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Objective:To investigate the effect of right stellate ganglion block (RSGB)-serratus anterior plane block (SAPB) combined with general anesthesia in thoracoscopic radical resection of lung cancer.Methods:A total of 90 patients who planned to undergo thoracoscopic radical resection of lung cancer in Xiangya Changde Hospital from March 2020 to September 2021 were prospectively selected and divided into 3 groups by random number table method: general anesthesia group (G group), (SAPB)+ general anesthesia group (SG group), RSGB+ SAPB+ general anesthesia group (RSG group), 30 cases in each group. The SG group received SAPB on the operative side before general anesthesia, and the RSG group received RSGB+ SAPB on the operative side before general anesthesia. After the blocking effect was determined, all patients were given general anesthesia in the same scheme according to their weight, and patients were given patient-controlled intravenous analgesia (PCIA) after surgery. The mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia (T 0), before intubation (T 1), 1 min after intubation (T 2), 5 min after intubation (T 3), at extubation (T 4) and 5 min after extubation (T 5). The intraoperative dosage of remifentanil, incidence of nausea and vomiting (PONV) within 24 hours after surgery, number of additional PCIA within 24 hours, the Visual Analogue Scale (VAS) of static and dynamic pain, the Bruggrmann Comfort Scale (BCS) and Richard Campbell Sleep Questionnaire (RSCQ) 24 hours after surgery were recorded. Results:Compared with T 0, the MAP and HR in 3 groups were increased 1 min after intubation (T 2) and at extubation (T 4), but the increases in RSG group were significantly less than those in G and SG groups (all P<0.05). The remifentanil dosage, PONV incidence and PCIA supplemental times in SG and RSG groups were less than those in G group, and the BCS score and RSCQ score were higher than those in G group (all P<0.05); the BCS score and RSCQ score in RSG group were higher than those in SG group (all P<0.05). Conclusions:RSGB+ SAPB combined with general anesthesia in thoracoscopic radical resection of lung cancer has little circulation fluctuation, good postoperative analgesia effect, less adverse reactions and high comfort level.
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Raynaud's phenomenon is a symptom complex manifested as intermittent fingertip ischemia caused by cold or other sympathetic drivers. Secondary Raynaud's phenomenon is often more severe and could even lead to finger ulceration, making it particularly complicated to treat. We describe a case of severe Raynaud's phenomenon secondary to subclinical hypothyroidism lasting for more than 6 hours in a 65-year-old woman. The patient was also diagnosed with hypothyroidism, epilepsy, and secondary soft tissue infection of the right middle and ring fingers. After careful multidisciplinary consultation and discussion, the patient received vasodilation, anticoagulation, thyroxine supplementation, stellate ganglion block, hyperbaric oxygen therapy and debridement. The patient responded well to the medication, avoiding amputation or obviously dysfunction. Multidisciplinary team gathering the doctors from different departments proposes appropriate strategies for patients with severe Raynaud's phenomenon and could improve the prognosis and satisfaction of patient effectively.
Subject(s)
Female , Humans , Aged , Hypothyroidism/complications , Raynaud Disease/diagnosisABSTRACT
Objective:To observe any effect of combining ultrasound-guided stellate ganglion pulsed radiofrequency irradiation with electroacupuncture in treating migraine.Methods:Seventy-two migraine patients were randomly divided into a combined group, an electroacupuncture group and a control group, each of 24. All three groups were treated with etocoxib and zolmitriptan dispersible tablets, while the electroacupuncture group and the combined group were additionally provided with electroacupuncture or ultrasound-guided stellate ganglion pulsed radiofrequency irradiation combined with electroacupuncture. The therapeutic interventions were administered once daily for 7 days. A visual analogue scale (VAS), a migraine-specific quality of life questionnaire (MSQOL), the Hamilton anxiety scale (HAMA), the Hamilton depression scale (HAMD) and a migraine disability scale (MIDAS) were used to evaluate each patient before the experiment and on the 3rd, 7th, 30th and 90th days after completion of the treatment.Results:The average VAS, MSQOL, HAMA and HAMD scores of the combined and acupuncture groups had improved significantly at all time points. Moreover, the average MIDAS scores of the combined and acupuncture groups had improved significantly 30 and 90 days after the treatment. On the 3rd day after the treatment, the average VAS, MSQoL, HAMA and HAMD scores of the combined group were significantly higher than the acupuncture group′s averages, while the average MIDAS score of the former group was significantly lower on the 30th and 90th days after the treatment. The average VAS, HAMA and HAMD scores of the combined group were significantly lower than the control group′s averages 3, 7, 30 and 90 days after the treatment, while their average MSQOL score was significantly higher. The average MIDAS score of the combined group was significantly lower than the control group′s average 30 and 90 days after the treatment.Conclusion:Ultrasound-guided stellate ganglion pulsed radiofrequency irradiation combined with electroacupuncture can significantly relieve the symptoms of migraine and improve the life quality of migraine patients for at least 3 months.
