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Luo D, Su Y, Pang Y. Effects of ultrasound-guided stellate ganglion block on postoperative sore throat and postoperative sleep disturbance after lumbar spine surgery: a randomized controlled trial. BMC Anesthesiol 2023; 23:343. [PMID: 37838663 PMCID: PMC10576298 DOI: 10.1186/s12871-023-02301-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/28/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Postoperative sore throat and sleep disturbance are prevalent among patients undergoing spinal surgery, and these conditions can substantially impact their postoperative satisfaction and quality of life. The present study aimed to examine the impact of ultrasound-guided stellate ganglion block (SGB) on the occurrence of postoperative sore throat (POST) and postoperative sleep disturbance (PSD) in patients who undergo lumbar spine surgery under general anesthesia. METHODS Sixty patients were randomly assigned to either the experimental group (SGB group) or the control group (CG). Both groups received the same induction and maintenance drugs. However, the SGB group received a right SGB under ultrasound guidance 15 min before anesthesia induction, while the CG did not receive any block anesthesia intervention before anesthesia induction. We monitored the incidence and severity of POST at 1, 6, 24, and 48 h after surgery in both groups. Additionally, we evaluated the deep sleep quality score on the first, second, and fifth days after surgery in both groups. RESULTS The incidence of POST at 1 h and 6 h after surgery was significantly lower in the SGB group (10.0% and 13.3%) than in the CG (43.3% and 36.7%) (P < 0.05). The postoperative sore throat scores of the SGB group (0.10 ± 0.31 and 0.17 ± 0.46) at 1 h and 6 h after surgery were lower than those of the CG (0.57 ± 0.73 and 0.50 ± 0.77) (P < 0.05). Moreover, the deep sleep quality score on the first, second, and fifth days after surgery were significantly higher in the CG (5.40 ± 3.37, 4.70 ± 3.19, 4.53 ± 3.44) than in the SGB group (3.87 ± 2.30, 3.13 ± 1.77, 3.03 ± 1.84) (P < 0.05). CONCLUSION Ultrasound-guided SGB can reduce the incidence and severity of POST and improve PSD in patients undergoing lumbar spine surgery. TRIAL REGISTRATION This study was registered on Chinese Clinical Trial Registry, (ChiCTR2200065279) on 01/11/2022.
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Affiliation(s)
- Decai Luo
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yanhong Su
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yong Pang
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
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2
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Yuan Z, Luo J, Cheng QF, Zhang Q. Clinical efficacy of ultrasound-guided stellate ganglion block combined with extracorporeal shock wave therapy on limb spasticity in patients with ischemic stroke. BMC Neurol 2023; 23:349. [PMID: 37794321 PMCID: PMC10548723 DOI: 10.1186/s12883-023-03391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION To observe the clinical efficacy of ultrasound-guided stellate ganglion block (SGB) + extracorporeal shock wave therapy (ESWT) for limb spasticity in patients with ischemic stroke. METHODS A total of 60 patients with post-stroke limb spasticity in our hospital were selected and randomly divided into four groups (n = 15). In the control group, patients received routine rehabilitation training. Based on routine rehabilitation training, SGB group patients underwent ultrasound-guided SGB, ESWT group patients received ESWT, and SGB + ESWT group patients received ultrasound-guided SGB combined with ESWT. The total treatment course was one month. The Modified Barthel Index (MBI) score, Fugl-Meyer Assessment and upper limb rehabilitation training system were applied to evaluate the activities of daily living, upper limb motor function and upper limb performance before and after treatment. Finally, the improvement after treatment was compared among different groups. RESULTS After treatment, compared with the control group, the MBI score and the upper limb score based on Fugl-Meyer Assessment in the SGB, ESWT, and SGB + ESWT groups were significantly increased (P < 0.05). Furthermore, compared with the SGB and ESWT groups, SGB + ESWT exhibited a higher upper limb function score (P < 0.05), while the MBI score was not significantly different (P > 0.05). In terms of upper limb performance ability, patients in the SGB, ESWT and SGB + ESWT groups had better fitting degree, participation and exertion of exercise than those in the control group, and the SGB + ESWT group patients had the same movement trajectory as robots. CONCLUSION Ultrasound-guided SGB and ESWT can reduce the muscle tension of patients, alleviate spasticity, promote the motor function of the upper limb, and improve the working performance of patients. However, the effect of SGB combined with ESWT is better.
