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Groenendyk J, Mandler A, Luan D, Goljo E, Tedore T, Cheung JW, Markowitz SM. Management of Rapid Atrial Fibrillation Using Stellate Ganglion Blockade. JACC Case Rep 2024; 29:102530. [PMID: 39359988 PMCID: PMC11442341 DOI: 10.1016/j.jaccas.2024.102530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 07/16/2024] [Indexed: 10/04/2024]
Abstract
Background Stellate ganglion blockade has been demonstrated as an efficacious treatment for refractory ventricular tachyarrhythmias. There are no published reports of the use of this technique in management of rapid atrial arrhythmia. Case Summary A 73-year-old woman presented to our institution in rapid atrial fibrillation and cardiogenic shock. She was intubated for airway protection and underwent successful electrical cardioversion. However, atrial fibrillation returned multiple times with weaning of sedation for extubation. Stellate ganglion infusion catheter was placed with infusion of ropivacaine and subsequent maintenance of sinus rhythm, with successful extubation, ablation of atrial fibrillation, improvement of left ventricular ejection fraction, and discharge. Take-Home Message For selected patients, stellate ganglion blockade can be used as a technique to aid in the management of rapid atrial fibrillation.
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Affiliation(s)
- Jacob Groenendyk
- Department of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Ari Mandler
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Danny Luan
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Erden Goljo
- Department of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Tiffany Tedore
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Jim W Cheung
- Department of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Steven M Markowitz
- Department of Cardiology, Weill Cornell Medicine, New York, New York, USA
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Men X, Wang Q, Chen P, Hu WS, Chai Y, Shou HY, Zhou ZF. Subcutaneous nitroglycerin increased the success rate of radial artery cannulation in women with gestational hypertension undergoing cesarean section : A randomized controlled trial. DIE ANAESTHESIOLOGIE 2023; 72:28-35. [PMID: 36884054 PMCID: PMC10692033 DOI: 10.1007/s00101-023-01264-6] [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: 06/22/2022] [Revised: 10/06/2022] [Accepted: 11/20/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Radial artery cannulation helps to maintain the stability of maternal hemodynamics and reduce complications; however, it is difficult for women with gestational hypertension. Subcutaneous nitroglycerin was found to improve the first attempt success rate of radial artery cannulation in pediatric patients. Therefore, this study evaluated the effect of subcutaneous nitroglycerin on the radial artery diameter and area, blood flow rate and the success rate of radial artery cannulation in women with pregnancy-induced hypertension. METHODS A total of 94 women with gestational hypertension and risk of intraoperative bleeding undergoing cesarean section were identified and randomized into the subcutaneous nitroglycerin group and control group. The primary outcome was the success rate of left radial artery cannulation within 3 min after subcutaneous injecting (T2). The puncture time, number of attempts, the overall complications, and ultrasonographic measurements including radial artery diameter, cross-sectional area and depth were also recorded before subcutaneous injection (T1), 3 min after subcutaneous injection (T2) and immediately after radial artery cannulation (T3). RESULTS The first attempt success rate of radial artery cannulation was significantly higher (97.9% vs. 76.6%, p = 0.004) and procedure time to success was significantly shorter (111 ± 18 s vs. 171 ± 70 s, p < 0.001) in the subcutaneous nitroglycerin group as compared to the control group. The subcutaneous nitroglycerin group also had a significantly less overall number of attempts as 1/2/3 attempts (n), 46/1/0 vs. 36/7/4 (p = 0.008). Compared with the control group, the diameter and cross-sectional area of radial artery increased significantly at the T2 and T3 points in the subcutaneous nitroglycerin group (p < 0.001), as well as percentage change of radial artery diameter and CSA. Vasospasm (6.4% vs. 31.9%; p = 0.003) was significantly lower in the subcutaneous nitroglycerin group; however, no difference was found in hematoma (2.1% vs. 12.8%; p = 0.111). CONCLUSION Subcutaneous nitroglycerin along with the routine local anesthetic preparation before radial artery cannulation increased the first attempt success rate of radial artery cannulation and decreased the overall number of cannulation attempts in women with gestational hypertension and risks of intraoperative bleeding undergoing cesarean section, it also decreased cannulation times and overall number of vasospasms.
