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PubMed1997

Comparison of stellate ganglion block with intravascular infusion of prostaglandin E1 on brachial artery blood flow in dogs.

We sought to determine whether sympathetic blockade or infusion of prostaglandin E1 (PGE1) is better for vasodilation. We measured brachial artery blood flow (BABF) in 10 mongrel dogs using an ultrasonic time flowmeter to compare the effects of stellate ganglion block (SGB) and intravascular infusion of PGE1. The experimental protocol was designed as follows: 1) intravenous (IV) infusion of PGE1 at a rate of 10 ng x kg(-1) x min(-1) for 10 min, 2) IV infusion of PGE1 at a rate of 150 ng x kg(-1) x min(-1) for 10 min, 3) intraarterial infusion of PGE1 at a rate of 0.1 ng x kg(-1) x min(-1) for 10 min, 4) SGB with 0.5% mepivacaine 1.0 mL was used as a sympathetic blockade. These procedures were successively performed on each dog. Mean arterial pressure (MAP), heart rate (HR), and BABF were measured before and after each procedure for 40 min. MAP and HR did not change significantly after the procedures. BABF increased significantly after IV infusion of PGE1 150 ng x kg(-1) x min(-1), intraarterial infusion of PGE1 and SGB, reaching maximums of 157%, 174%, and 171% 10 min after IV infusion of PGE1 150 ng x kg(-1) x min(-1), intraarterial infusion of PGE1 and SGB compared with the prevalues, respectively. These data indicate that sympathetic blockade may produce the same vasodilation as IV infusion of PGE1 150 ng x kg(-1) x min(-1) and intraarterial infusion of PGE1 0.1 ng x kg(-1) x min(-1). Intravascular infusion of PGE1 could provide clinically equivalent vasodilation without the complications associated with SGB.

Alprostadil↗
PubMed1990

[Stellate ganglion block in the treatment of ischemic syndrome in an upper limb due to accidental intra-arterial injection of pharmacologic substances or narcotics].

The paper describes five cases of accidental intraarterial injection of pharmacological drugs (diazepam or thiopentone) or dope (heroin) in an upper limb. Following a review of the physiopathological mechanisms which led to ischemic damage, the Authors outline a protocol of continuous pharmacological sympathicolysis in the affected limb, using repeated anesthetic blocks of the homolateral stellate ganglion.

Arm↗
PubMed1990

Effect of stellate ganglion block on cerebral blood flow in normoxemic and hyperoxemic states.

This study was undertaken to clarify whether stellate ganglion block (SGB) changed cerebral blood flow (CBF) in both atmospheric conditions (rest) and hyperbaric oxygen (HBO, under 2 atm absolute). Unilateral SGB was performed on 16 patients with sudden deafness with the injection of 8 ml of 1% mepivacaine and CBF was measured 20 min thereafter. The mean hemispheric blood flow on the block side (CBFi) and the nonblock side (CBFc) was measured by the intravenous xenon-133 method, being expressed as the initial slope index. In the atmospheric condition, the CBFi of seven patients before and after SGB was 50.4 +/- 8.4 and 49.0 +/- 5.9 (mean +/- SD) ml/100 g/min, respectively, with no significant change between them. There was also no significant change in the regional distribution of CBF, i.e., the blood flow of the frontal, pariental, temporal, and occipital lobes in hemispheres. In the hyperbaric condition, the CBFi of nine patients under HBO(mean PaO2 = 1,141 mm Hg) and HBO with SGB (mean PaO2 = 1,138 mm Hg) was 39.4 +/- 6.2 and 37.7 +/- 7.0 ml/100 g/min, respectively, being significantly less (p <0.05) than 46.5 +/- 8.0 ml/100 g/min at rest (mean PaO2 = 88 mm Hg). However, SGB had no effect on the reduction in CBFi in the hyperoxemic state. There was also no effect of SGB on CBFc, which was almost equal to the corresponding CBFi in the atmospheric and hyperbaric environments. It is concluded that unilateral SGB does not alter CBF and its regional distribution at least in neurologically normal humans, whether in the normoxemic or hyperoxemic state. It is also suggested that blockade of the cervical sympathetic nervous system is not preventive of the CBF reduction in the hyperoxemic state.

Journal Article↗
PubMedDate not supplied

Transient locked-in syndrome after vascular injection during stellate ganglion block.

Intravertebral artery injection of local anesthetics is a rare and alarming complication of neural blocks of the neck. Although seizures, apnea, and loss of consciousness occur, an unusual syndrome with sparing of eye movement might also occur. In transient locked-in syndrome, the patient remains conscious despite inability to breathe or move. The authors report a patient with apparent transient locked-in syndrome that resulted during a stellate ganglion block. This complication is different from frequently reported stroke-like complications. Needle position in the vertebral artery is a possible explanation for the negative aspiration of blood this patient experienced.

