design was performed, we were able to detect activations well known to be engaged in the central processing of touch and pain. A parametric fMRI analysis in which cutaneous vasoconstrictor activity was correlated with MRI signals revealed two distinct patterns of brain activity. During (i) noxious stimulation itself, brain activity correlated with sympathetic activity in the anterior insula, ventrolateral prefrontal cortex (VLPFC), anterior cingulate cortex (ACC), and secondary somatosensory cortex (S2). During (ii) baseline, brain activity correlated with sympathetic activity in the VMPFC, dorsolateral prefrontal cortex (DLPFC), OFC, PCC, cuneus, precuneus, occipital areas, and hypothalamus. Conjunction analysis revealed significant similar responses during periods of noxious stimulation and periods of sympathetic activation in the anterior insula, ACC and VLPFC (activation) and VMPFC, OFC, PCC, cuneus and precuneus (deactivation). Therefore, we here describe a cerebral network which may be engaged in the processing of the autonomic subdimension of the human pain experience.
Correlation of human cold pressor pain responses with 5-HT<inf>1A</inf> receptor binding in the brain
2007, Brain Research
Citation Excerpt :
CPP tolerance was measured only once in order to avoid unnecessary distress. Cutaneous vasoconstriction response, which is a sympathetic reflex (Wallin, 1990), was induced by CPP and Valsalva maneuver. Assessment of a CPP-induced sympathetic vasoconstriction should allow comparing CPP-induced sensory versus reflex responses with 5-HT1A BP and dissociation of the influence of 5-HT1A receptors on supraspinal versus spinal pain-related responses.
We determined whether serotonin 5-HT_1A receptor availability in the brain is associated with cold pressor pain (CPP) or sympathetic reflex responses. Psychophysical testing was performed in eleven healthy males who had participated in a positron emission tomography study with [carbonyl-¹¹C]WAY-100635 ligand for the assessment of 5-HT_1A receptor binding potential (BP). Psychophysical testing consisted of determining CPP threshold, tolerance, intensity, unpleasantness and CPP threshold modulation by conditioning CPP. Autonomic control was assessed by determining the cutaneous vasoconstriction responses in the finger induced by CPP and Valsalva maneuver. CPP intensity was inversely correlated with 5-HT_1A BP in multiple cortical and subcortical areas, including the prefrontal and cingulate cortices, insula, amygdala and the dorsal raphe. CPP unpleasantness was not significantly correlated with 5-HT_1A BP in any of the regions of interest. Increase of CPP threshold by conditioning CPP was directly correlated with 5-HT_1A BP in the amygdala and medial prefrontal cortex. Vasoconstriction induced by Valsalva but not CPP was directly correlated with 5-HT_1A BP in the ventral part of the anterior cingulate cortex and the anterior insula. The results suggest that 5-HT_1A receptors in the brain influence pain and Valsalva-induced sympathetic vasoconstriction reflex. In general, subjects with high availability of 5-HT_1A receptors have low CPP intensity accompanied by a high capacity for central suppression of pain or a sympathetic vasoconstriction response by a Valsalva maneuver.

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Neural control of human skin blood flow

Abstract

Am. Heart J.

The effect of mental arithmetic on the blood flow through normal, sympathectomized and hyperhydrotic hands

J. Physiol. (Lond.)

Direct evidence of neurally mediated vasodilatation in hairy skin of the human foot

J. Physiol. (Lond.)

Vasoconstriction following deep inspiration

J. Physiol. (Lond.)

Are there sympathetic vasodilator nerves to the vessels of the hands?

J. Physiol. (Lond.)

Local reflex in microcirculation in human cutaneous tissue

Acta. Physiol. Scand.

Reflexes in postganglionic fibres within skin and muscle nerves after noxious stimulation of the skin

Exp. Brain Res.

The Blood Vessels of the Human Skin and Their Responses