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Affiliation(s)
- Xin Men
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China
| | - Qian Wang
- Department of Anesthesiology, The Affiliated ZheJiang Hospital, School of Medicine, Zhejiang University, 315014, Hangzhou, China
| | - Pei Chen
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China
| | - Wen-Sheng Hu
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China
| | - Yun Chai
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China
| | - Hong-Yan Shou
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China
| | - Zhen-Feng Zhou
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China.
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Darçın K, Çetin S, Karakaya MA, Yenigün Y, Ateş MŞ, Gürkan Y. The effect of erector spinae plane block on arterial grafts in coronary artery bypass grafting. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:186-191. [PMID: 37484629 PMCID: PMC10357865 DOI: 10.5606/tgkdc.dergisi.2023.24089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/08/2022] [Indexed: 07/25/2023]
Abstract
Background This study aims to evaluate the sympathectomy effects of erector spinae plane block on the diameters and cross-sectional areas of the left and right internal mammary arteries and of the radial arteries. Methods This prospective study included a total of 25 patients (14 males, 11 females; median age: 67 years; range, 23 to 75 years) who underwent erector spinae plane block categorized as the American Society of Anesthesiologists Class III and underwent off-pump coronary artery bypass grafting between June 01, 2020 and March 01, 2021. The effects of erector spinae plane block on the diameters and cross-sectional areas of the left and right internal mammary arteries and radial arteries were assessed using ultrasonography images taken both before and 45 min after the procedure, from the third, fourth, and fifth intercostal spaces for the left and right internal mammary arteries and from 3 cm proximal to the wrist for the radial arteries. Results The diameters and cross-sectional areas of the left and right internal mammary arteries and radial arteries significantly increased compared to baseline values after the erector spinae plane block (p<0.05). There was no significant difference in the pre- and post-procedural heart rate and mean arterial pressure values (p>0.05). Conclusion The bilateral erector spinae plane block, which was performed at the T5 level, provided vasodilatation of the left and right internal mammary arteries and radial arteries without causing any significant difference in the heart rate and mean arterial pressure. These findings indicate that the sympathetic block produced by the erector spinae plane block may facilitate better surgical conditions by preventing arterial spasms. Thus, bilateral erector spinae plane block may be a promising technique to achieve regional anesthesia for off-pump coronary artery bypass grafting.
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Affiliation(s)
- Kamil Darçın
- Department of Anaesthesiology and Reanimation, Koç University Faculty of Medicine, Istanbul, Türkiye
| | - Seçil Çetin
- Department of Anaesthesiology and Reanimation, Koç University Faculty of Medicine, Istanbul, Türkiye
| | - Muhammet Ahmet Karakaya
- Department of Anaesthesiology and Reanimation, Acıbadem Ataşehir Hospital, Istanbul, Türkiye
| | - Yılmaz Yenigün
- Department of Anaesthesiology and Reanimation, Liv Hospital Vadistanbul, Istanbul, Türkiye
| | - Mehmet Şanser Ateş
- Department of Cardiovascular Surgery, Koç University Faculty of Medicine, Istanbul, Türkiye
| | - Yavuz Gürkan
- Department of Anaesthesiology and Reanimation, Koç University Faculty of Medicine, Istanbul, Türkiye
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Muacevic A, Adler JR, Castillo D. Brachial Plexus Block for Removal of Retained Radial Artery Sheath. Cureus 2022; 14:e33068. [PMID: 36726880 PMCID: PMC9886372 DOI: 10.7759/cureus.33068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
In this case, we present a lesser-known application of regional anesthesia, specifically, managing a patient with vasospasm and retained radial artery (RA) vascular sheath after coronary angiography. Providing an ultrasound-guided supraclavicular block, in combination with general anesthesia, allowed the proceduralist to remove the retained sheath after several hours of failed treatment and manipulation. Severe arterial spasm was alleviated by eliciting a sympathectomy, along with analgesia of the right upper extremity, and maintaining this post-procedure. The block optimized arterial flow through the RA post-intervention and helped manage the patients' pain from manipulation.