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Objective:To develop a model of stellate ganglion block (SGB) in mice and investigate the effect of SGB on cerebral cortical blood flow.Methods:Thirty clean-grade healthy male C57BL/6 mice, aged 8-9 weeks, weighing 23-27 g, were divided into 5 groups ( n=6 each) using a random number table method: control group (group C), left SGB group (group L), left normal saline group (group SL), right SGB group (group R) and right normal saline group (group SR). Group C received no intervention.SGB was performed with 0.25% ropivacaine 0.08 ml via percutaneous posterior approach in L and R groups, while the equal volume of normal saline 0.08 ml was given instead at the location of left and right stellate ganglion in SL and SR groups, respectively.The cerebral cortical blood flow was determined using laser speckle contrast imaging system before SGB (T 0) and at 10, 30, 60, 90 and 120 min after SGB (T 1-5). Results:Mice developed ptosis on the block side, indicating that the model of SGB was successfully developed in L and R groups.There was no significant difference in cerebral cortical blood flow at each time point among C, SL and SR groups ( P>0.05), and cerebral cortical blood flow on the block side decreased at T 1, began to increase at T 2, peaked at T 3, and decreased at T 5 which was still higher than that at T 0 in group L and group R ( P<0.01). Compared with C and SL groups, the left cerebral cortical blood flow was significantly decreased at T 1, 5 and increased at T 2-4 in group L ( P<0.01). Compared with C and SR groups, the right cerebral cortical blood flow was significantly decreased at T 1, 5 and increased at T 2-4 in group R ( P<0.01). There were no significant differences in cerebral cortical blood flow at each time point between group C and group SL and between group C and group RL ( P>0.05). Conclusions:The mouse model of SGB via percutaneous posterior approach is successfully developed.Unilateral SGB can affect cerebral cortical blood flow on the block side, which shows a transitory decrease followed by a sustained significant increase.
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OBJECTIVE@#To explore the effects of ultrasound-guided stellate ganglion block (SGB) on perioperative stress response, gastrointestinal hormones and postoperative gastrointestinal function recovery in patients undergoing laparoscopic radical gastrectomy for gastric cancer.@*METHODS@#This study was conducted among 60 American Society of Anesthesiologists (ASA) class II-III patients with gastric cancer (regardless of gender, aged 35-75 years with BMI of 18.5-26 kg/m2) undergoing elective laparoscopic radical gastrectomy. The patients were randomized into experimental group (S group, n=30) and control group (NS group, n=30). In S group, SGB at the C6 level of the right cervical spine was performed under ultrasound guidance 15 min before induction of anesthesia by injection of 7 mL 0.5% ropivacaine; the patients in NS group received injections of normal saline in the same manner. Peripheral venous blood samples were collected before SGB (T1), after surgery (T2), and on the 2nd and 6th days after surgery (T3 and T4) for determination of the levels of motitin (MOT), vasoactive intestinal peptide (VIP), cortisol (COR), and blood glucose (GLU). Intraoperative usage of sufentanil, recovery rate of intestinal sounds at 36, 48, 60, 72, 84 and 96 h after operation and the time of first passage of flatus were recorded and compared between the two groups.@*RESULTS@#There was no significant difference in the total amount of sufentanil consumption between the two groups. Compared with those in NS group, the patients in S group had significant lower COR and VIP levels (P < 0.05) and higher MOT level (P < 0.05) at T2, T3 and T4. Glu level at T2 and T3 was also significantly lower in S group (P < 0.05). The recovery rates of intestinal sounds at 36, 48, 60, 72 and 84 h after surgery were significantly higher (P < 0.05) and the time of the first passage of flatus was earlier in S group than in NS group (P < 0.05).@*CONCLUSION@#In patients with gastric cancer undergoing laparoscopic radical gastrectomy, ultrasound-guided SGB can reduce postoperative stress level, promote the recovery of gastrointestinal hormone secretion, and accelerate postoperative recovery of gastrointestinal functions.
Subject(s)
Adult , Aged , Humans , Middle Aged , Gastrectomy , Laparoscopy , Recovery of Function , Stellate Ganglion , Stomach Neoplasms/surgery , Ultrasonography, InterventionalABSTRACT
Resumen: Se presenta una serie de 4 casos clínicos de pacientes con y sin cardiopatía estructural, que tuvieron uno o más episodios de tormenta arrítmica. Se describen los tratamientos con sus resultados y una revisión bibliográfica con los avances en el tema más allá de la ablación con catéter.
