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Dai D, Zheng B, Yu Z, Lin S, Tang Y, Chen M, Ke P, Zheng C, Chen Y, Wu X. Right stellate ganglion block improves learning and memory dysfunction and hippocampal injury in rats with sleep deprivation. BMC Anesthesiol 2021; 21:272. [PMID: 34749669 PMCID: PMC8574040 DOI: 10.1186/s12871-021-01486-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Sleep deprivation (SD) often leads to complex detrimental consequences, though the mechanisms underlying these dysfunctional effects remain largely unknown. We investigated whether the right stellate ganglion block in rats can improve the spatial learning and memory dysfunction induced by sleep deprivation by alleviating the damage of hippocampus in rats. Methods Sixty four male Sprague Dawley rats were randomly divided into four groups: Control, SD (sleep deprivation), SGB (stellate ganglion block) and SGB + SD (stellate ganglion block+ sleep deprivation) (n = 16). The SGB and SD + SGB groups were subjected to right stellate ganglion block through posterior approach method once per day. SD and SD + SGB groups were treated with modified multi-platform water environment method for 96 h sleep deprivation in rats and their body weights were analyzed. Histopathological changes of hippocampal neurons in rats and the expression of Caspase-3 in hippocampus of rats was detected by western blotting. ELISA was used to detect the content of IL-6, IL-1 in hippocampus and serum melatonin levels. Results Compared with the group SD, the spatial learning and memory function of the group SD + SGB was improved, the weight loss was alleviated, the pathological damage of the hippocampus was reduced and the expression of IL-6, IL-1β and Caspase-3 in the hippocampus was decreased. The content of rat serum melatonin was also increased. Conclusions The right stellate ganglion block can improve the spatial learning and memory dysfunction of rats with sleep deprivation, and the underlying mechanism may be related to alleviating the apoptosis and inflammation of hippocampus of rats with sleep deprivation. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01486-4.
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Affiliation(s)
- Dongsheng Dai
- Department of Anesthesiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Biqiong Zheng
- Department of Anesthesiology, Anesthesiology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Zenggui Yu
- Department of Anesthesiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Shizhu Lin
- Department of Anesthesiology, Anesthesiology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Yijie Tang
- Fujian Provincial Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Mengnan Chen
- Fujian Provincial Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Peng Ke
- Fujian Provincial Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Chengjie Zheng
- Fujian Provincial Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Yanqing Chen
- Department of Anesthesiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China.
| | - Xiaodan Wu
- Department of Anesthesiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China.
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Jordão MR, Pessoa FG, Fonseca KC, Zanoni F, Salemi VM, Souza LE, Ribeiro ON, Fernandes F, Irigoyen MC, Moreira LFP, Mady C, Ramires FJA. Effects of sympathectomy on myocardium remodeling and function. Clinics (Sao Paulo) 2021; 76:e1958. [PMID: 33503174 PMCID: PMC7798118 DOI: 10.6061/clinics/2021/e1958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/08/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To evaluate the effects of sympathectomy on the myocardium in an experimental model. METHODS The study evaluated three groups of male Wistar rats: control (CT; n=15), left unilateral sympathectomy (UNI; n=15), and bilateral sympathectomy (BIL; n=31). Sympathectomy was performed by injection of absolute alcohol into the space of the spinous process of the C7 vertebra. After 6 weeks, we assessed the chronotropic properties at rest and stress, cardiovascular autonomic modulation, myocardial and peripheral catecholamines, and beta-adrenergic receptors in the myocardium. The treadmill test consisted of an escalated protocol with a velocity increment until the maximal velocity tolerated by the animal was reached. RESULTS The bilateral group had higher levels of peripheral catecholamines, and consequently, a higher heart rate (HR) and blood pressure levels. This suggests that the activation of a compensatory pathway in this group may have deleterious effects. The BIL group had basal tachycardia immediately before the exercise test and increased tachycardia at peak exercise (p<0.01); the blood pressure had the same pattern (p=0.0365). The variables related to autonomic modulation were not significantly different between groups, with the exception of the high frequency (HF) variable, which showed significant differences in CT vs UNI. There was no significant difference in beta receptor expression between groups. There was a higher concentration of peripheral norepinephrine in the BIL group (p=0.0001), and no significant difference in myocardial norepinephrine (p=0.09). CONCLUSION These findings suggest that an extra cardiac compensatory pathway increases the sympathetic tonus and maintains a higher HR and higher levels of peripheral catecholamines in the procedure groups. The increase in HF activity can be interpreted as an attempt to increase the parasympathetic tonus to balance the greater sympathetic activity.