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Affiliation(s)
- Zhen Yuan
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China
- Rehabilitation medicine and physiotherapy, Medical Department of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Jun Luo
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China
| | - Qing-Feng Cheng
- Urology Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China
| | - Qiao Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.
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3
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Schwarzkopf P, Feigl GC, Mäcken T, Pracht K, Litz RJ. [Ultrasound-guided low-volume continuous cervical sympathetic nerve block for treatment of an electrical storm]. DIE ANAESTHESIOLOGIE 2023; 72:647-653. [PMID: 37433939 DOI: 10.1007/s00101-023-01312-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 07/13/2023]
Abstract
In addition to the treatment for complex regional pain syndrome (CRPS), the stellate ganglion block is a treatment option for refractory intermittent ventricular tachycardia (VT). Despite the use of imaging techniques, such as fluoroscopy and ultrasound, numerous side effects and complications have been reported. These are a result of the complex anatomical site and the volume of injected local anesthetics. This article reports on the catheter placement for continuous block of the cervical sympathetic trunk with high-resolution ultrasound imaging (HRUI) in a patient with intermittent VT. The tip of the cannula was placed on the anterior aspect of the longus colli muscle and 20 mg prilocaine 1% (2 ml) was injected. The VT stopped and a continuous infusion of 1 ml/h ropivacaine 0,2 % was started. Nevertheless, during the next hour the patient developed hoarseness and dysphagia, so that a block of the recurrent laryngeal nerve and the deep ansa cervicalis (C1-C3) was carried out. The infusion was paused and restarted later with 0.5 ml/h. The spread of the local anesthetic was controlled by ultrasound. Over the next 4 days the patient showed no VT or detectable side effects. After implantation of a defibrillator 1 day later the patient could then be discharged home on the following day. This case shows that the HRUI can be advantageously used in the catheter placement and also when adjusting the flow rate. In this way the risk of complications and side effects related to the puncture and local anesthetic volume can be reduced.
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Affiliation(s)
- Peter Schwarzkopf
- Klinik für Anästhesiologie, Intensiv‑, Palliativ- und Schmerzmedizin, Sana Kliniken Leipziger Land GmbH, Klinikum Borna, Rudolf-Virchow-Straße 2, 04552, Borna, Deutschland.
| | - Georg C Feigl
- Institut für Anatomie, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - Tim Mäcken
- Klinik für Anästhesiologie, Intensiv- und Schmerzmedizin, BG Universitätsklinikum Bergmannsheil, Bochum, Deutschland
| | - Karsten Pracht
- Klinik für Anästhesiologie, Intensiv‑, Palliativ- und Schmerzmedizin, Sana Kliniken Leipziger Land GmbH, Klinikum Borna, Rudolf-Virchow-Straße 2, 04552, Borna, Deutschland
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4
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van Weperen VYH, Ripplinger CM, Vaseghi M. Autonomic control of ventricular function in health and disease: current state of the art. Clin Auton Res 2023; 33:491-517. [PMID: 37166736 PMCID: PMC10173946 DOI: 10.1007/s10286-023-00948-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Cardiac autonomic dysfunction is one of the main pillars of cardiovascular pathophysiology. The purpose of this review is to provide an overview of the current state of the art on the pathological remodeling that occurs within the autonomic nervous system with cardiac injury and available neuromodulatory therapies for autonomic dysfunction in heart failure. METHODS Data from peer-reviewed publications on autonomic function in health and after cardiac injury are reviewed. The role of and evidence behind various neuromodulatory therapies both in preclinical investigation and in-use in clinical practice are summarized. RESULTS A harmonic interplay between the heart and the autonomic nervous system exists at multiple levels of the neuraxis. This interplay becomes disrupted in the setting of cardiovascular disease, resulting in pathological changes at multiple levels, from subcellular cardiac signaling of neurotransmitters to extra-cardiac, extra-thoracic remodeling. The subsequent detrimental cycle of sympathovagal imbalance, characterized by sympathoexcitation and parasympathetic withdrawal, predisposes to ventricular arrhythmias, progression of heart failure, and cardiac mortality. Knowledge on the etiology and pathophysiology of this condition has increased exponentially over the past few decades, resulting in a number of different neuromodulatory approaches. However, significant knowledge gaps in both sympathetic and parasympathetic interactions and causal factors that mediate progressive sympathoexcitation and parasympathetic dysfunction remain. CONCLUSIONS Although our understanding of autonomic imbalance in cardiovascular diseases has significantly increased, specific, pivotal mediators of this imbalance and the recognition and implementation of available autonomic parameters and neuromodulatory therapies are still lagging.