Apnea↗
PubMed2005

Modulation of Ca2+ channels by opioid receptor-like 1 receptors natively expressed in rat stellate ganglion neurons innervating cardiac muscle.

Postganglionic sympathetic nerve terminals innervate cardiac muscle and express opioid receptor-like 1 (ORL1) receptors, the most recently described member of the opioid receptor subclass. ORL1 receptors are stimulated by the endogenous heptadecapeptide nociceptin (Noc). To better understand how the signaling events by Noc regulate sympathetic neuron excitability, the goal of the present study was to determine whether sympathetic stellate ganglion (SG) neurons, innervating the heart, natively express ORL1 opioid receptors and couple to Ca(2+) channels. SG neurons in adult male rats were retrograde-labeled with a fluorescent tracer via injection of the ventricular muscle employing ultrasound imaging. Thereafter, N-type Ca(2+) channel modulation was investigated using the whole-cell variant of the patch-clamp technique. Exposure of labeled SG neurons to Noc resulted in a concentration-dependent inhibition of Ca(2+) currents (with an estimated EC(50) of 193 +/- 14 nM). Pre-exposure of SG neurons to the ORL1 receptor blocker, [Nphe(1),Arg(14),Lys(15)]N/OFQ-NH(2) (UFP-101), significantly decreased the Noc-mediated Ca(2+) current inhibition. The Ca(2+) current inhibition was also blocked by pertussis toxin pretreatment, indicating that signaling occurs via Galpha(i/o) G proteins. Finally, the full-length ORL1 receptor cDNA in SG neurons was cloned and sequenced. Of the two known alternatively spliced variants in rats, sequencing analysis showed that the ORL1 receptor expressed in SG neurons is the short form. Overall, these results suggest that stimulation of postsynaptic ORL1 receptors by Noc in SG neurons regulate cardiac sympathetic activity.

Amino Acid Sequence↗
PubMedDate not supplied

The effects of stellate ganglion block on the idiopathic prolongation of the Q-T interval with cardiac arrhythmia (the Romano-Ward syndrome).

The association of a prolonged Q-T interval, congenital deafness, and syncopal attacks due to ventricular fibrillation following emotional or physical stress is known as the Jervell-Lange-Nielsen syndrome. Absence of the congenital deafness characterizes the otherwise identical Romano-Ward syndrome. Both conditions have a high mortality rate and are recognized as contributing to sudden death in children. Although the pathogenetic factors are not yet completely elucidated, the condition is well enough understood to permit effective treatment. The authors performed a left stellate ganglion block in a 12-year-old girl with a mild form of the Romano-Ward syndrome, shortening the Q-T interval and eliminating the ventricular tachyarrhythmia. The left stellete ganglion block should be considered by anesthesiologists as an emergency measure, effective in interrupting the attack.

Child↗
PubMed2004

Long-term subthreshold electrical stimulation of the left stellate ganglion and a canine model of sudden cardiac death.

OBJECTIVES: We sought to develop a high-yield canine model of sudden cardiac death (SCD). BACKGROUND: Because electrical stimulation is a powerful means to elicit nerve sprouting, we hypothesize that subthreshold electrical stimulation is more effective than nerve growth factor (NGF) infusion in inducing nerve sprouting and SCD in dogs with myocardial infarction (MI) and complete atrioventricular block (CAVB). METHODS: We gave subthreshold electrical stimulation to the left stellate ganglion (LSG) in six normal dogs for 41 +/- 9 days (protocol 1) and to six dogs with MI and CAVB for 41 +/- 29 days, while continuously monitoring their cardiac rhythm (protocol 2). We also monitored the rhythm of two dogs with MI, CAVB, and NGF infusion to the LSG and determined the ventricular nerve density in six healthy control dogs. RESULTS: In protocol 1, the hearts from dogs with LSG electrical stimulation had a higher density of nerve fibers immunopositive to tyrosine hydroxylase, synaptophysin, and growth-associated protein-43 than those of normal control dogs (p < 0.01). In protocol 2, there was a high magnitude of cardiac nerve sprouting in all dogs studied. Ventricular tachycardia > or =8 beats and > or =20 beats was more frequent in dogs with electrical stimulation than in dogs with NGF infusion to the LSG (36 +/- 60 and 11 +/- 17 vs. 4.7 +/- 6.1 and 0.1 +/- 0.33 episodes per day, p < 0.05 and p < 0.03, respectively). Four of six dogs in protocol 2 had SCD. CONCLUSIONS: Subthreshold electrical stimulation of the LSG induces cardiac nerve sprouting and sympathetic hyperinnervation and facilitates the development of a high-yield canine model of ventricular arrhythmia and SCD.