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Affiliation(s)
- Maurício Rodrigues Jordão
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fernanda G. Pessoa
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Keila C.B. Fonseca
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fernando Zanoni
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Vera M.C. Salemi
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Leandro E. Souza
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Orlando N. Ribeiro
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fábio Fernandes
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Maria Claudia Irigoyen
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz Felipe P. Moreira
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Charles Mady
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Felix Jose Alvarez Ramires
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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Filippiadis DK, Tselikas L, Tsitskari M, Kelekis A, de Baere T, Ryan AG. Percutaneous Neurolysis for Pain Management in Oncological Patients. Cardiovasc Intervent Radiol 2019; 42:791-799. [DOI: 10.1007/s00270-019-02185-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 02/13/2019] [Indexed: 12/29/2022]
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Thompson LC, Ledbetter AD, Haykal-Coates N, Cascio WE, Hazari MS, Farraj AK. Acrolein Inhalation Alters Myocardial Synchrony and Performance at and Below Exposure Concentrations that Cause Ventilatory Responses. Cardiovasc Toxicol 2017; 17:97-108. [PMID: 26894885 DOI: 10.1007/s12012-016-9360-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Acrolein is an irritating aldehyde generated during combustion of organic compounds. Altered autonomic activity has been documented following acrolein inhalation, possibly impacting myocardial synchrony and function. Given the ubiquitous nature of acrolein in the environment, we sought to better define the immediate and delayed functional cardiac effects of acrolein inhalation in vivo. We hypothesized that acrolein inhalation would increase markers of cardiac mechanical dysfunction, i.e., myocardial dyssynchrony and performance index in mice. Male C57Bl/6J mice were exposed to filtered air (FA) or acrolein (0.3 or 3.0 ppm) for 3 h in whole-body plethysmography chambers (n = 6). Echocardiographic analyses were performed 1 day before exposure and at 1 and 24 h post-exposure. Speckle tracking echocardiography revealed that circumferential strain delay (i.e., dyssynchrony) was increased at 1 and 24 h following exposure to 3.0 ppm, but not 0.3 ppm, when compared to pre-exposure and/or FA exposure. Pulsed wave Doppler of transmitral blood flow revealed that acrolein exposure at 0.3 ppm, but not 3.0 ppm, increased the Tei index of myocardial performance (i.e., decreased global heart performance) at 1 and 24 h post-exposure compared to pre-exposure and/or FA exposure. We conclude that short-term inhalation of acrolein can acutely modify cardiac function in vivo and that echocardiographic evaluation of myocardial synchrony and performance following exposure to other inhaled pollutants could provide broader insight into the health effects of air pollution.
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Affiliation(s)
- Leslie C Thompson
- Environmental Public Health Division, United States Environmental Protection Agency (USEPA), 109 TW Alexander Drive, Mail Code: B105-02, Research Triangle Park, NC, 27711, USA
| | - Allen D Ledbetter
- Environmental Public Health Division, United States Environmental Protection Agency (USEPA), 109 TW Alexander Drive, Mail Code: B105-02, Research Triangle Park, NC, 27711, USA
| | - Najwa Haykal-Coates
- Environmental Public Health Division, United States Environmental Protection Agency (USEPA), 109 TW Alexander Drive, Mail Code: B105-02, Research Triangle Park, NC, 27711, USA
| | - Wayne E Cascio
- Environmental Public Health Division, United States Environmental Protection Agency (USEPA), 109 TW Alexander Drive, Mail Code: B105-02, Research Triangle Park, NC, 27711, USA
| | - Mehdi S Hazari
- Environmental Public Health Division, United States Environmental Protection Agency (USEPA), 109 TW Alexander Drive, Mail Code: B105-02, Research Triangle Park, NC, 27711, USA
| | - Aimen K Farraj
- Environmental Public Health Division, United States Environmental Protection Agency (USEPA), 109 TW Alexander Drive, Mail Code: B105-02, Research Triangle Park, NC, 27711, USA.
