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PubMed1979

Right stellate ganglion block for treatment of hypertension after cardiopulmonary bypass.

Right stellate ganglion block was performed on 24 patients in whom hypertension developed after cardiopulmonary bypass. Changes in blood pressure, central venous pressure, cardiac output, and heart rate were evaluated. Most patients evidenced a decrease in systolic blood pressure (average, 40 mm Hg) and diastolic blood pressure (average, 19 mm Hg). Systemic vascular resistance was measured in 8 patients, and 7 demonstrated a decrease (average reduction, 6.7 resistance units). Changes in cardiac output were variable. Although stellate ganglion block can be safely performed and, in most patients, markedly reduces systolic blood pressure, the results suggest that other hypotensive agents may be more advantageous in the treatment of hypertension subsequent to coronary artery operation.

Autonomic Nerve Block↗
PubMed1995

[Influence of stellate ganglion block on respiratory system].

The purpose of this study was to investigate the influence of a stellate ganglion block (SGB) or stellate ganglion electrical stimulation (SGES) on pulmonary resistance, on blood flows of the bronchial, pulmonary and common carotid arteries, and on arterial blood gases. Thirteen mongrel dogs were divided into two groups; a SGB group (n = 8) and a SGES group (n = 5). Anesthesia was induced with pentobarbital 25 mg.kg-1 and the animals were mechanically ventilated to maintain constant PaO2 (90-100 mmHg) and PaCO2 (35-40 mmHg). After a thoracotomy, the SGB with 0.5% mepivacaine 1.5 ml was performed, or the SGES was performed at a strength of 12 volts, and at a frequency of 50 Hz, applied for 30 min. In the SGB group, pulmonary resistance after the block did not significantly differ from the control. No significant change occurred in blood flows of the bronchial and pulmonary arteries, but the common carotid artery flow increased significantly after the SGB. Arterial blood gases did not change significantly after the SGB. In the SGES group, pulmonary resistance after the stimulation did not significantly differ from the pre-value. However, blood flows of the bronchial, pulmonary and common carotid arteries decreased significantly after the SGES. Arterial blood gases did not change significantly after the SGES. These results suggest that the SGB may not influence the respiratory system under normal conditions.

Animals↗
PubMed1993

Distribution of neuropeptides in the porcine stellate ganglion.

The localization and distribution of neuropeptides including neuropeptide Y (NPY), [Met5]enkephalin-Arg6-Gly7-Leu8 (MEAGL), vasoactive intestinal polypeptide (VIP), calcitonin gene-related peptide (CGRP), substance P and somatostatin (SOM) were analyzed in the stellate ganglion of the pig by use of the indirect immunofluorescence technique. NPY, MEAGL, SOM, VIP and CGRP immunoreactivities were found to exist in subpopulations of neuronal cell bodies of the stellate ganglion. A population of the small intensely fluorescent (SIF) cells showed MEAGL immunoreactivity. In addition, the presence of NPY-, MEAGL-, CGRP-, SP-, SOM- and VIP-immunoreactive nerve fibers and axonal varicosities were observed in the stellate ganglion. The localization and pattern of distribution of these peptides in the porcine stellate ganglion were compared with studies carried out on stellate ganglia of other mammalian species.

Animals↗
PubMed1987

Effect of preganglionic stimulation on neuropeptide-like immunoreactivity in the stellate ganglion of the cat.

In pentobarbital-anesthetized cats, treated with hexamethonium and atropine, 40 Hz stimulation of the preganglionic input to the decentralized right stellate ganglion caused cardioacceleration. When the 40-Hz stimulation is maintained for 2 h, this cardioacceleration was progressively attenuated and eventually irreversibly lost. At this time, neurotensin-like and leucine-enkephalin-like immunoreactivity associated with intraganglionic fibers and presumptive axon terminals was also lost. Preganglionic 40 Hz stimulation for 2 h did not change substance P-like, somatostatin-like, vasoactive intestinal peptide-like and corticotropin-releasing factor-like immunoreactivity in the stellate ganglion. A 40-Hz 2-h stimulation of the intact stellate ganglion output caused no change of the neuropeptide immunoreactivity pattern. These findings suggest that neurotensin and leucine-enkephalin are released by sympathetic preganglionic axon terminals and that the releasable pool of these peptides is depleted by prolonged preganglionic stimulation. The association of peptide depletion with loss of the cardioacceleration, evoked by stimulation of the input to the stellate ganglion in the presence of cholinergic antagonists, suggests the possibility that peptides are involved in the non-cholinergic mechanism of ganglionic transmission mediating the cardioacceleration.

Animals↗
PubMed1976

Stellate ganglion blocks for idiopathic sensorineural hearing loss.