Abstract: We present 4 clinical cases of patients with and without structural heart disease, who had one or more episodes of arrhythmic storm. Treatments, results and a bibliographic review with advances beyond catheter ablation are described.
Subject(s)
Humans , Male , Middle Aged , Aged , Ventricular Fibrillation/therapy , Arrhythmias, Cardiac/therapy , Stellate Ganglion , Sympathectomy , Treatment Outcome , Tachycardia, Ventricular/therapy , Catheter AblationABSTRACT
Objective:To investigate the effect of ultrasound-guided stellate ganglion block (SGB) in patients undergoing radical mastectomy, and to provide an effective reference for the selection of clinical anesthesia.Methods:A total of 86 patients undergoing radical mastectomy for breast cancer in the First Affiliated Hospital of Hunan Traditional Chinese Medicine College from January 2018 to December 2019 were selected as the research objects and randomly divided into two groups, with 43 cases in each group. On the basis of conventional general anesthesia, the observation group was treated with ultrasound-guided SGB intervention at the level of the sixth cervical vertebra on the left, and 0.5% ropivacaine was injected with 7 ml. The control group was treated with ultrasound-guided injection of equal volume normal saline at the same site. The hemodynamics and serum inflammatory factors, cellular immunity, prostaglandin E 2 (PGE 2), substance P (SP), serotonin (5-HT) expression, cerebral oxygen metabolism indexes before anesthesia induction (T 1), before intubation (T 2), immediately after intubation (T 3), during skin incision (T 4) and extubation (T 5), and cognitive function score before and after surgery of the two groups were measured respectively. Results:⑴ Hemodynamics: the heart rate (HR) and mean arterial pressure (MAP) of the observation group at T 2, T 3, T 4 were lower than those of the control group ( P<0.05), and there was no significant difference between the two groups at T 1, T 5 ( P>0.05). ⑵ Inflammation and immune status: there was no significant difference in interleukin (IL)-2, IL-18, tumor necrosis factor-α (TNF-α), CD3 + , CD4 + and CD8 + between the two groups at T 1, T 5 ( P>0.05); the IL-2, IL-18, TNF-α and CD8 + at T 2, T 3 and T 4 in the observation group were lower than those in the control group, while the CD3 + and CD4 + were higher than that in the control group ( P<0.05). ⑶ Pain mediators and cerebral oxygen metabolism indexes: there was no significant difference in the levels of PGE 2, SP, 5-HT, SjvO 2, Da-jvO 2 and CEO 2 between the two groups at T 1 and T 5 ( P>0.05); The levels of PGE 2, SP, 5-HT, Da-jvO 2 and CEO 2 in the observation group at T 2, T 3 and T 4 were lower than those in the control group, and the SjvO 2 was higher than those in the control group ( P<0.05). ⑷ Cognitive function: there was no significant difference in Mini Mental State Examination (MMSE) scores between the two groups at 1 day before and 5 days after operation ( P>0.05). At 1 and 3 days after operation, the MMSE score of the observation group was higher than that of the control group ( P<0.05). Conclusions:Ultrasound-guided SGB has a good application effect in patients undergoing radical mastectomy and can reduce the fluctuation of intraoperative hemodynamics, intraoperative inflammatory stress and immunosuppressive effects of the body, reduce the release of pain mediators, and at the same time improve cerebral oxygen metabolism, and promote postoperative cognitive function recovery.
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Abstract Objective: To observe the effects of preoperative right stellate ganglion block on perioperative atrial fibrillation in patients undergoing lung lobectomy. Methods: Two hundred patients who underwent a scheduled lobectomy were randomly divided into the S and C groups. The S group was injected with 4 mL of 0.2% ropivacaine under ultrasound guidance, and the C group did not receive stellate ganglion block. The patients underwent continuous ECG monitoring, and the incidences of atrial fibrillation and other types of arrhythmias were recorded from the start of surgery to 24 hours after surgery. Results: The respective incidences of atrial fibrillation in the S group and the C group were 3% and 10% (p = 0.045); other atrial arrhythmias were 20% and 38% (p = 0.005); and ventricular arrhythmia were 28% and 39% (p = 0.09). Conclusions: The results of the study indicated that preoperative right stellate ganglion block can effectively reduce the incidence of intraoperative and postoperative atrial fibrillation.