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Rajesh MC, Deepa KV, Ramdas EK. Stellate Ganglion Block as Rescue Therapy in Refractory Ventricular Tachycardia. Anesth Essays Res 2017; 11:266-267. [PMID: 28298801 PMCID: PMC5341629 DOI: 10.4103/0259-1162.194566] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Pain physicians and anesthesiologists routinely perform stellate ganglion block for the treatment of painful upper extremity sympathetic dystrophy. Close proximity of ganglion to vascular structures warrants some expertise and training in the procedure. Off late, successful use of the technique in intractable ventricular tachyarrhythmias has come in literature. We have few cases wherein we could successfully ablate intractable ventricular tachycardia with stellate block which was refractory to repeated shocks. We are reporting one such case with the intention of making an awareness in the anesthesia community about this treatment option.
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Affiliation(s)
- M C Rajesh
- Department of Anaesthesia, Baby Memorial Hospital, Kozhikode, Kerala, India
| | - K V Deepa
- Department of Anaesthesia, Baby Memorial Hospital, Kozhikode, Kerala, India
| | - E K Ramdas
- Department of Anaesthesia, Baby Memorial Hospital, Kozhikode, Kerala, India
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6
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Burke SM, Wein RO, Brinckerhoff LH, Dandekar MN, Naber SP, Riesenburger RI. Granular cell tumor of the stellate ganglion presenting with Horner's syndrome. J Clin Neurosci 2015; 22:1387-91. [PMID: 26094560 DOI: 10.1016/j.jocn.2015.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/27/2015] [Accepted: 03/03/2015] [Indexed: 11/25/2022]
Abstract
We report a granular cell tumor (GCT) that occurred within the stellate ganglion of a 26-year-old woman who initially presented with a unilateral Horner's syndrome and progressive right upper extremity pain. We also review the literature related to the differential diagnoses of such a cervicothoracic tumor, with particular emphasis on the embryologic origin of these possibilities. GCT are rare tumors of Schwann cell origin which are more often found in subcutaneous locations than in relation to neural elements. In this woman, a mass identified on preoperative imaging was positioned anterolateral to the T1 vertebral body and displaced the vertebral artery anteriorly. During surgery, the lesion was observed within the sympathetic chain in the area of the stellate ganglion. The sympathetic chain was transected above and below the mass in order to achieve an adequate resection. The pathology demonstrated polygonal cells with diffuse eosinophilic granular cytoplasm positive for CD68 (a marker of lysosomes) and S-100 (a marker of neural crest derivatives) which established the diagnosis of GCT. This is the first patient, to our knowledge, with a granular cell tumor arising from the stellate ganglion.
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Affiliation(s)
- Shane M Burke
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street #178, Proger 7, Boston, MA 02111, USA
| | - Richard O Wein
- Department of Otolaryngology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Laurence H Brinckerhoff
- Department of General Surgery, Division of Thoracic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Monisha N Dandekar
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Stephen P Naber
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ron I Riesenburger
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street #178, Proger 7, Boston, MA 02111, USA.
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Zhou W, Yamakawa K, Benharash P, Ajijola O, Ennis D, Hadaya J, Vaseghi M, Shivkumar K, Mahajan A. Effect of stellate ganglia stimulation on global and regional left ventricular function as assessed by speckle tracking echocardiography. Am J Physiol Heart Circ Physiol 2013; 304:H840-7. [PMID: 23335795 DOI: 10.1152/ajpheart.00695.2012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Left ventricular (LV) twist mechanics and regional strain during cardiac sympathetic efferent activation are poorly understood. The purpose of this study was to compare the effects of left stellate ganglia (LSG) and right stellate ganglia (RSG) stimulation on cardiac twist/untiwst mechanics and regional strain. In nine pigs, echocardiographic imaging and LV pressure-volume measurements were performed before and during unilateral and bilateral stellate ganglion stimulation. LSG and RSG stimulation significantly augmented LV end-systolic pressure by 24% and 22% (P < 0.01), maximal rate of LV pressure change by 167% and 165% (P < 0.01), and time constant of LV relaxation by 20% and 12% (P < 0.01), respectively. RSG stimulation resulted in a greater chronotropic response than LSG stimulation (RSG: 68% vs. LSG: 12%, P < 0.01). Both LSG and RSG stimulation significantly increased global epicardial and endocardial LV rotation and diastolic untwisting rate and reduced the time to peak rotation (P < 0.05). However, LSG stimulation predominantly increased radial and circumferential strain in the LV inferoseptal, inferior, posterior, and lateral regions, whereas RSG stimulation primarily increased radial and circumferential strain in the anteroseptal, anterior, and lateral LV regions. Stimulation of both stellate ganglia led to a uniform increase in all LV segments. Our data suggest that LSG and RSG stimulation lead to a global increase in LV twist, driven by distinct regional strain heterogeneity that may result from myocardial innervation from the LSG and RSG. These findings provide a better understanding of the global and regional functional consequences of regional myocardial innervation from the LSG and RSG.