Fifty-six patients, treated with a series of anesthetizing blocks of the stellate ganglion for idiopathic sudden sensorineural loss, were compared with 20 patients of similar diagnosis who were treated by other means as to amount of pure-tone gain, speech discrimination improvement, nature of symptoms, and delay in start of surgery. Seventy percent of the stellate-ganglion-block-treated patients achieved substantial hearing improvement. Only 15% to 20% of the non-stellate-ganglion-block-treated patients achieved substantial hearing improvement in discrimination or pure-tone levels. The delay time from onset of symptoms to start of stellate block therapy appears to be important. The type of tinnitus, presence or absence of vertigo, and fullness in the ear may be useful prognostic signs.

Autonomic Nerve Block↗
PubMed1991

Somatosensory evoked potentials are unchanged by reflex sympathetic dystrophy and by stellate ganglion block.

Median nerve somatosensory evoked potentials (SEPs) were monitored in patients with chronic pain before and after stellate ganglion blockade. A change caused by the syndrome or by the block would suggest that SEPs might be useful in the diagnosis and treatment of chronic pain. We observed 20 subjects. Group I (n = 10) had chronic pain not involving the upper extremity. Group II (n = 8) had reflex sympathetic dystrophy of the arm. All patients underwent unilateral stellate ganglion block using an anterior paratracheal approach. The SEPs were recorded by median nerve stimulation on the blocked (affected) side and unblocked (unaffected) side before and 30 min after the block. Recording sites were ipsilateral brachial plexus, the cervical spinal cord, and the contralateral sensory cortex. There were no between-group differences before or after the block. Paired analysis within each group showed that the SEPs were not different from baseline (unaffected side before block) at any time throughout the study. We conclude that since SEPs are not changed by the reflex sympathetic dystrophy or stellate ganglion block, they would not be useful in the evaluation of pain or in determining the effectiveness of sympathetic block. Both the pain and the block appear to involve alteration of conducting pathways separate from those monitored by median nerve SEPs.

Adolescent↗
PubMed1983

Quinine overdose. Prevention of visual damage by stellate ganglion block.

A case of quinine poisoning is described. Stellate ganglion block was performed immediately on the basis of the clinical history of visual disturbance without waiting for physical signs to develop. There was no residual field defect despite the presence of toxic levels of the drug. It is suggested that stellate ganglion block may prevent development of visual field defects.

Adult↗
PubMed1989

[Stellate ganglion block therapy against progressive facial hemiatrophy].

A typical case with progressive facial hemiatrophy was treated with a new therapeutic trial, stellate ganglion block. The present case, a Japanese girl, suffered from progressive atrophy involving the soft tissue of the left buccal region, with onset at the age of 6 following a minor local trauma. She visited our hospital at the age of 9, and as soon as the diagnosis was made, left stellate ganglion block was initiated. Local injection of lidocaine was performed 53 times over the period of 1 year and 4 months. During this period of therapy and the subsequent follow-up period of 4 years, the state of atrophy remained unchanged and nonprogressive. Stellate ganglion block as a therapy against progressive facial hemiatrophy was considered to be worth further evaluation, although it was impossible to judge, based solely on our experience, whether the arrest of progression was attributable to the therapy. The rationale of this therapy was also discussed. It was based upon the assumption that atrophy may result from irritation of the cervical sympathetic nerve, one of the most popular theories regarding the pathomechanism of progressive facial hemiatrophy.

Autonomic Nerve Block↗
PubMed2003

Histochemical features of neurons in the cat stellate ganglion during postnatal ontogenesis.

Changes in the distribution of NADPH-diaphorase (NADPH-d) and acetylcholinesterase (AChE) were studied in neurons of the stellate ganglion in newborn, 10-, 20-day-old, 1-, 2-, 4- and 6-month-old kittens. AChE-positive neurons were revealed in the stellate ganglion (SG) from birth onwards. The number of these neurons increased until 20 days of postnatal life and then declined in 1- and 2-month-old kittens. A small number of weakly stained, NADPH-d-positive cells were found in newborn kittens, while intensely stained neurons first appeared in 10-day-old animals and increased in number up to the second month of life. The size of AChE-positive neurons was larger in comparison with NADPH-d-positive cells in the stellate ganglion of all animals under study. We suggest that putative vasodilator neurons or cells innervating sweat glands exhibit different development patterns from the moment of birth.

Acetylcholinesterase↗
PubMed2000

Haemodynamic effects of a left stellate ganglion block in ASA I patients. An echocardiographic study.

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.

Adult↗
PubMed1993

[Stellate ganglion blocks as the suspected route of infection in a case of cervical epidural abscess].