Resumo Objetivo: Observar os efeitos do bloqueio do gânglio estrelado na fibrilação atrial no período perioperatório em pacientes submetidos a lobectomia pulmonar. Método: Duzentos pacientes programados para lobectomia foram divididos aleatoriamente nos grupos S e C. O grupo S recebeu infusão de 4 mL de ropivacaína a 0,2% orientada por ultrassom e o grupo C não foi submetido a bloqueio do gânglio estrelado. Os pacientes foram submetidos à monitoração contínua de ECG, e as incidências de fibrilação atrial e outros tipos de arritmias foram registradas do início da cirurgia até 24 horas depois da cirurgia. Resultados: As incidências de fibrilação atrial no grupo S e no grupo C foram 3% e 10%, respectivamente (p = 0,045); as de outras arritmias atriais foram 20% e 38% (p = 0,005); e de arritmias ventriculares, 28% e 39% (p = 0,09). Conclusões: Os resultados do estudo indicaram que o bloqueio do gânglio estrelado no pré-operatório pode ser efetivo na redução da incidência de fibrilação atrial nos períodos intra- e pós-operatório.
Subject(s)
Humans , Male , Female , Aged , Pneumonectomy , Atrial Fibrillation/epidemiology , Autonomic Nerve Block/methods , Stellate Ganglion , Ultrasonography, Interventional , Intraoperative Complications/epidemiology , Atrial Fibrillation/diagnosis , Incidence , Monitoring, Intraoperative , Electrocardiography , Intraoperative Complications/diagnosis , Middle AgedABSTRACT
Introducción: El bloqueo terapéutico de ganglio estrellado es un procedimiento para aliviar dolores crónicos de miembros superiores, cabeza y cuello. Actualmente se realiza con anestésicos locales más adyuvantes; pero en Cuba sólo se usan anestésicos locales para este bloqueo. Objetivo: Cotejar información reciente sobre la pertinencia del uso de anestésicos locales con adyuvantes, para estimular la actualización de su práctica nacional acorde a las rutinas y los resultados de esta pericia en el contexto internacional. Métodos: Se revisaron más de 150 informes científicos en línea, referentes a esta técnica a nivel mundial, respecto al uso de drogas y resultados terapéuticos, en bases de datos en inglés, español y portugués. Desarrollo: El bloqueo anestésico precisa conocimientos de farmacología y habilidades prácticas para efectuarlo. La necesidad de anestésicos locales y adyuvantes varía, y depende del paciente y tipo de bloqueo. Para tratar el dolor crónico se usan también opioides, solos y con anestésicos locales. Se publican además beneficios razonables con el uso de ketamina y esteroides en combinación con anestésicos locales. Conclusión: Los resultados terapéuticos más intensos y duraderos que se obtienen al aplicar anestésico local más adyuvante, sugieren actualizar estas prácticas a nivel nacional(AU)
Introduction: The therapeutic block of the stellate ganglion is a procedure for relieving chronic pain of the upper limbs, head, and neck. It is currently performed with more adjuvant local anesthetics, but in Cuba only local anesthetics are used for this block. Objective: To compare recent information about the relevance of using local anesthetics with adjuvants to stimulate the updating of their practice nationally, according to the routines and the outcomes of this expertise in the international setting. Methods: More than 150 scientific reports were reviewed online, referring to this technique worldwide, regarding drug use and therapeutic outcomes, in databases in English, Spanish, and Portuguese. Development: The anesthetic block requires knowledge about pharmacology and practical skills to perform it. The need for local anesthetics and adjuvants varies, and depends on the patient and type of block. Opioids are also used to treat chronic pain, alone or with local anesthetics. Reasonable benefits are also published regarding the use of ketamine and steroids in combination with local anesthetics. Conclusion: The most intense and lasting therapeutic outcomes obtained by applying more adjuvant local anesthetic suggest updating these practices nationally(AU)
Subject(s)
Humans , Male , Female , Adjuvants, Anesthesia/therapeutic use , Nerve Block/methods , Stellate GanglionABSTRACT
Introduction: Stellate ganglion block (SGB) is used for thetreatment of many vascular disorders and sympatheticallymediated pain including pain of head, neck, cancer, phantom,postherpetic neuralgia, cardiac arrythmia, orofacial pain, andvascular headache. Various modalities to localize stellateganglion use of fluoroscopy, computerized tomography,magnetic resonance imaging, and radionucleotide tracers.Ultrasound imaging is a best tool for SGB due to its clarity,low cost, lack of radiation and portability. In this study weaimed to compare the efficacy of fluoroscopy vs ultrasoundguided stellate ganglion block in lowering the pain usingnumeric rating scale (NRS).Material and Methods: Study was perform in 40 patientssuffering from upper limb and head and neck, neuropathicpain. The first group (Group I) received stellate ganglion blockunder ultrasound guidance while the second group (Group II)received stellate ganglion block under fluoroscopy guidance.The t-test and Man Whitney test were perform to analyses thedata.Results: The requirement of different analgesia werecomparable in both group I and group II patients. Change inpain score was maximum at immediate post-block, 1 h postblock, 6 h post block (65.84% of baseline) while change wasminimum at 48 h post-block (48.45% of baseline). The painwas significantly lower in group I from baseline as comparedto group II at all periods. Range of Ease rating score were alsolower in group I. Block was statistically achieved earlier inGroup I (4.55±0.69 min) as compared to Group II (12.60±2.56min).Conclusion: USG and fluoroscopy are both good techniquesfor stellate ganglion block, but due to less complication, earlyblocking effect time, more precise placement of medicationultrasound guided block is preferred over fluoroscopy method.