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Affiliation(s)
- Wei Zhou
- Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
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Comparison of 2% mepivacaine, clipping, and radiofrequency thermocoagulation for duration and magnitude of action in peripheral arterial blood flow induced by sympathetic block in anesthetized dogs. Reg Anesth Pain Med 2011; 35:525-8. [PMID: 20975467 DOI: 10.1097/aap.0b013e3181fa69d2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Thoracic sympathetic block has recently been performed by placement of the clips on the sympathetic chain to interrupt nerve conduction. The aim of this study was to compare clipping with 2% mepivacaine and radiofrequency thermocoagulation for the potency of sympathetic block from the results of the duration and magnitude of the vasodilation effect induced by thoracic sympathetic block in dogs. METHODS We measured mean arterial pressure, heart rate, and right and left brachial artery blood flow (BABF) before and after thoracic sympathetic block in 24 dogs. The experimental protocol was designed as follows: (1) left thoracic sympathetic block by 1.0 mL of 2% mepivacaine (n = 8), (2) left thoracic sympathetic block by clipping (n = 8), and (3) left thoracic sympathetic block by radiofrequency thermocoagulation (n = 8). RESULTS Mean arterial pressure and heart rate did not change significantly throughout the study in either group. Left thoracic sympathetic block by 2% mepivacaine increased left BABF significantly from 5 to 70 mins after the block (baseline, 100%; peak at 10 mins after the block, 179% ± 33%; P < 0.01). Left thoracic sympathetic block by clipping increased left BABF significantly from 5 to 120 mins after the block (baseline, 100%; peak at 30 mins after the block, 156% ± 31%; P < 0.01). Left thoracic sympathetic block by radiofrequency thermocoagulation increased left BABF significantly from 5 to 120 mins after the block (baseline, 100%; peak at 10 mins after the block, 206% ± 31%; P < 0.01). CONCLUSIONS Clipping may have a same potency compared with 2% mepivacaine and a less potency compared with radiofrequency thermocoagulation in thoracic sympathetic block in dogs.
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Garneau SY, Deschamps A, Couture P, Levesque S, Babin D, Lambert J, Tardif JC, Perrault LP, Denault AY. Preliminary Experience in the Use of Preoperative Echo-guided Left Stellate Ganglion Block in Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2011; 25:78-84. [DOI: 10.1053/j.jvca.2010.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Indexed: 11/11/2022]
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10
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Comparison of bupivacaine, ropivacaine, and levobupivacaine in an equal dose and concentration for sympathetic block in dogs. Reg Anesth Pain Med 2011; 35:409-11. [PMID: 20814280 DOI: 10.1097/aap.0b013e3181e6acf1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to compare the potency of bupivacaine, ropivacaine, and levobupivacaine in an equal dose and concentration for sympathetic block. METHODS We measured mean arterial pressure, heart rate (HR), and right and left brachial artery blood flow (BABF) before and after cervicothoracic sympathetic block in 24 dogs. The experimental protocol was designed as follows: (1) left cervicothoracic sympathetic block with 1.0 mL of 0.25% bupivacaine (n = 8), (2) left cervicothoracic sympathetic block with 1.0 mL of 0.25% ropivacaine (n = 8), and (3) left cervicothoracic sympathetic block with 1.0 mL of 0.25% levobupivacaine (n = 8). RESULTS Mean arterial pressure and heart rate did not change significantly throughout the study in either group. Left cervicothoracic sympathetic block with 0.25% bupivacaine increased left BABF significantly from 5 to 100 mins after the block (baseline, 100%; peak at 20 mins after the block, 218% +/- 48%; P < 0.01). Left cervicothoracic sympathetic block with 0.25% ropivacaine increased left BABF significantly from 5 to 100 mins after the block (baseline, 100%; peak at 10 mins after the block, 254 +/- 38%; P < 0.01). Left cervicothoracic sympathetic block with 0.25% levobupivacaine increased left BABF significantly from 5 to 80 mins after the block (baseline, 100%; peak at 20 mins after the block, 183% +/- 38%; P < 0.01). CONCLUSIONS Ropivacaine may induce a greater increase in vasodilation than bupivacaine and levobupivacaine at the same dose and concentration for sympathetic block in dogs.
