Left Stellate Ganglion Block Prior to Induction of Anesthesia for Surgical Sympathectomy in a Patient with Long QT Syndrome / 대한마취과학회지

Long QT Syndrome is characterized by syncope and fatal ventricular arrhythmia. Monotherapy with beta blockers is the first-line therapy. In patients with recurrent syncope despite therapy with beta blockers, combinations of the following modalities of treatment may be considered: pacemakers, left cervicothoracic sympathectomy, and implantable cardioverter defibrillators. Recently, we anesthetized a patient with Long QT Syndrome who underwent thoracoscopic left upper ganglionectomy for recurrent episodes of syncope and ventricular arrhythmia despite aggressive use of propranolol. Because of the increased risk of developing fatal ventricular arrhythmias during anesthesia and surgery, we performed a left stellate ganglion block prior to induction of anesthesia to prevent the ventricular arrhythmia that may be triggered by stimulation of the sympathetic nervous system and to assess the effect of surgical ganglionectomy on the QT interval. Following the block, the QT interval was shortened, and anesthesia and surgery was uneventful though anesthetic induction caused serious sympathetic responses. We recommend a left stellate ganglion block prior to induction of anesthesia in patients with Long QT Syndrome resistant to beta blocker to prevent fatal arrhythmia and to predict the efficacy of the surgical sympathectomy on the QT interval.

Stellate Ganglion Block for the Preventive Effect on the Attacks of Cluster Headache: A case report / 대한마취과학회지

Cluster headaches are recurrent, unilateral attacks of severe pain that almost always occur on the same side of the head. They are oculofrontal or oculotemporal, with radiation to the upper jaw. The precise cause of cluster headaches are still unknown and treatments are very difficult. A 34 year old male patient suffering from severe classical cluster headache was refered to the pain clinic from department of neurosurgery. The patient complained of severe pain on right oculotemporal area and his symptoms had been refractory to any other treatment. His symptoms were effectively relieved after oxygen inhalation and sphenopalatine ganglion block with 4% lidocaine 2 ml during his attack. I could effectively prevent the attack of the cluster headache using stellate ganglion block (SGB) with 0.25% bupivacaine 5 ml twice daily during 3 weeks.