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PubMedDate not supplied

Ultrasound imaging for stellate ganglion block: direct visualization of puncture site and local anesthetic spread. A pilot study.

BACKGROUND AND OBJECTIVES: Stellate ganglion block (SGB) inhibits sympathetic innervation and is a common treatment for reflex sympathetic dystrophy. During the positioning of the needle, there is a risk of injury to the adjacent structures. The aim of the study was to develop an ultrasonographic imaging technique for the performance of SGB. METHODS: Twelve patients (ASA I-II) underwent SGB first by using the blind standard technique (group A: 8 mL bupivacaine 0.25%) and a second time by using an ultrasonographic imaging technique (group B: 5 mL bupivacaine 0.25%). In group B a 10 MHz ultrasound scanning probe was used to identify the anatomic structures and to guide the needle toward the transverse process of C6. RESULTS: Stellate ganglion block was satisfactory in 11 of 12 attempts by the blind technique. Ultrasonographic guidance (group B) resulted in a complete block in all patients. Onset of block was observed within 10 minutes in only 10 of 12 group A patients, while all patients in group B exhibited an adequate block after 10 minutes. During the imaging technique, the needle was inserted to an average depth of 22 +/- 3 mm and the injection of 5 mL bupivacaine resulted in an anesthetic depot with a mean diameter of 14 +/- 3 mm. Distance from the depot to the vagal nerve was 5 +/- 3 mm and 5 +/- 4 mm to the root of C6. All patients (n = 4) with a distance of < 1 mm between anesthetic depot and the root of C6 developed paresthesia within the corresponding cutaneous segment. Blind technique resulted in hematoma formation in three study patients, with no hematoma occurring during imaging technique. CONCLUSIONS: Ultrasonographic guided SGB may improve safety and allows the visualization of the local anesthetic depot. Studying the local anesthetic spread might allow the avoidance of side effects as well as typical complications of SGB.

Adult↗
PubMed1976

Effects of unilateral stellate ganglion blockade on the arrhythmias associated with coronary occlusion.

In anesthetized dogs the circumflex and/or the anterior descending coronary artery were briefly occluded (10 to 90 seconds) and ectopic beats occurring during the occlusion or for 60 seconds following release were counted. Control occlusions were alternated with occlusions performed during complete, reversible, unilateral blockade of either the right or the left stellate ganglion. This was achieved with thermodes through which coolant was circulated. In this way the shortcomings associated with stellectomy, which is irreversible, are avoided. Blockade of the right stellate ganglion increased the number of ectopic beats associated with coronary occlusion. The occurrence of episodes of ventricular tachycardia and fibrillation was also greater. By contrast, blockade of the left stellate ganglion reduced or abolished occlusion-induced arrhythmias. These effects are independent of changes in heart rate or vegal activity; they depend solely upon unilateral alteration in sympathetic tone, and are not demonstrable when such tone is low. We suggest that the right and left cardiac sympathetic nerves have a different influence upon cardiac excitability.

Animals↗
PubMed1996

Reflex stimulation of aortic chemoreceptors through the stellate ganglion during hypoxia and hypotension in cats.

1. In cats anaesthetized with sodium pentobarbitone (35 mg kg-1), an investigation was made of the mechanisms underlying the enhancement of aortic chemoreceptor activity through the excitatory effect mediated by the sympathetic outflow to them during hypoxia and hypotension. 2. Removal of the right stellate ganglion significantly (P < 0.01) reduced the responses of the chemoreceptors to hypoxia and hypotension. Injection of a bolus of sodium pentobarbitone reduced the responses before, but not after, stellectomy. This indicated that the excitatory sympathetic influence on the chemoreceptors (attributed to glomeral vasoconstriction leading to reduction in blood flow) is exerted entirely through the right stellate ganglion. This excitatory effect was abolished after cutting the vagi and both carotid sinus nerves. 3. It is concluded that, in addition to the direct excitatory effect of hypoxia on aortic chemoreceptors, a reflex chemoreceptor excitatory component is mediated through the vagi, carotid sinus nerves and right stellate ganglion.

Animals↗
PubMed1975

Hemodynamic and humoral characteristics of hypertension induced by prolonged stellate ganglion stimulation in conscious dogs.

Recent evidence has suggested that cardiac factors may play a role in the evolution of arterial hypertension. To test the possibility that an increase in cardiac-performance can lead to a sustained increase in systemic blood pressure, we electrically stimulated the left stellate ganglion of six conscious dogs continuously for a 7-day period and monitored cardiac output and arterial blood pressure. In all six dogs, stimulation elicited an abrupt rise in systemic blood pre-sure that was entirely due to rise in cardiac output that lasted at least 6 hours. After 1 day of continuous stimulation, cardiac output retured to control values, but blood pressure remained elevated. After 7 days of stimulation, blood pressure was increased by an average of 25 mm Hg and peripheral resistance by 35 plus and minus 4%. Measurements of blood volume, plasma renin activity, circulating catecholamines (three of the six dogs), and sodium balance showed that none of these factors could explain the development pf this sustained hypertension. Pharmacologic blockade with phenoxybenzamine prevented in large part the rise in blood pressure in short-term stellate ganglion stimulations, whereas propranolol had very little effect on the pressor response, although it nearly abolished the increase in cardiac output. The data indicate that continuous stimulation of the stellate ganglion in conscious dogs leads to substained rises in both blood pressure and peripheral resistance; these changes are apparently mediated by increased activity of the sympathetic nervous system.