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Saxena AK, Aggarwal B, Nakra D, Sethi AK, Aggarwal AN. Evaluation of PR, RR, QT intervals and QT dispersion following stellate ganglion block in chronic shoulder-hand pain patients. Pain Pract 2007; 4:91-7. [PMID: 17166192 DOI: 10.1111/j.1533-2500.2004.04204.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Right stellate ganglion block (SGB) can increase QT interval, rate-corrected QT interval (QTc), QT dispersion (QTD), rate-corrected QTD (QTcD), and RR interval while left SGB can decrease these intervals in healthy volunteers. No such studies have been conducted in patients with chronic pain, hence this study was designed to investigate the effects of left and right SGB on these variables in chronic shoulder-hand pain patients. In this study, 28 patients with chronic shoulder-hand pain of at least 6 months duration were given right or left SGB depending on the shoulder affected. A 12-lead electrocardiogram (ECG) was recorded before the block, 30 minutes and 60 minutes after the block. PR interval, RR interval, QT interval were recorded in all 12 leads while QTc, QTD, and QTcD were calculated. Right SGB was performed in 21 patients. A significant decrease (P < 0.05) in PR interval and a significant increase (P < 0.05) in RR interval, QT interval, and QTc interval were observed. QTD showed a significant increase (P < 0.05) only at 30 minutes after right SGB. Left SGB was performed in seven patients. A significant decrease (P < 0.05) in QT interval was observed throughout the study period, while QTc showed a significant decrease (P < 0.05) only at 60 minutes after the block. We conclude that right SGB induces significant increase of QT interval, RR interval, QTc interval, QTD, and a significant decrease of PR interval while left SGB produces a significant decrease in QT and QTc intervals in patients with chronic shoulder-hand pain.
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Affiliation(s)
- Ashok K Saxena
- Department of Anesthesiology, University College of Medical Science and GTB Hospital, Dilshad Garden, Delhi, India.
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Comparison of 0.25% Levobupivacaine, 0.25% Bupivacaine, and 0.125% Bupivacaine for Duration and Magnitude of Action in Peripheral Arterial Blood Flow Induced by Sympathetic Block in Dogs. Reg Anesth Pain Med 2007. [DOI: 10.1097/00115550-200703000-00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Abdi S, Zhou Y, Doshi R, Patel N. Stellate ganglion block: Emphasis on the new oblique fluoroscopic approach. ACTA ACUST UNITED AC 2005. [DOI: 10.1053/j.trap.2005.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Comparison of 0.2% ropivacaine, 0.125% bupivacaine, and 0.25% bupivacaine for duration and magnitude of action in peripheral arterial blood flow induced by sympathetic block in dogs. Reg Anesth Pain Med 2004. [DOI: 10.1097/00115550-200409000-00009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Saxena AK, Saxena N, Aggarwal B, Sethi AK. An Unusual Complication of Sinus Arrest Following Right-Sided Stellate Ganglion Block: A Case Report. Pain Pract 2004; 4:245-8. [PMID: 17173606 DOI: 10.1111/j.1533-2500.2004.04309.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We present a case of a 29-year-old female patient who had presented to us for the management of her chronic right shoulder-hand pain and developed a sinus arrest following a right-sided stellate ganglion block (RSGB). This patient on receiving a diagnostic RSGB via the anterior paratracheal (C6) approach developed sinus arrest followed by apnea and unconsciousness. On institution of resuscitative measures involving tracheal intubation, positive pressure ventilation, cardiac massage, and intravenous atropine, spontaneous cardiac activity recovered in about 3 minutes. Other signs and symptoms resolved fully in a total of 10 minutes. She had persistent postural hypotension lasting for about 24 hours requiring bed rest and was discharged about 36 hours after the procedure, without any adverse sequelae. As the sinus node is supplied by the right-sided sympathetic chain, its blockade probably resulted in unopposed parasympathetic activity leading to asystole. Available evidence of the role of right stellate ganglion in regulation of cardiac electrophysiology and functioning is also discussed.