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Affiliation(s)
- Valerie Y H van Weperen
- Division of Cardiology, Department of Medicine, UCLA Cardiac Arrythmia Center, University of California, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | | | - Marmar Vaseghi
- Division of Cardiology, Department of Medicine, UCLA Cardiac Arrythmia Center, University of California, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA.
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Jentzer JC, Noseworthy PA, Kashou AH, May AM, Chrispin J, Kabra R, Arps K, Blumer V, Tisdale JE, Solomon MA. Multidisciplinary Critical Care Management of Electrical Storm: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81:2189-2206. [PMID: 37257955 PMCID: PMC10683004 DOI: 10.1016/j.jacc.2023.03.424] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/14/2023] [Indexed: 06/02/2023]
Abstract
Electrical storm (ES) reflects life-threatening cardiac electrical instability with 3 or more ventricular arrhythmia episodes within 24 hours. Identification of underlying arrhythmogenic cardiac substrate and reversible triggers is essential, as is interrogation and programming of an implantable cardioverter-defibrillator, if present. Medical management includes antiarrhythmic drugs, beta-adrenergic blockade, sedation, and hemodynamic support. The initial intensity of these interventions should be matched to the severity of ES using a stepped-care algorithm involving escalating treatments for higher-risk presentations or recurrent ventricular arrhythmias. Many patients with ES are considered for catheter ablation, which may require the use of temporary mechanical circulatory support. Outcomes after ES are poor, including frequent ES recurrences and deaths caused by progressive heart failure and other cardiac causes. A multidisciplinary collaborative approach to the management of ES is crucial, and evaluation for heart transplantation or palliative care is often appropriate, even for patients who survive the initial episode.
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Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Anthony H Kashou
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam M May
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jonathan Chrispin
- Clinical Cardiac Electrophysiology, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rajesh Kabra
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Kelly Arps
- Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Vanessa Blumer
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - James E Tisdale
- College of Pharmacy, Purdue University, West Lafayette, Indiana, USA; School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Michael A Solomon
- Critical Care Medicine Department, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, Maryland, USA; Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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6
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Patel S. Tranexamic acid-associated intrathecal toxicity during spinal anaesthesia: A narrative review of 22 recent reports. Eur J Anaesthesiol 2023; 40:334-342. [PMID: 36877159 DOI: 10.1097/eja.0000000000001812] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Therapeutic use of tranexamic acid (TXA) to minimise blood loss is common during a wide range of surgical procedures. This review aims to explore the clinical features of the accidental intrathecal administration of TXA and to identify contributory factors that might prevent future incidents. The author searched published reports of accidental intrathecal administration of TXA using Medline and Google Scholar databases from July 2018 to September 2022, including error reports in any language but excluding errors via nonintrathecal routes. The human factors analysis classification system (HFACS) framework was used to examine and classify the human and systemic factors that contributed to the errors. Twenty-two errors of accidental intrathecal administration were reported during the search period. The analysis showed that the outcome was death in eight patients (36%) and permanent harm in four (19%). The fatality rate was higher among female individuals (6/13 versus 2/8 male individuals). Two-thirds of errors (15/22) occurred during orthopaedic surgery (10) and lower segment caesarean sections (5). Nineteen of 21 patients developed refractory or super refractory status epilepticus, requiring mechanical ventilation and intensive care for 3 days to 3 weeks for those who survived the initial few hours. Severe sympathetic stimulation resulting in refractory ventricular arrhythmias was the final event in some patients, with death within a few hours. Lack of familiarity with clinical characteristics caused delayed diagnosis or confusion with other clinical conditions. A proposed plan to manage intrathecal TXA toxicity is presented, including immediate cerebrospinal fluid lavage; however, there is no specific approach. The HFACS suggested mistaking look-alike TXA ampoules for local anaesthetic was the predominant cause. The author concludes that inadvertent intrathecal TXA is associated with mortality or permanent harm in more than 50% of patients. The HFACS demonstrates that all errors are preventable.