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Objective To explore the application value of ultrasound-guided stellate ganglion block in patients with aneurysmal cerebral hemorrhage.Methods Eighty patients with subarachnoid hemorrhage caused by aneurysm from November 2017 to March 2019 in Hangzhou Hospital of Zhejiang Medical Health Group were selected.The patients were divided into observation group and control group by random digits table method with 40 cases in each group.All patients were treated with craniotomy hematoma removal.At the conclusion of the surgical procedure,the control group was treated with nimodipine,while the observation group was treated with ultrasound-guided right stellate ganglion block on the basis of nimodipine.The blood flow velocity of middle cerebral artery before operation and 6,24 h after operation by transcranial Doppler sonography were detected to reflect cerebral vasospasm status;the blood samples from the radial artery and internal jugular bulb 24 h after operation were used to detect and count cerebral oxygen metabolism indexes,including the blood oxygen saturation of internal jugular bulb,arteriovenous oxygen content difference and cerebral oxygen uptake rate;the IgG,IgA and IgM 24 h after operation were detected.The patients were followed up at 1 week after operation,and the complication was observed.Results There was no statistical difference in the blood flow velocity of middle cerebral artery before operation between 2 groups (P＞0.05);the blood flow velocity of middle cerebral artery 6 and 24 h after operation in observation group was significantly lower than that in control group:(100.8± 8.2) cm/s vs.(123.5 ± 9.9) cm/s and (89.7 ± 5.3) cm/s vs.(118.9 ± 7.1) cm/s,and there was statistical difference (P＜0.01).The blood oxygen saturation of internal jugular bulb,cerebral oxygen uptake rate,IgG,IgA and IgM 24 h after operation in observation group were significantly higher than those in control group:0.704 ± 0.035 vs.0.598 ± 0.058,(57.5 ± 6.5)％ vs.(49.7 ± 3.6)％,(12.5 ± 0.3) mg/L vs.(5.0 ± 0.1) mg/L,(5.5 ± 0.3) mg/L vs.(2.1 ± 0.1) mg/L and (4.3 ± 0.3) mg/L vs.(1.9 ± 0.2) rg/L,the arteriovenous oxygen content difference and incidence of complication were significantly lower than those in control group:(40.8 ± 3.2) ml/L vs.(58.3 ± 8.6) ml/L and 5.0％ (2/40) vs.25.0％ (10/40),and there were statistical differences (P＜0.01 or ＜0.05).Conclusions For patients with aneurysmal intracerebral hemorrhage,ultrasound-guided stellate ganglion block therapy can effectively improve cerebral blood flow,ensure cerebral oxygen supply,improve humoral immunity,reduce the incidence of postoperative complication,and achieve the purpose of improving clinical therapeutic effect.