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Affiliation(s)
- Ashok K Saxena
- Pain Clinic, Department of Anesthesiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Shahdara, India.
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Klein RN, Burk DT, Chase PF. Anatomically and physiologically based guidelines for use of the sphenopalatine ganglion block versus the stellate ganglion block to reduce atypical facial pain. Cranio 2001; 19:48-55. [PMID: 11842841 DOI: 10.1080/08869634.2001.11746151] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This literature review is designed to develop guidelines needed for the use of a sphenopalatine ganglion block versus a stellate ganglion block to reduce atypical facial pain. We have reviewed the basic anatomy of both ganglia and the physiological responses usually associated with each, and have given an opinion on appropriate use of these therapeutic modalities.
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Affiliation(s)
- R N Klein
- Facial Pain Center, University of the Pacific School of Dentistry, San Francisco, California 94115, USA
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Müllenheim J, Preckel B, Obal D, Heiderhoff M, Hoff J, Thämer V, Schlack W. Left stellate ganglion block has only small effects on left ventricular function in awake dogs before and after induction of heart failure. Anesth Analg 2000; 91:787-92. [PMID: 11004027 DOI: 10.1097/00000539-200010000-00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Left stellate ganglion block (LSGB) results in acute sympathetic denervation of the left ventricular (LV) posterobasal wall. We investigated the effects of LSGB in chronically instrumented awake dogs before and after the induction of pacing-induced congestive heart failure. Twelve dogs were instrumented for measurement of global hemodynamics [LV pressure (LVP)], its first derivative (dP/dt), cardiac output (CO), and regional myocardial function (systolic posterobasal segment length shortening, mean velocity [SLmv]). Before the induction of heart failure (n = 12), LSGB did not affect CO [3.2+/-1.4 (control, mean +/- SD) vs. 3.3+/-1.6 L/min (LSGB, P = 0.45)] and SLmv (11.1+/-4.0 vs. 10.8+/-4.0 mm/s, P = 0.16), but slightly reduced LVP (130+/-12 vs. 125+/-14 mm Hg, P = 0.04), dP/dt(max) (3614+/-755 vs. 3259+/-644 mm Hg/s, P = 0.003) and dP/dt(min) (-3153+/-663 vs. -2970+/-725 mm Hg/s, P = 0.03). During heart failure (n = 8), global hemodynamics [CO (2.8+/-1.2 vs. 2.7+/-1.2 L/min, P = 0.04), LVP (119+/-6 vs. 112+/-9 mm Hg, P = 0.01), dP/dt(max) (1945+/-520 vs. 1824+/-554 mm Hg/s, P = 0.03) and dP/dt(min) (-2402+/-678 vs. -2243+/-683 mm Hg/s, P = 0.04)], as well as regional myocardial function, were significantly different after LSGB [SLmv] (8.0+/-3.8 vs. 6.9+/-3.4 mm/s, P = 0.02)]. In conclusion, even during heart failure, the hemodynamic changes after LSGB are small, confirming its broad margin of safety.
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Affiliation(s)
- J Müllenheim
- Institut für Herz- und Kreislaufphysiologie and Institut für Klinische Anaesthesiologie, Heinrich-Heine-Universität, Düsseldorf, Germany
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Lobato EB, Kern KB, Paige GB, Brown M, Sulek CA. Differential effects of right versus left stellate ganglion block on left ventricular function in humans: an echocardiographic analysis. J Clin Anesth 2000; 12:315-8. [PMID: 10960205 DOI: 10.1016/s0952-8180(00)00158-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVES To evaluate the effects of unilateral stellate ganglion blockade on left ventricular function. DESIGN Prospective cohort of patients with chronic regional pain syndrome type I and II of the upper extremity requiring therapeutic stellate ganglion blockade. SETTING University-affiliated hospital. PATIENTS Fifteen adult ASA physical status I and II patients with the diagnosis of chronic regional pain syndrome type I and II of the arm were studied. Right stellate ganglion block was performed in nine subjects and a left in six. INTERVENTIONS Stellate ganglion block was performed with 10 mL of 1% plain Xylocaine. Transthoracic echocardiograms were performed immediately prior and 30 min following the block. MEASUREMENTS Heart rate and blood pressure were monitored at regular intervals. Global systolic function was determined by calculating ejection fraction. Regional systolic motion was evaluated on the short axis and four-chamber views using the American Society of Echocardiography criteria. Diastolic function was assessed with pulsed-wave Doppler of the left ventricular outflow tract and the mitral valve. Data collected included isovolumic relaxation time and early and atrial velocity patterns. MAIN RESULTS A successful stellate ganglion block was achieved in all patients. Blood pressure and heart rate were not significantly different during data collection. Patients who underwent a right stellate ganglion block showed no significant differences in systolic or diastolic function. Following a left stellate ganglion block, global and regional systolic function remained unchanged. Isovolumic relaxation time was increased but did not reach statistical significance (80 +/- 13 ms to 88 +/- 9 ms; p = 0.09). Left ventricular end-diastolic (LVEDV) and end-systolic volumes (LVESV) were significantly increased (LVEDV from 73 +/- 9 mL to 100 +/- 9 mL, p < 0.02; LVESV from 31 +/- 4 mL to 37 +/- 4 mL, p < 0.03). CONCLUSIONS In patients without cardiovascular disease, unilateral denervation of the left ventricle after stellate ganglion block produces no clinical deleterious effects on left ventricular function.