Animals↗
PubMed1999

[A case of progressive hemifacial atrophy with Pourfour de Petit syndrome which was successfully treated by stellate ganglion block].

We herein report a 31-year-old woman with progressive hemifacial atrophy. The atrophy at her left face began about ten years ago. She had been in a traffic accident one year before the onset of her facial atrophy. Neurological examination revealed anisocoria (right < left) and retraction of the left eyelid, which thus suggested the presence of Pourfour de Petit syndrome. The pupillary reaction to both cocaine and tyramine were reduced bilaterally. Thermography of the face showed slightly lower surface temperature on the left side. A facial thermal sweat test was normal. These findings indicated local hyperactivity of the sympathetic nervous system at the Th 1-Th2 levels on the left side. A left stellate ganglion block effectively induced an accumulation of the subcutaneus tissue of her face on the left side. This is a very rare case in which local sympathetic hyperactivity is present and has caused progressive hemifacial atrophy.

Adult↗
PubMed2001

[Treatment with stellate ganglion block, continuous epidural block and ulnar nerve block of a patient with postherpetic neuralgia who developed complex regional pain syndrome (CRPS)].

We present a case of a 46-year-old female patient with systemic lupus erythematosus who developed herpes zoster of the right eighth cervical nerve. Her whole right forearm, hand and the first through fifth fingers were coated with some gel and protected against pain. She had been suffering from continuous and spasmodic burning pain, hyperalgesia, allodynia, drop in skin temperature, sudmotor disturbance, edema, constructure of the joints, muscle atrophy and bone atrophy of her right upper extremity probably due to postherpetic neuralgia (PHN) associated with complex regional pain syndrome (CRPS). She received right stellate ganglion block (SGB), continuous cervical epidural block and right ulnar nerve block. Reduction of pain and edema as well as improvement in mobility of each joint of her right upper extremity was observed. We suspect that SGB, continuous cervical epidural block and ulnar nerve block are effective and useful alternative treatments in a patient with PHN associated with CRPS of the eighth cervical nerve.

Analgesia, Epidural↗
PubMed1999

Sudden unexpected death following stellate ganglion block.

A 29-year-old woman, who had been suffering from left facial palsy, died 3.5 hours after undergoing stellate ganglion block (SGB). Autopsy revealed subcutaneous emphysema of the body, bilateral pneumothorax and a huge post-tracheal hematoma. The lower half of the trachea was markedly flattened by pressure from this hematoma. The cause of death was certified as airway obstruction due to a post-tracheal hematoma following SGB. The doctor cut both the anterior and the posterior wall of the trachea, because the trachea was flattened by the hematoma. He then intubated and sent air into the post-tracheal space. We consider that the patient could have recovered if she had received the correct tracheotomy. We therefore conclude that there was professional error on the part of the doctor in the form of medical malpractice.

Journal Article↗
PubMed1988

[The monitoring of sympathetic activity following stellate ganglion block].

Variations in skin resistance are an indicator of a patient's sympathetic nerve activity. To record these variations, a mobile measuring system was developed. Even if this method is not yet used as a clinical routine, it could be helpful in studying the effects of nerve blocks in anesthesia. It seems to be advantageous for estimating the effectiveness of a block, the stress of the patient, and for recognizing very early reactions of a patient's sympathetic system. METHOD. An objective sign of a successful and sufficient block should be diminishing and finally the total lack of skin reaction amplitudes if the block is total. This was measured in a patient (male, 30 years old, nonsmoker, calm type) who suffered from a sudden loss of hearing on the left for four consecutive days when his left stellate ganglion was blocked. The effectiveness of the block was estimated from a two-channel measurement of skin reactions. On one channel the skin resistance of the blocked left side was recorded and on the other, unblocked skin areas of the right side were measured simultaneously. RESULTS. Although all four blocks were successful, which was evidenced by a Horner syndrome as well as elevated skin temperature 1-2 min after the injection of 7 ml bupivacaine (C6/C7), in all four cases residual sympathetic activity could be measured. In Fig. 1, the diminishing amplitudes of channel A as compared with channel B demonstrate this finding after the onset of a block at 2:03 p.m. An interpretation of skin reactions generated by a series of action potentials is given.(ABSTRACT TRUNCATED AT 250 WORDS)

Autonomic Nerve Block↗
PubMed2006

M(1) and M(2) muscarinic acetylcholine receptor subtypes mediate Ca(2+) channel current inhibition in rat sympathetic stellate ganglion neurons.