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Men X, Wang Q, Hu WS, Chai Y, Ni TT, Sho HY, Zhou ZF. Median nerve block increases the success rate of radial artery cannulation in women with gestational hypertension undergoing cesarean section. BMC Anesthesiol 2022; 22:248. [PMID: 35931948 PMCID: PMC9354365 DOI: 10.1186/s12871-022-01793-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/28/2022] [Indexed: 02/06/2023] Open
Abstract
Background The radial artery cannulation helps to maintain the stability of maternal hemodynamics and reduce complications, however, it is difficult for women with gestational hypertension. Ultrasound-guided median nerve block can cause arterial vasodilation, which may improve the success rate of radial artery cannulation. Methods Ninety-two women with gestational hypertension and risks of intra-operative bleeding undergoing cesarean section following failed ultrasound-guided cannulation were identified and randomized into the median nerve block group and control group. Median nerve block was performed under the guidance of ultrasound in the middle forearm and 5 ml of 0.5% lidocaine was injected. Subcutaneous local block was administered in the control group. The ultrasound-guided radial artery cannulation was performed ten minutes after blocking. Baseline measurements (T1) were performed after 10 minutes of rest. All variables were measured again at 10 (T2) and 30 (T3) minutes after median nerve block or local block. The primary outcome was the success rate of radial artery cannulation within 10 minutes after blocking. The puncture time, number of attempts, the overall complications, and ultrasonographic measurements including radial artery diameter and cross-sectional area were recorded before (T1), 10 minutes (T2) after, and 30 minutes (T3) after block. Results A total of 92 pregnant women were identified and completed the follow-up. As compared to control group, the first-attempt success rate of radial artery cannulation was significantly higher (95.7% vs78.3%, p = 0.027) and procedure time to success was significantly shorter (118 ± 19 s vs 172 ± 66 s, p < 0.001) in median nerve group. Median nerve group also had a significantly less overall number of attempts (p = 0.024). Compared with control group, the diameter and cross-sectional area of radial artery increased significantly at the T2 and T3 points in median nerve group (p < 0.001), as well as percentage change of radial artery diameter and CSA. No difference was observed in the overall complication at chosen radial artery, which including vasospasm (21.7% vs 28.3%; p = 0.470) and hematoma (4.3% vs 8.7%; p = 0.677). Conclusions Ultrasound-guided median nerve block can increase the first-attempt success rate of chosen radial artery cannulation in women with gestational hypertension and risks of intra-operative bleeding undergoing cesarean section following failed radial artery cannulation, and especially for those anesthesiologists with less experienced in radial artery cannulation. Trial registration ChiCTR2100052862; http://www.chictr.org.cn, Principal investigator: MEN, Date of registration: 06/11/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01793-4.
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Affiliation(s)
- Xin Men
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), Hangzhou, 315014, China
| | - Qian Wang
- Department of Anesthesiology, The Affiliated ZheJiang Hospital, School of Medicine, Zhejiang University, Hangzhou, 315014, China
| | - Wen-Shen Hu
- Department of Obstetrics, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), Hangzhou, 315014, China
| | - Yun Chai
- Department of Obstetrics, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), Hangzhou, 315014, China
| | - Ting-Ting Ni
- Department of Anesthesiology, Ningbo NO.7 Hospital, Ningbo, 320000, China
| | - Hong-Ye Sho
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), Hangzhou, 315014, China.
| | - Zhen-Feng Zhou
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), Hangzhou, 315014, China.
