A lateral paracarotid approach for ultrasound-guided stellate ganglion block with a linear probe.

Recent reports suggest that ultrasound-guided stellate ganglion block (SGB) is safer and more accurate than classic SGB by the using the surface anatomical landmark. However, previous reports concern the classic paratracheal approach using a small specialized curved probe, which may not be appropriate in some patients. The authors have attempted several approaches, including paratracheal, trans-thyroidal, lateral paracarotid, and lateral approaches, to find a safe and suitable method for real-time ultrasound-guided SGB using a standard high-frequency linear probe. A total of 27 injections were performed on 27 patients with sensorineural hearing loss. The lateral paracarotid out-of-plane and lateral in-plane approaches were identified as the easiest and safest methods among the four tested. In this report, we describe a new lateral paracarotid approach for ultrasound-guided SGB. An ipsilateral paratracheal short-axis transverse scan was acquired at the C6 level with a linear probe (6-13 MHz). The probe was moved laterally, scanning the thyroid, carotid artery, internal jugular vein, longus colli muscle, and the transverse process of the C6, placing the carotid artery in the middle of the view. Light pressure was applied to the probe postero-medially to displace the carotid artery medially and completely compress the internal jugular vein. The needle was inserted out-of-plane between the lateral margin of the carotid artery and Chassaignac's tubercle, traversing the collapsed internal jugular vein, and targeted between the longus colli muscle and the prevertebral fascia. A total of 4 ml of 0.2% ropivacaine was injected for each procedure after a negative aspiration test. Successful blockade was confirmed with the onset of Horner's sign. All 27 injections resulted in successful blockade with Horner's sign presenting within 5 min after injection. Side effects were minor and caused minimal discomfort; they included hoarseness and a foreign body sensation. No hematomas formed after any injections. We suggest that this new lateral paracarotid approach, with out-of plane needle insertion at the C6 tubercle under transverse scan, is a convenient and safe method for performing real-time ultrasound-guided SGB, as it provides a wide, safe space for needle passage without risking thyroid or esophageal injury.

The optimal volume of 0.2% ropivacaine required for an ultrasound-guided stellate ganglion block.

BACKGROUND: This study was performed to find the optimal volume of local anesthetics needed for a successful ultrasound-guided stellate ganglion block (SGB) to treat head and neck pathology. METHODS: Fifteen female and fourteen male sensory-neural hearing loss patients received 4 times SGBs with 0.2% ropivacaine in volumes of 6, 4, 3 and 2 ml at 1 to 3 day intervals. Using the transverse short-axis view of the neck that showed Chassaignac's tubercle at the C6 level, a 25-gauge, and 4 cm needle was inserted via the lateral paracarotid approach with out-of-plane targeting between the prevertebral fascia and the ventral surface of longus colli muscle (subfascial injection). A successful block was confirmed with the onset of ptosis (Horner's syndrome). RESULTS: There were no significant statistical differences between the presence of Horner's syndrome and the volume of local anesthetics given. However, Horner's syndrome was present in all trials for the 4 ml and 6 ml groups. Six (20.7%) and three out (10.4%) of twenty-nine trials in the 2 ml and 3 ml groups, respectively, failed to elicit Horner's syndrome. The duration of action was significantly different in the 2 ml group compared to that of the 6 ml group, but there was no significant difference between the other groups, including the 4 ml vs. 6 ml groups. The side effects were not different between the groups. CONCLUSIONS: This data suggests that the optimal volume of 0.2% ropivacaine for ultrasound-guided SGB to treat the head and neck pathology in daily practice is 4 ml.

The effect of sub-Tenon lidocaine injection on emergence agitation after general anaesthesia in paediatric strabismus surgery.

BACKGROUND AND OBJECTIVE: Sevoflurane is widely used for paediatric anaesthesia. However, many cases of emergence agitation after sevoflurane anaesthesia have been reported and pain was suggested as a major contributing factor. The purpose of this study was to evaluate the effect of sub-Tenon lidocaine injection on emergence agitation in children receiving sevoflurane or propofol-remifentanil anaesthesia. METHODS: We enrolled 260 children, aged 4-10 years, who were scheduled for strabismus surgery, and randomized them to one of four groups: group SS, SL, BS, and BL. Anaesthesia was maintained with sevoflurane (SS, SL) or propofol-remifentanil infusion (BS, BL). At the end of surgery, the surgeon injected into the sub-Tenon space 1 ml of isotonic saline (SS, BS) or 2% lidocaine (SL, BL). Emergence behaviour was assessed in the post-anaesthesia care unit using a 5-point scoring scale (score 1, asleep; 2, awake and calm; 3, irritable or consolable crying; 4, inconsolable crying; and 5, severe restlessness). We defined a score of 4 or 5 as emergence agitation. The incidence of emergence agitation was analysed using χ² and Fisher's exact test. RESULTS: The incidence of emergence agitation in group SL and BL was significantly lower compared to group SS and BS, respectively (P = 0.011, 0.019). The lidocaine-injected group showed significantly lower occurrence of emergence agitation (10.4%) than isotonic saline-injected group (27.2%; P = 0.001). Emergence agitation was significantly higher following sevoflurane (25.0%) than balanced anaesthesia (13.1%; P = 0.023). CONCLUSION: The frequency of emergence agitation is significantly reduced by sub-Tenon lidocaine injection regardless of the modality of anaesthesia used.