Animals↗
PubMed1982

Dose requirement of local anaesthetic to produce grand mal seizure during stellate ganglion block.

Two case reports illustrate that low doses of local anaesthetics such as bupivacaine 2.5 mg and a mixture of bupivacaine 1.25 mg and lidocaine 5 mg can induce grand mal seizures if injected into the vertebral artery during stellate ganglion block. The effect of the dose of local anaesthetic agent and technique of administration into the stellate ganglion region discussed as is the relationship between vertebral artery blood flow and cerebral intravascular local anaesthetic concentration required to produce seizure activity. Suggestions are made concerning possible modification of the technique of anterior approach to the stellate ganglion, including test dose size, to reduce the incidence of inadvertent injection into the vertebral artery and subsequent central nervous system toxicity.

Adult↗
PubMed1986

[Sympathetic block after plexus anesthesia. Comparison with stellate ganglion block].

Plethysmographic measurements of the upper extremity were performed in ten patients after axillary plexus block and in eight patients after stellate ganglion block. Axillary plexus block was followed by a mean increase of 396% in arterial blood flow. After stellate ganglion block, the arterial blood flow increased by 232% (P less than or equal to 0.001) compared to the pre-block value. There was no change in venous capacity after either method. The results indicate that both blocks can alternatively be used, as they have the same effects regarding increased arterial flow and stable venous capacity.

Adult↗
PubMed2005

Stellate ganglion blockade provides relief from menopausal hot flashes: a case report series.

OBJECTIVE: To investigate whether standard C6 stellate ganglion blockade (SGB) might provide relief from hot flashes associated with menopause. METHODS: Six women were referred for severe menopausal hot flashes and elected to undergo standard SGB (5 ml 0.375% Marcaine, Abbott Labs, Abbott Park, IL) to evaluate a novel intervention for hot flash relief. Hot flashes were assessed by self-reporting before and after stellate ganglion block. RESULTS: Initial SGB (SGB1) was successful in all 6 subjects, as evidenced by a positive Horner's syndrome and anhydrosis. Successful SGB caused complete alleviation of hot flashes for times ranging from 2 to 5 weeks. Patients returned for follow-up SGB after mild hot flashes returned. A second SGB produced additional asymptomatic periods of relief ranging from 4 to 18 weeks. In each case, repeated block provided hot flash relief equal to or greater than that of the initial block. Two patients who submitted for a third SGB reported 15 and 48 weeks of relief. CONCLUSION: Successful SGB appears to be related to relief of hot flashes. Repeat SGB results in efficacious multiple week relief of severe hot flashes associated with menopause.

Anesthesia, Local↗
PubMed1976

Termination in the stellate ganglion of axons arising from the hilar vegetative plexus of the lung. Peripheral reflex arcs.

In cats the right lung was removed by thoracotomy. After 24-48 h the right stellate ganglion, the communicating branches between the right stellate ganglion and the right vagus, as well as the portion of both vagus nerves below and above the communicating branches, were processed for electron-microscopic investigation. Degeneration of synaptic axon terminals in the anteromedial part of the stellate ganglia, occurring after removal of the ipsilateral lung, shows that processes of ganglion cells located in the terminal ganglia of the bronchial tree establish synapses in the stellate ganglia. These results speak in favour of the existence of peripheral reflex arcs in the autonomic nervous system. For the time being, the data are not sufficient to define a new pathway related to the autonomic ganglia.

Animals↗
PubMed1984

Identification of the sympathetic preganglionic pathway to the cat stellate ganglion.

Both intraspinal and segmental preganglionic pathways to sympathetic ganglia have been proposed based on different methods of horseradish peroxidase application. The present study mapped the projections of preganglionic neurons to the stellate ganglion in the cat by horseradish peroxidase injection into ganglia with various white rami intact. Central and peripheral cut ends of the severed white rami were tied to eliminate leakage of peroxidase from the ganglia. In control cats with all white rami intact, an average of 9186 neurons were labeled in the spinal cord ipsilateral to the injection from C8 to T9; the highest density of labeling occurred in the first and second thoracic segments. In cats with single white rami intact (T1, T2, or T3), neurons were labeled only in the spinal cord segment that corresponded to the intact ramus and one segment rostral to it. In additional experiments, the spinal cord was hemisected a few segments below, and ipsilateral to the injected ganglion with all rami intact. In these cats neurons were labeled with a similar distribution to control cats, indicating that the preganglionic pathway was extraspinal. Finally, experiments were performed on cats with a single ramus intact, but without ligatures around the cut rami. The distribution of neuronal labeling was similar to control cats (labeled cells from C8 to T9). These results demonstrate that peroxidase leakage from the stellate ganglion can result in an artifactual labeling which would indicate an intraspinal preganglionic pathway. Thus, the present experiments support a segmental distribution of upper thoracic sympathetic preganglionic neurons to the stellate ganglion in the cat, and do not provide evidence for long intraspinal pathways of preganglionic neurons before exit from the cord.