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Zafeiropoulos S, Doundoulakis I, Farmakis IT, Miyara S, Giannis D, Giannakoulas G, Tsiachris D, Mitra R, Skipitaris NT, Mountantonakis SE, Stavrakis S, Zanos S. Autonomic Neuromodulation for Atrial Fibrillation Following Cardiac Surgery: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 79:682-694. [PMID: 35177198 DOI: 10.1016/j.jacc.2021.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/12/2021] [Accepted: 12/07/2021] [Indexed: 12/17/2022]
Abstract
Autonomic neuromodulation therapies (ANMTs) (ie, ganglionated plexus ablation, epicardial injections for temporary neurotoxicity, low-level vagus nerve stimulation [LL-VNS], stellate ganglion block, baroreceptor stimulation, spinal cord stimulation, and renal nerve denervation) constitute an emerging therapeutic approach for arrhythmias. Very little is known about ANMTs' preventive potential for postoperative atrial fibrillation (POAF) after cardiac surgery. The purpose of this review is to summarize and critically appraise the currently available evidence. Herein, the authors conducted a systematic review of 922 articles that yielded 7 randomized controlled trials. In the meta-analysis, ANMTs reduced POAF incidence (OR: 0.37; 95% CI: 0.25 to 0.55) and burden (mean difference [MD]: -3.51 hours; 95% CI: -6.64 to -0.38 hours), length of stay (MD: -0.82 days; 95% CI: -1.59 to -0.04 days), and interleukin-6 (MD: -79.92 pg/mL; 95% CI: -151.12 to -8.33 pg/mL), mainly attributed to LL-VNS and epicardial injections. Moving forward, these findings establish a base for future larger and comparative trials with ANMTs, to optimize and expand their use.
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Affiliation(s)
- Stefanos Zafeiropoulos
- Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, New York, USA; Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, USA.
| | - Ioannis Doundoulakis
- Department of Cardiology, 424 General Military Training Hospital, Thessaloniki, Greece; Athens Heart Center, Athens Medical Center, Athens, Greece
| | - Ioannis T Farmakis
- Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Santiago Miyara
- Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, New York, USA; Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, USA
| | - Dimitrios Giannis
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, USA
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Raman Mitra
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Nicholas T Skipitaris
- Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York City, New York, USA
| | | | - Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Stavros Zanos
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, USA.
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Sinha C, Kumar A, Kumari P, Kumar A, Bhar D, Singh V. Does radial or median nerve blocks affect the area and blood flow of radial artery? Anaesth Crit Care Pain Med 2021; 40:100831. [PMID: 33744492 DOI: 10.1016/j.accpm.2021.100831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS Radial artery is a common site of cannulation in acute care setting. There are conflicting reports as to which nerve, radial or median or both supplies the radial artery. We did this prospective study in patients undergoing minor procedures under peripheral nerve blocks to ascertain which nerve block, radial or median increases the cross sectional area and blood flow in the radial artery. METHODS Ninety ASA I/II patients undergoing upper limb minor surgeries under various blocks (radial or median or radial + median nerve) were enrolled in this study. Patients in group R were those who received Ultrasound-guided (USG) radial nerve block, group M median nerve block while group MR received both the nerve blocks. The primary objective was to assess the increase in cross sectional area (CSA) of radial artery in the groups after the block. Secondary objectives included assessment of time average maximum velocity (TAMAX) and blood volume (BV) after the block. RESULTS The CSA, TAMAX and BV of radial artery increased in all the three groups. Within each group the difference between the preblock and postblock parameters were highly significant. However, the differences are greater in groups M and M + R than in group R; (P < 0.001). CONCLUSION Ultrasound-guided median nerve block causes arterial vasodilation, and an increase in radial artery blood flow velocity. There was no added benefit of radial block along with median block in increasing the blood flow further.
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Affiliation(s)
- Chandni Sinha
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Amarjeet Kumar
- Department of Trauma and Emergency, All India Institute of Medical Sciences (AIIMS), Patna, India.