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Affiliation(s)
- E B Lobato
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville 32610-0254, USA
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Schlack W, Dinter W. Haemodynamic effects of a left stellate ganglion block in ASA I patients. An echocardiographic study. Eur J Anaesthesiol 2000; 17:79-84. [PMID: 10758450 DOI: 10.1046/j.1365-2346.2000.00606.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In anaesthetized dogs, stellate ganglion blockade led to a moderate disturbance in left ventricular diastolic function. We investigated the effect of a left-sided block, following injection of 10 mL bupivacaine 0.5%, on echocardiographic variables of ventricular function in eight otherwise healthy patients with sympathetically mediated pain syndromes. After the blockade, heart rate (control: 66+/-3 (mean+/- SEM), block: 64+/-3 min-1) and mean arterial blood pressure (88.5+/-6.0 vs. 84.0+/-8.1 mmHg) were unchanged, but afterload decreased (end-systolic meridional wall stress; 69.6+/-9.9 vs. 59.8+/-7.1, P < 0.05). Stroke volume increased from 71.2+/-8.1 to 79.6+/-7.4 mL, P < 0.05. Variables of systolic function were unchanged, but relaxation was prolonged (isovolumic relaxation time; 71+/-5 vs. 81+/-4 ms, P < 0.05). In patients who were ASA I, there was a small impairment in echocardiographic variables during ventricular relaxation after a left stellate ganglion blockade. This small effect did not compromise ventricular function, and the heart responded with a small stroke volume increase to the simultaneous afterload reduction.
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Affiliation(s)
- W Schlack
- Institute of Clinical Anaesthesiology, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
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Ohinata Y, Makimoto K, Kawakami M, Haginomori S, Araki M, Takahashi H. Blood flow in common carotid and vertebral arteries in patients with sudden deafness. Ann Otol Rhinol Laryngol 1997; 106:27-32. [PMID: 9006357 DOI: 10.1177/000348949710600105] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Blood flow was measured in the common carotid artery (CCA) and the vertebral artery (VA) by the ultrasonic Doppler method in 14 male patients with sudden deafness and 70 normal adults. In the patients, blood flow on the affected side was slower than that on the normal side or that of the control group. Although these differences were not statistically significant in the CCA or in the VA, significant differences in the blood flow were noted between the group with a hearing loss of greater than 50 dB and the group with a loss of less than 50 dB. A negative correlation was found between blood viscosity and blood flow in both CCAs and both VAs. After stellate ganglion block (SGB), the blood flow of the CCA and VA increased on the side of the SGB and decreased on the opposite side. The changes in blood flow after SGB decreased with age, presumably because of changes in the blood vessel walls and a weaker response to sympathetic nerve receptors in the arterial wall.