Spinal epidural abscess is a comparatively rare disease. Its prognosis reportedly depends on degree and duration of the neurological symptoms before the treatment. Thus, the importance of early diagnosis and prompt surgical treatment has been emphasized repeatedly. In the case reported here stellate ganglion blocks were considered to be involved in the etiology of a cervical epidural abscess. The 47-year old woman complained of tinnitus and vertigo and repeatedly underwent stellate ganglion blocks over a period of 10 months. In August, 1991, the patient complained of back pain and developed fever. A few days later she noticed motor weakness and sensory disturbances in the legs. Ten days after the onset of these neurological symptoms she complained of rapidly progressive tetraplegia and was referred to this hospital for admission. On admission, she was fully conscious but febrile. Neurologically, she presented tetraplegia, hypesthesia below level of C7 and slight cervical rigidity. Bladder and bowel dysfunction were also observed. MRI examination showed an epidural mass behind vertebral bodies C6-7 compressing the spinal cord. Antibiotic therapy was initiated immediately and emergency surgical decompression was performed through an anterior approach. Intraoperative findings showed a discitis and yellowish liquid pus in the epidural space. Culture of the pus revealed staphylococcus aureus. In this case repeated stellate ganglion blocks before onset of the symptoms were the suspected route of infection. Postoperative MR images confirmed satisfactory decompression of the spinal cord and motor power was gradually recovered after surgery. Approximately 4 months after surgery she could walk independently. Cervical epidural abscess has been rarely reported as a complication of stellate ganglion block.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed2004

Immunocytochemical properties of stellate ganglion neurons during early postnatal development.

Neurotransmitter features in sympathetic neurons are subject to change during development. To better understand the neuroplasticity of sympathetic neurons during early postnatal ontogenesis, this study was set up to immunocytochemically investigate the development of the catecholaminergic, cholinergic, and peptidergic phenotypes in the stellate ganglion of mice and rats. The present study was performed on Wistar rats and Swiss mice of different ages (newborn, 10-day-old, 20-day-old, 30-day-old, and 60-day-old). To this end, double labeling for tyrosine hydroxylase (TH), choline acetyltransferase (ChAT), vasoactive intestinal (poly)peptide (VIP), neuropeptide Y (NPY), galanin (GAL), and somatostatin (SOM) was applied. The results obtained indicate that the majority of the neurons in the stellate ganglion of both species were TH-positive from birth onward and that a large part of these neurons also contained NPY. The percentage of neurons containing TH and NPY invariably increased with age up to 60 days postnatally. A smaller portion of the stellate ganglion neurons contained other types of neuropeptides and showed a distinct chronological pattern. The proportion of VIP- and ChAT-positive neurons was maximal in 10-day-old animals and then decreased up to 60 days of age, whereas the number of SOM-positive cells in rats significantly decreased from birth onward. In newborn rats, VIP-, ChAT- and SOM-positive neurons were largely TH-positive, while their proportions decreased in 10-day-old and older rats. Accordingly, the largest part of VIP-positive neurons also expressed SOM immunoreactivity at birth, after which the number of neurons containing both peptides diminished. The VIP- and SOM-positive cells did not contain NPY in any of the age groups studied. In rats up to 10 days of life, GAL-immunoreactive (-IR) neurons were scarce, after which their number increased to reach a maximal value in 30-day-old animals and then declined again. The SOM-reactive cells had the smallest size in all rats, while the largest neurons were those containing ChAT. In the mouse stellate ganglion, VIP- and ChAT-IR neurons were larger in comparison to NPY- and TH-IR cells. Our study further revealed some species differences: compared to mice the proportion of neurons containing TH and NPY was higher in rats at all ages under study. Furthermore, no GAL-immunostained neurons were found in mice and the number of SOM-positive cells in mice was limited compared to that observed in rats. In conclusion, the development of neurotransmitter composition is complete in rats and mice by their second month of life. At this age, the percentages of immunopositive cells have become similar to those reported in adult animals.

Animals↗
PubMed1978

Localization of sensory neurons traversing the stellate ganglion of the cat.

The distribution of sensory cells whose axons traverse the stellate ganglion and project via sympathetic cardiac nerves to the heart of the cat has been examined quantitatively. Horseradish peroxidase (HRP) injected at multiple sites in the right stellate ganglion, or applied to the middle cardiac nerve, labelled small numbers of cells in the thoracic dorsal root ganglia (DRG) from T1 to T8. These cells were most numerous between T2 and T5 and were consistently small (less than 40 micrometer) relative to other cells in the DRG. When HRP was applied to middle cardiac nerves, the numbers of labelled sensory cells always exceeded the numbers of myelinated axons counted in the same nerves from other cats. It is concluded that the distribution of the cells of cardiac sensory fibers is more extensive within thoracic DRG than has been previously reported, and it is suggested that such fibres travelling in the sympathetic cardiac nerves may be either myelinated or unmyelinated.