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Affiliation(s)
- Santosh Patel
- From the Department of Anaesthesia, Tawam Hospital, Al Ain, UAE
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7
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Deng JJ, Zhang CL, Liu DW, Huang T, Xu J, Liu QY, Zhang YN. Treatment of stellate ganglion block in diseases: Its role and application prospect. World J Clin Cases 2023; 11:2160-2167. [PMID: 37122525 PMCID: PMC10131013 DOI: 10.12998/wjcc.v11.i10.2160] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/24/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
The stellate ganglion (SG), as a type of sympathetic ganglion, consists of the sixth and seventh cervical vertebrae and the first thoracic sympathetic ganglia. SG block (SGB) is a minimally invasive injection that aims to inject low-concentration local anesthetics to induce a broad sympathetic blocking effect near the SG. There have been no changes and progress in the clinical application of SGB since the 1830s due to several potential risks, including hematoma from blood vessel injury, hoarseness from recurrent laryngeal nerve injury, and cardiopulmonary arrest. The feasibility and safety of SGB have greatly improved since the appearance of ultrasound-guided SGB. In recent years, SGB has been widely applied in the field of non-anesthesiology sedation, with significant therapeutic effects on pain, immunological diseases, somnipathy, psychological disorders, arrhythmias, and endocrine diseases. The present study reviews the present application of SGB in clinical practice.
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Affiliation(s)
- Jing-Jing Deng
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou 514700, Guangdong Province, China
| | - Cai-Ling Zhang
- Department of Anesthesiology, Meizhou Hospital of Traditional Chinese Medicine, Meizhou 514700, Guangdong Province, China
| | - Dian-Wen Liu
- Department of Anesthesiology, Shangqiu Maternal and Children Health Care Hospital, Shangqiu 476000, Henan Province, China
| | - Tao Huang
- Department of Anesthesiology, Fengshun Hospital of Traditional Chinese Medicine, Meizhou 514700, Guangdong Province, China
| | - Jian Xu
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou 514700, Guangdong Province, China
| | - Qing-Yan Liu
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou 514700, Guangdong Province, China
| | - Yue-Nong Zhang
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou 514700, Guangdong Province, China
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8
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Chunyao LBS, Huiwen LMS, Yajiang ZMS, Ji LBS, Jingru YMS, Wei LMS, Jin GBS, Rong WMD. Application of Ultrasound-guided Stellate Ganglion Block in Treatment of Allergic Rhinitis. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2023. [DOI: 10.37015/audt.2023.220008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Chen W, Chen B, Wang F, Wu Q, Liu W, Wei H, Li C. Clinical Study of Stellate Ganglion Block Combined with General Anesthesia on Hemodynamics, Cognitive Function, and Gastrointestinal Function in Elderly Patients Undergoing Partial Hepatectomy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:1426753. [PMID: 34539796 PMCID: PMC8443347 DOI: 10.1155/2021/1426753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/28/2021] [Indexed: 02/05/2023]
Abstract
Partial hepatectomy under general anesthesia is prone to hemodynamic alterations, and stress reactions are the main contributing factors to postoperative cognitive function in elderly partial hepatectomy patients. Postoperative cognitive dysfunction increases the incidence of postoperative complications and long-term morbidity and mortality in elderly patients. With the increasing trend of aging population and the gradual increase of elderly people undergoing surgical treatment, it is especially important to study the corresponding prevention and treatment measures. In this study, a total of 90 patients with primary liver cancer who received hepatectomy in our hospital from July 2020 to July 2021 were included as the research subject. The changes in hemorheology, stress-related indexes, cognitive function, postoperative pain, and gastrointestinal function were compared between the two groups The results showed that SGB combined with general anesthesia can effectively reduce hemodynamic fluctuations in elderly partial hepatectomy patients, alleviate surgical stress, promote postoperative recovery of cognitive function and gastrointestinal function with high safety, and is worthy of clinical promotion.