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Objective: To observe the impact and difference of resection of left stellate ganglion (LSG) or right stellate ganglion (RSG) on rats with heart failure. Methods: Thirty male SD rats were divided into 3 groups (n=10 each) by random number table method: control group, LSG group, RSG group. All three groups underwent TAC surgery to establish a pressure-overloaded heart failure model. Then, LSG and RSG were bluntly separated and removed in rats assigned to the LSG group or RSG group by surgery, while rats in the control group underwent sham operation. The changes in blood pressure and heart rate before operation, 30 minutes and 10 weeks after operation were recorded; echocardiography was performed before operation and 10 weeks after operation to detect the thickness of the ventricular septum, left ventricle posterior wall diameter, left ventricular end diastolic diameter, left ventricular end diastolic volume, and calculate the left ventricular fractional shortening and left ventricular ejection fraction. HE staining and Masson staining were performed to observe the degree of myocardial hypertrophy and myocardial fibrosis, and to judge the ventricular remodeling. Results: The heart rates of the three groups of rats were (352.4±4.3), (320.3±4.0) and (297.9±5.9) beats/min, and the blood pressure was (142.8±2.3), (123.4±2.7) and (129.6±2.9) mmHg(1 mmHg=0.133 kPa) at thirty minutes after surgery; the heart rates of the three groups of rats were (352.9±4.0), (321.6±3.4) and (301±4.1) beats/min, and the blood pressure was (145.6±1.9), (124.8±1.7) and (130.4±4.4) mmHg at 10 weeks after surgery. The heart rate and blood pressure in the LSG group and RSG group at 30 min and 10 weeks after surgery were significantly lower than those in the control group; at 10 weeks after surgery, the heart rate in the RSG group was significantly lower than that in the LSG group (P both<0.001). After 10 weeks, rats in the control group developed severe left ventricular dilatation. Degree of left ventricular hypertrophy was significantly reduced in the LSG group and RSG group than in the control group, the thickness of the ventricular septum was (3.2±0.3), (2.5±0.1) and (2.5±0.1) mm; the left ventricular end-diastolic diameters were (7.5±0.3), (5.5±0.3) and (5.7±0.2) mm; the left ventricular end-diastolic volume was (9.5±0.3), (4.5±0.2) and (4.8±0.2) ml; the left ventricular fractional shortening was (21.6±1.3)%, (49.1±3.9)% and (47.4±1.5)%; and the left ventricular ejection fraction was (50.9±2.5)%, (81.9±2.1)% and (80.0±2.3)%, respectively in the control group, LSG group and RSG group. Compared with the control group, the left ventricular posterior wall diameter, left ventricular end-diastolic diameter and left ventricular end-diastolic volume were significantly lower and the left ventricular fractional shortening and left ventricular ejection fraction were significantly higher in the LSG group and RSG group (all P<0.001). 10 weeks after operation, the values of type Ⅰ collagen in the control group, LSG group, and RSG group were (0.354±0.013), (0.211±0.012) and (0.243±0.013), respectively. Ratio of type Ⅰ/Ⅲ collagen was (1.109±0.065), (0.737±0.055) and (0.839±0.075), respectively. Compared with the control group, the ratio of type Ⅰcollagen and ratio of type Ⅰ/Ⅲ collagen were significantly lower in the LSG group and RSG group (P<0.001). Conclusion: Both left and right stellate ganglion resection can similarly reduce ventricular remodeling caused by pressure overload and delay the progression of heart failure in tis TAC rat model.
Subject(s)
Animals , Male , Rats , Heart Failure/surgery , Heart Ventricles , Rats, Sprague-Dawley , Stroke Volume , Ventricular Function, LeftABSTRACT
The electric storm is an emergency whose handling is very demanding. Our case report describes a patient with multiple episodes of ventricular tachycardia, refractory to conventional therapy (antiarrhythmics, beta blockers and sedoanalgesia) where the sympathetic activity of the heart seems to play a crucial role. We decided to try as additional therapeutic strategy, the performing of a transient and bilateral blockade of the stellate ganglion under ultrasound guidance, this procedure was carried out at the patient's bed, without complications during the same. The sympathetic modulation allowed us to optimize conventional antiarrhythmic therapy, thus reducing the appearance of malignant arrhythmias.
La tormenta eléctrica es una emergencia cuyo manejo es muy exigente. Nuestro reporte de caso describe a un paciente con múltiples episodios de taquicardia ventricular refractarios a terapia convencional (antiarrítmicos, betabloqueadores y sedoanalgesia) donde la actividad simpática del corazón parece jugar un rol crucial. Decidimos plantear como estrategia terapéutica adicional la realización de un bloqueo transitorio y bilateral del ganglio estrellado bajo guía ecográfica, este procedimiento se realizó en la cama del paciente, sin complicaciones durante el mismo. La modulación simpática nos permitió optimizar la terapia antiarrítmica convencional, logrando así reducir la aparición de arritmias malignas.
Subject(s)
Humans , Male , Aged , Arrhythmias, Cardiac/therapy , Autonomic Nerve Block/methods , Stellate Ganglion/drug effects , Anesthetics, Local/administration & dosage , Bupivacaine/administration & dosageABSTRACT
Objective: To compare the efficacy and safety of ultrasound-guided stellate ganglion block (UGSGB) through anterior scalenus muscle (ASM) and through internal jugular vein (IJV). Methods: Totally 144 patients with cervicogenic headache were distributed into 2 groups randomly. USSGB was performed through ASM (ASM group, n=72) or through IJV (IJV group, n=72), respectively. The ratio of successful blocks, the appearing time of Honer syndrome and the ratio of adverse reaction were compared between two groups. Results: The successful block ratio was 97.22% (70/72) of ASM group and 98.61%(71/72) of IJV group, while Honer syndrome appearing times was (2.18±0.96)min and (1.96±0.87)min after operation, respectively. There was no significant difference between 2 groups (both P>0.05). The adverse reaction ratio was 19.44%(14/72) of SCM group and 4.17%(3/72) of IJV group (P=0.01). Conclusion: USSGB through ASM approach and USSGB through IJV approach are both safe and efficient. IJV approach has less adverse reaction than SCM approach.