Animals↗
PubMed2002

Neuronal organization and cell interactions of the cat stellate ganglion.

The functional structure of the cat stellate ganglion (SG) and, in particular, its extra- and intraganglionic connections and neuronal organization, were investigated using histochemical, immunohistochemical, morphological and histological methods. Retrograde axonal transport of horseradish peroxidase was used to determine most of the extraganglionic interactions. Of the targets tested, the most extensive efferent connections of the SG were with the stemocleidomastoid muscle, trachea, esophagus and heart. Neurons of the SG also send a small number of postganglionic efferents to the thyroid and stomach. Furthermore, ganglion cells send axons to the spinal ganglia. Several afferent connections of the SG were determined. Sympathetic preganglionic neurons of segments C8-T10 of the spinal cord, sensory neurons of C8-T9 spinal ganglia, intramural ganglia of the thoracic viscera and the reticular formation of the medulla oblongata send their axons to the SG. Intraganglionic interactions of intemeurons with principal ganglionic cells were assumed to occur, based on the presence of interneurons immunoreactive to GABA and substance P. GABA- and substance P-immunoreactive fibers located around a small number of postganglionic neurons were also identified. Morphological study revealed asymmetry between the left and right ganglia: the right ganglion is larger than the left and contains more cells. This asymmetry was also reflected in basic structural parameters of neurons, such as average neuronal area and average diameter of cell somata. The present data has been used to develop a scheme for the basic inter- and intraneuronal connections of the cat SG. This ganglion is a true nervous center, with postganglionic neurons, some of which might be performing sensory functions, and interneurons. The ganglion is connected not only with the spinal cord and spinal ganglia, but also with neurons of the intramural ganglia and, by direct links, with efferent neurons of the medulla oblongata. Thus, the SG may play an essential role in viscera-visceral reflexes.

Afferent Pathways↗
PubMed2005

Severe hypertension after stellate ganglion block.

Haemodynamic effects may occur after stellate ganglion block (SGB) arising from autonomic imbalance and local anaesthetic infiltration to barosensitive areas. We report seven patients who developed severe hypertension (systolic arterial pressure >200 mm Hg) after SGB in our pain clinic service. We postulate that diffusion of the local anaesthetic along the carotid sheath may produce vagal blockade causing unopposed sympathetic activity as a result of attenuation of the baroreceptor reflex. We recommend close monitoring of arterial pressure measurement in patients who received SGB.

Adult↗
PubMed1985

[Inhibition of cardiac activity by the stellate ganglion].

Mechanisms of cardiac activity inhibition in response to the excitation of the stellate ganglion were investigated in acute and chronic experiments involving guinea pigs (43) and rabbits (35). The inhibitory effect was shown to proceed from the excitation of vagal cholinergic fibres that anastomosed with branches of the stellate ganglion, while alpha-adrenoreceptors had no apparent effect on cardiac activity. Neither the hypothesis of preganglionic sympathetic fibres switching to intracardiac cholinergic neurons, nor the one of the cholinergic link in the mechanism of catecholamine release by sympathetic nervous endings was confirmed, therefore the well-known Dale's principle (one neuron produces its efferent effect via one mediator) appears valid here.

Animals↗
PubMed2002

The neck crease as a landmark of Chassaignac's tubercle in stellate ganglion block: anatomical and radiological evaluation.

BACKGROUND: Stellate ganglion block (SGB) is most commonly performed at the transverse process of the sixth cervical vertebra, the identification of which could be difficult in patients with short and wide necks. This study was conducted to evaluate whether the neck skin crease is a reliable indicator of the C6 level. METHODS: Forty-nine relatively obese pain clinic patients were investigated. They assumed a standard position for SGB. A radiopaque wire was placed along the neck skin crease caudad to the thyroid cartilage. Next, a radiopaque indicator was placed on the skin above the tubercle found to be most prominent by palpation. X-rays of the neck were obtained after each procedure. RESULTS: The probability that the neck crease would cross C5, C6 and C7 was 16%, 71%, and 12%, respectively. The most prominent tubercle corresponded to the C5, C6 and C7 levels in 16%, 69% and l4% of cases, respectively. CONCLUSION: The studied means to identify the C6 transverse process was found to correlate well with each other (P<0.001). Since in 30% of cases the C6 process could not be identified by any of the studied means, radiological guidance is recommended in order to ensure optimal safety and efficacy of SGB in selected cases.

Autonomic Nerve Block↗