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Affiliation(s)
- Wen Chen
- Department of Anesthesiology, Yuebei People's Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong 512026, China
| | - Baohua Chen
- Department of General Surgery, The 908th Hospital of Chinese People's Liberation Army Joint Logistic Support Force, Yingtan, Jiangxi 335001, China
| | - Fengxiang Wang
- Department of Anesthesiology, Yuebei People's Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong 512026, China
| | - Qingsong Wu
- Department of Hepatobiliary Surgery, Yuebei People's Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong 512026, China
| | - Wenying Liu
- Department of Hepatobiliary Surgery, Yuebei People's Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong 512026, China
| | - Hong Wei
- Department of Anesthesiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518052, China
| | - Changke Li
- Department of Anesthesiology, Yuebei People's Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong 512026, China
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Deshpande K, Gama W, Emerick T. An Alternative Role for the Pain Physician: Utilization of Stellate Block for Treatment Resistant Cardiac Arrhythmias. PAIN MEDICINE 2021; 22:1447-1451. [PMID: 33616170 DOI: 10.1093/pm/pnaa445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- K Deshpande
- Department of Anesthesiology and Perioperative Medicine, Division of Chronic Pain, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - W Gama
- Department of Anesthesiology and Perioperative Medicine, Division of Chronic Pain, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - T Emerick
- Department of Anesthesiology and Perioperative Medicine, Division of Chronic Pain, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Külahçıoğlu Ş, Kültürsay B, Küp A, Gürcü ME, Çardak ME, Gülşen K, Uslu A. Stellate ganglion blockade with percutaneous bupivacaine injection followed with surgical denervation in the management of electrical storm. J Electrocardiol 2021; 67:94-97. [PMID: 34102558 DOI: 10.1016/j.jelectrocard.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/08/2021] [Accepted: 05/24/2021] [Indexed: 12/07/2022]
Abstract
Electrical storm is a life-threatening medical emergency that requires immediate diagnosis and treatment. It can remain a clinical challenge despite anti-arrhythmic drugs and catheter ablation therapies. Autonomic modulation techniques have gained increased recognition in the treatment of refractory electrical storm cases. In our case, we present a patient with recurrent ventricular tachycardia/fibrillation episodes one week after a myocardial infarction. Patient's arrhythmia was refractory to antiarrhythmic drugs and hemodynamical status was unstable, thus catheter ablation under temporary mechanical circulatory support was the initial strategy. Ventricular fibrillation episodes relapsed 48 h after catheter ablation and we proceeded with autonomic modulation treatment options. Bilateral stellate ganglion blockade was performed under ultrasound guidance using bupivacaine. Sinus bradycardia was present and no ventricular arrhythmias were detected on post-procedure ECG. Stellate ganglion blockade was complemented with video-assisted thoracoscopic cardiac sympathetic denervation. After the last procedure, patient remained on sinus rhythm, was hemodynamically stable and extubated successfully.
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Affiliation(s)
- Ş Külahçıoğlu
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, Istanbul, Turkey
| | - B Kültürsay
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, Istanbul, Turkey.
| | - A Küp
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, Istanbul, Turkey
| | - M E Gürcü
- Department of Anesthesiology, Kartal Koşuyolu Education and Research Hospital, Istanbul, Turkey
| | - M E Çardak
- Department of Thoracic Surgery, Kartal Koşuyolu Education and Research Hospital, Istanbul, Turkey
| | - K Gülşen
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, Istanbul, Turkey
| | - A Uslu
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, Istanbul, Turkey
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Mohd Y, Kumar A, Sheikh I, Fatima A, Bhoi S, Jamshed N, Aggarwal P. Calming the storm - Stellate ganglion block in refractory ventricular arrhythmia in the emergency department. Am J Emerg Med 2021; 45:685.e5-685.e8. [PMID: 33436317 DOI: 10.1016/j.ajem.2020.12.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yaseen Mohd
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Akshay Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Irtiqa Sheikh
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Afroz Fatima
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Nayer Jamshed
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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