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Affiliation(s)
- Y Ohinata
- Dept of Otolaryngology, Saiseikai Nakatsu Hospital, Osaka, Japan
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Schlack W, Ebel D, Thämer V. Effect of inotropic stimulation on the synchrony of left ventricular wall motion in a dog model of myocardial stunning. Acta Anaesthesiol Scand 1996; 40:621-30. [PMID: 8792895 DOI: 10.1111/j.1399-6576.1996.tb04498.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Reperfusion after short coronary occlusion induces regional myocardial dysfunction ("stunning"), including asynchrony of left ventricular (LV) wall motion. Contractile function of stunned myocardium can be increased by inotropic stimulation, but whether this has an influence on wall motion asynchrony is unknown. METHODS In six anaesthetized dogs, the effect of inotropic stimulation on regional myocardial function, and LV asynchrony was tested after the induction of regional stunning (by 15 min of left circumflex artery side branch occlusion). Regional myocardial function was assessed as mean systolic wall thickening velocity (Vswt) by sonomicrometry in the stunned (posterobasal wall) and normal myocardium (anteroapical wall), and LV asynchrony by the phase difference (phi) of the first Fourier transform of the wall thickness signals. RESULTS In the stunned myocardium, Vswt decreased from 8.6 +/- 1.0 to 1.7 +/- 1.4 mm s-1 (mean +/- SEM), P < 0.01, and simultaneously phi increased from 10.8 +/- 3.6 to 85.7 +/- 14.3 degrees, P < 0.01. Intracoronary noradrenaline (NADR, 0.25 microgram) improved Vswt (8.3 +/- 1.4 mm s-1, P < 0.01) in the stunned region and changed phi to -38.1 +/- 18.0 degrees, P < 0.05. Systemic NADR (5 micrograms) also increased Vswt of the stunned region (to 3.8 +/- 2.1 mm s-1, P < 0.05), but left phi unchanged (82.9 +/- 19.8 degrees). CONCLUSION Regional function of stunned myocardium can be augmented by inotropic stimulation with noradrenaline, but this does not result in an improvement of LV wall motion asynchrony during systemic inotropic stimulation.
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Affiliation(s)
- W Schlack
- Institut für Klinische Anaesthesiologie, Heinrich-Heine-Universität, Düsseldorf, Germany
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Schlack W, Thämer V. Unilateral changes of sympathetic tone to the heart impair left ventricular function. Acta Anaesthesiol Scand 1996; 40:262-71. [PMID: 8848929 DOI: 10.1111/j.1399-6576.1996.tb04430.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Different regions within the left ventricle are preferentially supplied by the left or right sympathetic system. In order to characterize different influences of left vs right sympathetic lateralization on LV function, haemodynamic effects of right and left stellate ganglion stimulations (RSGS and LSGS) as well as a right sympathetic block (RSB) were compared. METHODS Seven alpha-chloralose anaesthetized open chest dogs were instrumented for measurement of LV pressure (tip manometers) and regional LV wall thickness (WT, sonomicrometry) in the antero-apical wall (AW, innervated by right stellate ganglion) and postero-basal wall (PW, left stellate ganglion). Timing of regional myocadial wall motion was evaluated by the phase of the first Fourier transform of the WT signals, LV asynchrony by the phase difference (phi) between both regions, and LV diastolic function by the time constant of isovolumic relaxation (tau). Measurements were performed before and after RSB (5 ml of lidocaine 1%); in 6 dogs of this group, RSGS and LSGS (4 V, 0.2 ms, 20 Hz) were performed before RSB. In order to investigate a regional inotropic stimulation without systemic effect, 6 additional dogs received intracoronary noradrenaline injections (NIC, 0.25 microgram) into the left circumflex artery perfused myocardium. RESULTS LSGS and NIC led to an earlier PW-motion within the cardiac cycle (phase reduction by 40.0 +/- 15.0 degree (SEM) and 55.5 +/- 11.2 degrees) and RSGS induced an earlier AW-motion (by 33.7 +/- 15.2 degrees). After RSB, AW-motion was delayed (38.1 +/- 9.2 degrees). The consequence was an asynchronous wall motion pattern after all interventions (change in phi: LSGS-64.7 +/- 18.7 degrees, RSGS 41.1 +/- 15.7 degrees, NIC -74.5 +/- 17.4 degrees, RSB -52.6 +/- 14.6 degrees), and a prolonged relaxation (tau increase: RSGS 9.4 +/- 1.9, NIC 8.3 +/- 1.5, RSB 3.7 +/- 0.8 ms). CONCLUSION Unilateral increases as well as decreases of sympathetic tone to the heart result in an asynchronous wall motion pattern and an impaired LV relaxation.
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Affiliation(s)
- W Schlack
- Institut für Klinische Anaesthesiologie, Heinrich-Heine-Universität Düsseldorf, Germany
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