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Objective@#To establish a monitoring model of stellate ganglion discharge in rats.@*Methods@#Thirty healthy Sprague-Dawley rats of either sex, aged 6-7 weeks, weighing 230-270 g, were selected.The left stellate ganglion was isolated after anesthesia and hung on the platinum electrode head to observe its electrical signal.Heart rate was recorded immediately after successful anesthesia (T0), immediately after the stellate ganglion was suspended in the electrode head (T1), at 10, 20 and 30 min after the stellate ganglion was suspended in the electrode head (T2-4), the frequency and amplitude of discharge of the stellate ganglion was recorded at T1-4.After recording the nerve electrical signal at T4, the stellate ganglion was locally infiltrated with 0.2% lidocaine 0.2 ml and then the frequency and amplitude of discharge was recorded 5 min later (T5). The occurrence of Horner′s syndrome was considered as a sign of successful block, and the success of block was recorded.@*Results@#There was no significant difference in heart rate at each time point (P>0.05). Paroxysmal clustered and rhythmically regular neuroelectrical activity of stellate ganglion was found at T1-4, and there was no significant difference in the frequency and amplitude of discharge at each time point (P>0.05). The frequency and amplitude of discharge of stellate ganglion were significantly decreased at T5 than at T1-4 (P<0.01).@*Conclusion@#The discharge monitoring model of stellate ganglion is successfully established in rats.
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Objective To establish a monitoring model of stellate ganglion discharge in rats.Methods Thirty healthy Sprague-Dawley rats of either sex,aged 6-7 weeks,weighing 230-270 g,were selected.The left stellate ganglion was isolated after anesthesia and hung on the platinum electrode head to observe its electrical signal.Heart rate was recorded immediately after successful anesthesia (T0),immediately after the stellate ganglion was suspended in the electrode head (Tt),at 10,20 and 30 min after the stellate ganglion was suspended in the electrode head (T2-4),the frequency and amplitude of discharge of the stellate ganglion was recorded at T1-4.After recording the nerve electrical signal at T4,the stellate ganglion was locally infiltrated with 0.2％ lidocaine 0.2 ml and then the frequency and amplitude of discharge was recorded 5 min later (Ts).The occurrence of Horner's syndrome was considered as a sign of successful block,and the success of block was recorded.Results There was no significant difference in heart rate at each time point (P＞0.05).Paroxysmal clustered and rhythmically regular neuroelectrical activity of stellate ganglion was found at T1-4,and there was no significant difference in the frequency and amplitude of discharge at each time point (P＞0.05).The frequency and amplitude of discharge of stellate ganglion were significantly decreased at T5 than at T1-4 (P＜0.01).Conclusion The discharge monitoring model of stellate ganglion is successfully established in rats.
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@#Objective To determine the effects of resecting the lower half of left stellate ganglion (LSG) on fast ventricular rate (VR) in persistent atrial fibrillation (AF) and its mechanism. Methods Twelve mature healthy male beagle dogs (15–25 kg) were studied. They were randomly divided into two groups (an experimental group and a control group, 6 dogs in each group). The control group were merely performed with rapid left atrial pacing to induce persistent AF. The experimental group were disposed with rapid left atrial pacing and received resection of the lower half of LSG after the persistent AF was documented. Simultaneously the ventricular rates were monitored separately before anesthesia, after anesthesia, 30 minutes and one month after LSG resection. The forward passing effective refractory period (ERP) of the canine atrioventricular node (AVN) was also measured. Results Each dog was documented with persistent AF after 3–6 weeks’ left atrial pacing. After resecting the lower half of LSG for 30 minutes (the control group was only observed for 30 minutes without LSG resection), the average VR of the control group attained 144.5±4.2 beats/min, while that of the experimental group was 121.5±8.7 beats/min (P<0.001). After resecting the lower half of LSG for one month (the control group was observed for one month without LSG resection), the average VR of the control group was 139.2±5.6 beats/min, while that of the experimental group was 106.5±4.9 beats/min (P<0.001). Meantime, the forward passing ERP of AVN of the experimental group was significantly prolonged than that of the control group (265.6±7.8 msvs.251.1±4.6 ms, P=0.003). Conclusion Resection of the lower half of LSG is efficient in reducing VR in canines with persistent AF, one of the mechanisms of which may be prolonging the forward passing ERP of AVN.
