Reporte de caso: bloqueo del ganglio estrellado para manejo de la tormenta eléctrica / Case report: stellate ganglion blockade for electric storm management

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.

[Sonoanatomy survey of the distance between the suface of the skin and sixth cervical transverse process]

One of interventional procedure in pain specialty is Stellate Ganglion Block. In this study we tried to show more on the sonoanatomy of the area, including the diameter of longus coli muscle and the distance between sixth cervical transverse process and the surface of skin. Obviously, understanding different anatomical locations can help to more successful block and avoid possible complications. This descriptive study was performed on 145 patients who were candidated for elective orthopedic surgery. After patients consented, neck sonography was performed. Demographic data were recorded. Neck circumference, diameter of longus coli muscle and the distance between sixth cervical transverse process and the surface of skin were measured. The average distance from the skin to the transverse process was 2.84 cm and a maximum of 3.7 cm was recorded. Anteroposterior diameter of Longus coli muscle was 0.76 cm, on average. The distance from skin to the transverse process was significantly correlated with body mass index and neck circumference in both sexes. Since the average distance from the skin to the transverse process was 2.84 cm therefore, without any pressure on the skin, inserting the needle more than 2.84 cm has to be with coution, and when it is inserted more than 3.7 cm, it is possibly going off the main path