| | - Poonam Kumari
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Ajeet Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Ditipriya Bhar
- Department of Community & Family Medicine, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Veena Singh
- Department of Burn & Plastic Surgery, All India Institute of Medical Sciences (AIIMS), Patna, India
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Chandran R, Sreedhar R, Gadhinglajkar S, Dash P, Karunakaran J, Pillai V. Combined effect of left stellate ganglion blockade and topical administration of papaverine on left internal thoracic artery blood flow in patients undergoing coronary revascularization. Ann Card Anaesth 2021; 23:170-176. [PMID: 32275031 PMCID: PMC7336979 DOI: 10.4103/aca.aca_144_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Left stellate ganglion blockade (LSGB) may have additive effect to topical administration of papaverine on prevention of vasospasm of left internal thoracic artery (LITA). Aims: This study aims to compare LITA blood flow with topical application of papaverine alone or in combination with LSGB. Setting: Tertiary care hospital. Design: Prospective randomized controlled study. Materials and Methods: A total of 100 patients operated for coronary revascularization were randomly and equally allocated into two groups. In control Group-C, papaverine was applied topically during the dissection of LITA. In Group-S, the additional LSGB was performed. Blood flow was measured from cut end of the LITA for 15 s. Primary objectives of the evaluation were to observe differences in the LITA blood flow. Observing incidence of radial-femoral arterial pressure difference after cardiopulmonary bypass (CPB) was secondary objective. Statistical Analysis: Student's unpaired t-test and Fisher's exact test to find out a significant difference between the groups. Results: LITA flow in Group-S was insignificantly more (49.28 ± 7.88 ml/min) than Group-C (47.12 ± 7.24 ml/min), (P = 0.15). Radio-femoral arterial pressure difference remained low for 40 min after termination of CPB in the Group-S compared to the Group-C (−0.99 ± 1.85 vs. −1.92 ± 2.26). Conclusion: Combining LSGB with papaverine does not increase the LITA blood flow compared to when the papaverine is used alone. However, ganglion blockade reduces radial-femoral arterial pressure difference after CPB. Blockade can be achieved successfully under the ultrasound guidance without any complications.
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Affiliation(s)
- Roshith Chandran
- Department of Cardiac Anaesthesia, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Rupa Sreedhar
- Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Shrinivas Gadhinglajkar
- Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Prashantkumar Dash
- Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jayakumar Karunakaran
- Department of CVTS, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Vivek Pillai
- Department of CVTS, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Imanishi A, Ichise H, Fan C, Nakagawa Y, Kuwahara K, Sumiyama K, Matsuda M, Terai K. Visualization of Spatially-Controlled Vasospasm by Sympathetic Nerve-Mediated ROCK Activation. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 191:194-203. [PMID: 33069718 DOI: 10.1016/j.ajpath.2020.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/06/2020] [Accepted: 09/23/2020] [Indexed: 01/30/2023]
Abstract
Contraction of vascular smooth muscle is regulated primarily by calcium concentration and secondarily by ROCK activity within the cells. In contrast to the wealth of information regarding regulation of calcium concentration, little is known about the spatiotemporal regulation of ROCK activity in live blood vessels. Here, we report ROCK activation in subcutaneous arterioles in a transgenic mouse line that expresses a genetically encoded ROCK biosensor based on the principle of Fӧrster resonance energy transfer by two-photon excitation in vivo imaging. Rapid vasospasm was induced upon laser ablation of arterioles, concomitant with a transient increase in calcium concentration in arteriolar smooth muscles. Unlike the increase in calcium concentration, vasoconstriction and ROCK activation continued for several minutes after irradiation. Both the ROCK inhibitor, fasudil, and the ganglionic nicotinic acetylcholine receptor blocker, hexamethonium, inhibited laser-induced ROCK activation and reduced the duration of vasospasm at the segments distant from the irradiated point. These observations suggest that vasoconstriction is initially triggered by a rapid surge of cytoplasmic calcium and then maintained by sympathetic nerve-mediated ROCK activation.
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Affiliation(s)
- Ayako Imanishi
- Laboratory of Bioimaging and Cell Signaling, Graduate School of Biostudies, Kyoto University, Kyoto, Japan
| | - Hiroshi Ichise
- Laboratory of Bioimaging and Cell Signaling, Graduate School of Biostudies, Kyoto University, Kyoto, Japan
| | - Chuyun Fan
- Laboratory of Bioimaging and Cell Signaling, Graduate School of Biostudies, Kyoto University, Kyoto, Japan
| | - Yasuaki Nakagawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Kenta Sumiyama
- Laboratory for Mouse Genetic Engineering, RIKEN Center for Biosystems Dynamics Research, Osaka, Japan
| | - Michiyuki Matsuda
- Laboratory of Bioimaging and Cell Signaling, Graduate School of Biostudies, Kyoto University, Kyoto, Japan; Department of Pathology and Biology of Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenta Terai
- Laboratory of Bioimaging and Cell Signaling, Graduate School of Biostudies, Kyoto University, Kyoto, Japan.