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Objective To investigate the effects of stellate ganglion block(SGB)on attention and executive function in middle-aged and elderly patients after surgery.Methods Middle-aged and elderly patients aged 55-75 years who underwent hip replacement surgery under lumbar anesthesia were randomized into a control group and an SGB group.Patients in the SGB group received ultrasound-guided stellate ganglion block 30 min before surgery,and patients in the control group were given no additional treatment before surgery.All patients were tested with a modified version of the Trail Making Test-Part A (TMT-A)and a modified version of the Symbol Digit Modalities Test (SDMT)1 day before surgery and 7 days after surgery.The Z-score method was used to diagnose postoperative attention and/or executive function impairment.Results The modified versions of TMT-A and SDMT had good reliability and validity among Chinese middle-aged and elderly people aged 55-75 years.Age was the main influencing factor for the two tests,and their two parallel versions had good alternate-form reliability.There was no significant difference between the control group and the SGB group in scores of modified TMT-A and SDMT at 7 days after surgery(P＞0.1).However,the incidence of attention and/or executive function impairment was lower in the SGB group than in the control group(19.3％ vs.36.6％,P＜0.05).Conclusions The modified TMT-A and SDMT have good reliability and validity among Chinese middle-aged and elderly people aged 55-75 years.Preoperative SGB may protect attention and executive function in middle-aged and elderly patients.
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Objective To evaluate the effect of stellate ganglion block (SGB) on vascular cognitive impairment (VCI) in rats.Methods Forty SPF healthy male Sprague-Dawley rats,aged 4-6 weeks,weighing 200-220 g,were divided into 4 groups (n =10 each) using a random number table method:sham operation group (group Sham),VCI group,right SGB group (group R) and left SGB group (groupL).VCI was induced by permanently ligating bilateral common carotid arteries of anesthetized rats.SGB model was established by transection of the left and right cervical sympathetic trunk while establishing the VCI model in group L and group R,respectively.At 8 weeks after establishing VCI model,Morris water maze test was performed to evaluate the spatial learning and memory abilities,serum neuron-specific enolase (NSE) and S100β protein concentrations were determined by enzyme-linked immunosorbent assay,the hippocampal superoxide dismutase (SOD) activity and malondialdehyde (MDA) contents were measured using microplate method,and the expression of peroxisome proliferator-activated receptor gamma coactivator1α (PGC-1α),NADPH oxidase 1 (NOX1),zonula occludens-1 (ZO-1),and claudin-5 was detected by Western blot.Results Compared with group Sham,the escape latency was significantly prolonged,the time of staying at the target quadrant was shortened,the hippocampal MDA content and concentration of serum S100β protein and NSE were increased,hippocampal SOD activity was decreased,the expression of PGC-1α,ZO-1 and claudin-5 was down-regulated,and the expression of NOX1 was up-regulated in group VCI (P＜0.05).Compared with group VCI,the escape latency was significantly shortened,the time of staying at the target quadrant was prolonged,the hippocampal MDA content and concentration of serum S100β protein and NSE were decreased,hippocampal SOD activity was increased,the expression of PGC-1α,ZO-1 and claudin-5 was up-regulated,and the expression of NOX1 was down-regulated in group R,and the escape latency was significantly prolonged,the hippocampal SOD activity was increased,the MDA content was decreased,and the expression of NOX1 was down-regulated in group L (P＜0.05).Compared with group R,the escape latency was significantly prolonged,the time of staying at the target quadrant was shortened,the hippocampal MDA content and serum NSE concentration were increased,the hippocampal SOD activity was decreased,the expression of PGC-1α and claudin-5 was down-regulated,and the expression of NOX1 was up-regulated in group L (P＜0.05).Conclusion SGB can alleviate VCI,and left SGB produces better efficacy than right SGB,and the mechanism may be related to inhibiting the oxidative stress responses and reducing the damage to blood brain barrier in rats.
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Breast cancer related lymphedema (BCRL) is one of the most intractable complications after surgery. Patients suffer from physical impairment, as well as psychological depression. Moreover, a recent study revealed that cellulitis significantly increased the risk of BCRL, and cellulitis has been suggested as a risk factor of BCRL development. We describe a patient treated with stellate ganglion blocks (SGBs) without steroid for relief of symptoms and reduction of the arm circumference of breast cancer-related infectious lymphedema in a month. We measured the arm circumference at four locations; 10 cm and 5 cm above and below the elbow crease, numeric rating scale (NRS) score, lymphedema and breast cancer questionnaire (LBCQ) score on every visit to the pain clinic. A serial decrease of the arm circumference and pain score were observed after second injection. In the middle of the process, cellulitis recurred, we performed successive SGBs to treat infectious lymphedema. The patient was satisfied with the relieved pain and swelling, especially with improved shoulder range of motion as it contributes to better quality of life. This case describes the effects of SGB for infectious BCRL patients. SGB could be an alternative or ancillary treatment for infectious BCRL patients.