Muscarinic acetylcholine receptors (mAChRs) are known to mediate the acetylcholine inhibition of Ca(2+) channels in central and peripheral neurons. Stellate ganglion (SG) neurons provide the main sympathetic input to the heart and contribute to the regulation of heart rate and myocardial contractility. Little information is available regarding mAChR regulation of Ca(2+) channels in SG neurons. The purpose of this study was to identify the mAChR subtypes that modulate Ca(2+) channel currents in rat SG neurons innervating heart muscle. Accordingly, the modulation of Ca(2+) channel currents by the muscarinic cholinergic agonist, oxotremorine-methiodide (Oxo-M), and mAChR blockers was examined. Oxo-M-mediated mAChR stimulation led to inhibition of Ca(2+) currents through voltage-dependent (VD) and voltage-independent (VI) pathways. Pre-exposure of SG neurons to the M(1) receptor blocker, M(1)-toxin, resulted in VD inhibition of Ca(2+) currents after Oxo-M application. On the other hand, VI modulation of Ca(2+) currents was observed after pretreatment of cells with methoctramine (M(2) mAChR blocker). The Oxo-M-mediated inhibition was nearly eliminated in the presence of both M(1) and M(2) mAChR blockers but was unaltered when SG neurons were exposed to the M(4) mAChR toxin, M(4)-toxin. Finally, the results from single-cell RT-PCR and immunofluorescence assays indicated that M(1) and M(2) receptors are expressed and located on the surface of SG neurons. Overall, the results indicate that SG neurons that innervate cardiac muscle express M(1) and M(2) mAChR, and activation of these receptors leads to inhibition of Ca(2+) channel currents through VI and VD pathways, respectively.

Animals↗
PubMed1988

Delayed afterdepolarizations elicited in vivo by left stellate ganglion stimulation.

Activation of cardiac sympathetic nerves is recognized as a triggering factor for cardiac arrhythmias. However, the mechanisms involved have only been speculated. Because evidence from studies in vitro has established a relation between catecholamines, delayed afterdepolarizations (DAD), and triggered rhythms, it seemed possible that in vivo adrenergic activation also might lead to the development of DAD. Because very little evidence was available for DAD in vivo, we have evaluated whether monophasic action potential (MAP) recording with a contact electrode could be a suitable technique for the detection of DAD from the endocardium of anesthetized cats. In six animals, atrial pacing and graded aortic constriction were performed during MAP recording to assess MAP stability during hemodynamic changes, and in no cases were modifications of the baseline observed. In 11 cats, calcium gluconate (0.5 g) and G-strophanthin (100 micrograms) were administered. Action potential duration at 50% (APD50) and 90% (APD90) repolarization were reduced (from 138 +/- 16 to 122 +/- 18 msec, p less than 0.02, and from 163 +/- 23 to 149 +/- 20 msec, p less than 0.025, respectively). In eight of 11 (73%) animals, DAD were elicited with a mean amplitude of 1.2 +/- 0.4 mV. In 14 cats, the left stellate ganglion was stimulated for 45 seconds. APD50 and APD90 decreased (from 153 +/- 15 to 145 +/- 16 msec, p less than 0.005, and from 176 +/- 18 to 165 +/- 13 msec, p less than 0.001, respectively). DAD were induced in 10 of 14 animals (71%) with a mean amplitude of 1.2 +/- 0.3 mV. These results show that DAD can be induced in vivo by administration of calcium and digitalis and by activation of the cardiac sympathetic nerves. This latter finding further strengthens the existing link between adrenergic activation and ventricular arrhythmogenesis and suggests triggered activity as a likely mechanism.

Action Potentials↗
PubMed1979

Sympathetic neurons in the cat spinal cord projecting to the stellate ganglion.

Horseradish peroxidase (HRP) was injected into the stellate ganglia of anesthetized cats. After a 2-day survival time the spinal cord was processed for the HRP reaction to study the distribution of the preganglionic neurons which project to the stellate ganglia. HRP-labeled neurons in the cord were located exclusively on the side ipsilateral to the injected stellate ganglia and were concentrated in four distinct areas: (1) intermediolateral cell column (78.2%), (2) lateral funiculus (18.5%), (3) intercalated area and (4) central autonomic area (3.3%) for the latter 2 areas). Their distribution pattern in the very rostral pole of the thoracic sympathetic preganglionic cell column was different from the typical thoracic pattern in that a greater proportion of the cells were located in the lateral funiculus, and a few labeled cells were observed in the ventral horn. Longitudinally, a wide range (C8-T8) of spinal cord levels projected to the stellate ganglia, with a peak at the T2 level. These observations infer that a large population of axonal processes of sympathetic preganglionic neurons traveled several segments of the spinal cord through an intraspinal pathway before exiting a particular ventral root.

Animals↗