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Abd Allah E, Bakr MA, Abdallah Abdelrahman S, Taha AM, Kamel EZ. Preoperative left stellate ganglion block: Does it offer arrhythmia-protection during off-pump CABG surgery? A randomized clinical trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2020. [DOI: 10.1080/11101849.2020.1819110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Essam Abd Allah
- Departments of Anesthesia and ICU, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | | | - Ahmed M. Taha
- Cardiothoracic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Emad Zarief Kamel
- Departments of Anesthesia and ICU, Faculty of Medicine, Assiut University, Assiut, Egypt
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Connors CW, Craig WY, Buchanan SA, Poltak JM, Gagnon JB, Curry CS. Efficacy and Efficiency of Perioperative Stellate Ganglion Blocks in Cardiac Surgery: A Pilot Study. J Cardiothorac Vasc Anesth 2017; 32:e28-e30. [PMID: 29162313 DOI: 10.1053/j.jvca.2017.10.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Christopher W Connors
- Department of Anesthesiology and Pain Management, Maine Medical Center/Spectrum Medical Group, Portland, ME
| | - Wendy Y Craig
- Maine Medical Center Research Institute, Scarborough, ME
| | - Scott A Buchanan
- Department of Cardiac Surgery, Maine Medical Center, Portland, ME
| | - Justin M Poltak
- Department of Anesthesiology and Pain Management, Maine Medical Center/Spectrum Medical Group, Portland, ME
| | - James B Gagnon
- Department of Anesthesiology and Pain Management, Maine Medical Center/Spectrum Medical Group, Portland, ME
| | - Craig S Curry
- Department of Anesthesiology and Pain Management, Maine Medical Center/Spectrum Medical Group, Portland, ME
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12
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Backman SB. Radial artery spasm: Should we worry? Can J Anaesth 2017; 64:1165-1168. [PMID: 28822090 DOI: 10.1007/s12630-017-0946-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/07/2017] [Indexed: 12/12/2022] Open
Affiliation(s)
- Steven B Backman
- Department of Anesthesia, McGill University, Royal Victoria Hospital, Glen Site, Montreal, QC, Canada.
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13
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He GW, Taggart DP. Antispastic Management in Arterial Grafts in Coronary Artery Bypass Grafting Surgery. Ann Thorac Surg 2016; 102:659-68. [PMID: 27319987 DOI: 10.1016/j.athoracsur.2016.03.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/19/2016] [Accepted: 03/07/2016] [Indexed: 10/21/2022]
Abstract
Arterial grafts have long-term patency superior to vein grafts but have a tendency to develop spasm that can lead to potentially life-threatening complications. A perfect antispastic protocol should include advanced surgical technique and adequate pharmacologic methods. All pharmacologic vasodilator drugs relax the vessel through specific mechanisms, and therefore, there is no perfect, single best vasodilator to prevent or treat spasm of the arterial graft against all mechanisms of contraction. One of the choices is to use a combination of pharmacologic vasodilators targeting different mechanisms of spasm to obtain the reliable and best effect.
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Affiliation(s)
- Guo-Wei He
- Department of Cardiovascular Surgery and Center for Basic Medical Research, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin and Zhejiang University and The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China, and Department of Surgery, Oregon Health and Science University, Portland, Oregon.