Comparison of the incidences and risk factors for pulmonary complications after primary and revision total hip arthroplasty.

BACKGROUND: Risk factors for postoperative pulmonary complication (PPC) after total hip arthroplasty (THA) are poorly studied. In addition, the risk factors associated with revision THA may differ from those associated with primary THA. The purpose of this study was to compare the incidences of PPC after revision THA with those observed after primary THA, and to evaluate the risk factors. METHODS: We reviewed data describing patients who underwent primary (n = 410) and revision THA (n = 90) during a 10 year study period. The data included age, gender, body mass index, concurrent cardiopulmonary comorbidity, anesthetic techniques, operative time, the number of perioperative transfusions, the amount of fluid replaced, and the American Society of Anesthesiologists physical status. PPCs were grouped together as a single outcome and the incidence and the risk factors for PPC were analyzed. RESULTS: The incidence of PPC after revision THA was significantly higher than after primary THA (23.3% vs. 11.5%, P = 0.004). The significant risk factors in revision THA were the amount of fluid replaced > or = 3,000 ml (P = 0.014) and operative time > or = 180 min (P < 0.001), while there were no risk factors identified by primary THA during univariate analysis. Furthermore, the only significant risk factor identified by multiple logistic regression analysis was operative time (odds ratio = 8.2, P < 0.05). CONCLUSIONS: Patients undergoing revision THA are at higher risk of PPC than primary THA. The operative time is an important factor in the occurrence of PPC after revision THA.

Immunomodulatory and antitumor effects in vivo by the cytoplasmic fraction of Lactobacillus casei and Bifidobacterium longum.

The immunomodulatory and antitumor effects of lactic acid bacteria (LABs) were investigated. Cytoplasmic fraction of Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium longum were tested for the antiproliferative activity in vitro to SNUC2A, SNU1, NIH/3T3 and Jurkat cell lines by crystal violet assay. All cytoplasmic fraction suppressed proliferation of tumor cells, though L. casei and B. longum were more effective. From these results, cytoplasmic fraction of L. casei and B. longum with Y400 as a control were administered as dietary supplements to Balb/c mice for 2, and 4 consecutive wks. Administration for 4 wks enhanced the number of total T cells, NK cells and MHC class II+ cells, and CD4-CD8+ T cells in flow cytometry analysis. To determine of antitumor activity of LABs preparation in vivo, F9 teratocarcinoma cells were inoculated on mice at 14th day. Body weight was decreased with increased survival rate in all groups with the cytoplasm of LABs. Our results showed that cytoplasmic fraction of LABs had direct antiproliferative effects on tumor cell lines in vitro, effects on immune cells in vivo, and antitumor effects on tumor-bearing mice with prolonged survival periods.

Immunomodulatory and antitumor effects in vivo by the cytoplasmic fraction of Lactobacillus casei and Bifidobacterium longum

The immunomodulatory and antitumor effects of lactic acid bacteria (LABs) were investigated. Cytoplasmic fraction of Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium longum were tested for the antiproliferative activity in vitro to SNUC2A, SNU1, NIH/3T3 and Jurkat cell lines by crystal violet assay. All cytoplasmic fraction suppressed proliferation of tumor cells, though L. casei and B. longum were more effective. From these results, cytoplasmic fraction of L. casei and B. longum with Y400 as a control were administered as dietary supplements to Balb/c mice for 2, and 4 consecutive wks. Administration for 4 wks enhanced the number of total T cells, NK cells and MHC class II+ cells, and CD4-CD8+ T cells in flow cytometry analysis. To determine of antitumor activity of LABs preparation in vivo, F9 teratocarcinoma cells were inoculated on mice at 14th day. Body weight was decreased with increased survival rate in all groups with the cytoplasm of LABs. Our results showed that cytoplasmic fraction of LABs had direct antiproliferative effects on tumor cell lines in vitro, effects on immune cells in vivo, and antitumor effects on tumor-bearing mice with prolonged survival periods.