| | - David P Taggart
- Department of Cardiothoracic Surgery, Oxford University, United Kingdom
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14
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He GW, Taggart DP. Spasm in Arterial Grafts in Coronary Artery Bypass Grafting Surgery. Ann Thorac Surg 2016; 101:1222-9. [DOI: 10.1016/j.athoracsur.2015.09.071] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/21/2015] [Accepted: 09/21/2015] [Indexed: 11/28/2022]
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15
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Guo W, Jin XJ, Yu J, Liu Y, Zhang JP, Yang DW, Zhang L, Guo JR. Effects of stellate ganglion block on the peri-operative vasomotor cytokine content and intrapulmonary shunt in patients with esophagus cancer. Asian Pac J Cancer Prev 2014; 15:9505-9. [PMID: 25422247 DOI: 10.7314/apjcp.2014.15.21.9505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To investigate the effects of stellate ganglion block (SGB) on the peri-operative vasomotor cytokine content and intrapulmonary shunt in patients with esophagus cancer who underwent thoracotomy. MATERIALS AND METHODS Forty patients undergoing elective resection of esophageal cancer patients who had I~II American Society of Anesthesiologist (ASA) were randomly divided into total intravenous anesthesia group (group N, n=20) and total intravenous anesthesia combined with SGB group (group S, n=20, 0.12 mL/kg 1% lidocaine was used for SGB 10 min before induction). Heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary arterial pressure (MPAP) and continuous cardiac output (CCO) were continuously monitored. The blood from internal jugular vein was drawn respectively before induction (T0), and 30 min (T1), 60 min (T2) and 120 min (T3) after one-lung ventilation (OLV), and 30 min (T4) after two-lung ventilation. The contents of plasma endothelin (ET), nitric oxide (NO) and calcitonin gene-related peptide (CGRP) were detected with enzyme linked immunosorbent assay (ELISA). Meanwhile, arterial and mixed venous blood samples were collected for determination of blood gas and calculation of intrapulmonary shunt fraction (Qs/Qt). RESULTS During OLV, ET contents were increased significantly in two groups (P<0.05), and no significant difference was presented (P>0.05). NO content in group S was obviously higher than in group N at T3 (P<0.05), whereas CGRP content in group N was markedly lower than in group S at each time point (P<0.05). Qs/Qt was significantly increased in both groups after OLV, but there was no statistical significant regarding the Qs/Qt at each time point between two groups. CONCLUSIONS Total intravenous anesthesia combined with SGB is conducive to regulation of perioperative vasomotor cytokines in thoracotomy, and has little effect on intrapulmonary shunt at the time of OLV.
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Affiliation(s)
- Wei Guo
- Department of Anesthesiology, Gongli Hospital of Shanghai Pudong New District, Shanghai, China E-mail :
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16
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Kulkarni KR, Kadam AI, Namazi IJ. Efficacy of stellate ganglion block with an adjuvant ketamine for peripheral vascular disease of the upper limbs. Indian J Anaesth 2011; 54:546-51. [PMID: 21224973 PMCID: PMC3016576 DOI: 10.4103/0019-5049.72645] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Stellate ganglion block (STGB) is commonly indicated in painful conditions like reflex sympathetic dystrophy, malignancies of head and neck, Reynaud’s disease and vascular insufficiency of the upper limbs. The sympathetic blockade helps to relieve pain and ischaemia. Diagnostic STGB is usually performed with local anaesthetics followed by therapeutic blockade with steroids, neurolytic agents or radiofrequency ablation of ganglion. There is increasing popularity and evidence for the use of adjuvants like opioid, clonidine and N Methyl d Aspartate (NMDA) receptor antagonist – ketamine – for the regional and neuroaxial blocks. The action of ketamine with sympatholytic block is through blockade of peripherally located NMDA receptors that are the target in the management of neuropathic pain, with the added benefit of counteracting the “wind-up” phenomena of chronic pain. We studied ketamine as an adjuvant to the local anaesthetic for STGB in 20 cases of peripheral vascular disease of upper limbs during the last 5 years at our institution. STGB was given for 2 days with 2 ml of 2% lignocaine + 8 ml of 0.25% bupivacaine, followed by block with the addition of 0.5 mg/kg of ketamine for three consecutive days. There was significant pain relief of longer duration with significant rise in hand temperature. We also observed complete healing of the gangrenous fingers in 17/19 patients.
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Affiliation(s)
- Kalpana R Kulkarni
- Department of Anesthesia, D.Y. Patil Medical College, Kolhapur, Maharashta, India
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