Animals↗
PubMed2001

Comparison of sensory and sympathetic innervation of the dura mater and posterior longitudinal ligament in the cervical spine after removal of the stellate ganglion.

Although cervical spinal tissues are rich in sensory and sympathetic fibers, which play a significant role in clinical phenomena, there is little information available regarding their anatomical characteristics. In this study, we compared the innervation of the cervical dura mater and the posterior longitudinal ligament (PLL) to that after removal of the stellate ganglion to determine whether the anatomical background plays a significant role in clinical manifestations. Immunoreactivities for calcitonin gene-related peptide (CGRP) and substance P (SP) were used as sensory markers, and immunoreactivity for neuropeptide Y (NPY) was used as a sympathetic marker. Sensory fibers in the cervical dura mater were distributed within each cervical segment, but those in the PLL extended beyond the segmental borders. A dense sensory fiber network forming a single layer was seen at the intervertebral disc region in the cervical PLL, whereas sympathetic fibers in this region were sparsely distributed. Sympathetic fibers were distributed not only around the vascular wall but also in the region independent from vessels, and some occasionally ran together with sensory fibers in both the dura mater and the PLL. Removal of the stellate ganglion had little effect on the distribution of sensory fibers but denervated the sympathetic fiber networks in the region independent from vessels of the upper ipsilateral cervical PLL. In conclusion, the cervical dura mater and the PLL have different sensory and sympathetic innervations. Sympathetic fibers pass through the stellate ganglion to project to the region independent from vessels in the upper cervical PLL. Clinical symptoms may be attributed to this characteristic innervation of the cervical spine.

Animals↗
PubMed1986

[Mechanism of inhibition of cardiac activity by the stellate ganglion in the cat and guinea pig].

In acute and chronic experiments on guinea pigs (43) and cats (49), the stellate ganglion inhibition of the heart activity was revealed to be a consequence of excitation of the vagus cholinergic fibers converging with branches of the stellate ganglion on their route to the heart. Alpha-adrenorecptors were shown to exert no noticeable effect on the heart work. Neither the hypothesis of switching of the sympathetic fibers over to intracardiac cholinergic neurons, nor the hypothesis of the cholinergic link in the mechanism of catecholamines release by the sympathetic nerve terminals, were confirmed. The Dayle principle stating that one neuron exerts its efferent affect by means of one transmitter, seems to be justified.

Animals↗
PubMed1998

Comparison of plasma lidocaine concentrations after injection of a fixed small volume in the stellate ganglion, the lumbar epidural space, or a single intercostal nerve.

UNLABELLED: We measured the plasma lidocaine concentrations after stellate ganglion block (SGB) and compared them with those after intercostal nerve block (ICNB) and epidural block (EB) using identical doses of lidocaine. Thirty patients undergoing SGB (n = 10), ICNB (n = 10), or EB (n = 10) in our pain clinic participated in this study. Six milliliters of 1% lidocaine was used for all nerve blocks. SGB was performed at the C6 transverse process, ICNB was performed on a single intercostal nerve, and epidural lidocaine was injected through the lumbar epidural catheter. After drug administration, venous blood samples were taken from an indwelling catheter in the arm every minute for the first 10 min and 15, 20, 30, 45, and 60 min thereafter. Plasma lidocaine concentrations were measured by using an enzyme immunoassay method. The SGB group showed significantly higher peak plasma lidocaine concentrations than other groups (SGB 1.65 +/- 0.21 microgram/mL, ICNB 0.89 +/- 0.12 microgram/mL, EB 0.91 +/- 0.19 microgram/mL; P < 0.01). The SGB group reached peak levels significantly faster than the other groups (SGB 3.4 +/- 1.0 min, ICNB 7.9 +/- 1.5 min, EB 6.9 +/- 0.7 min; P < 0.01). We conclude that the plasma lidocaine concentrations after SGB were higher than those after ICNB and EB when using small, equal doses of lidocaine. The high and rapid peak plasma lidocaine concentrations after SGB are probably related to the high vascularity of the injection site. IMPLICATIONS: Higher plasma concentrations of local anesthetics are reportedly obtained after multiple intercostal nerves blocks compared with those after other types of nerve blocks. Our results, however, showed that the peak plasma concentrations after stellate ganglion block were higher and faster than those after a single intercostal nerve block.

Absorption↗
PubMed2005

Mechanisms of angiotensin II-mediated decreases in intraneuronal Ca2+ in calcium-loaded stellate ganglion neurons.

Our laboratory has reported previously that angiotensin II, type-1 (AT(1)) receptor stimulation in isolated stellate ganglion neurons decreases intraneuronal calcium concentration ([Ca(2+)]i) acutely if baseline [Ca(2+)]i is high and increases [Ca(2+)]i if baseline [Ca(2+)]i is low. Part of the angiotensin II (Ang II) effect in high Ca(2+) neurons is mediated through stimulation of Na(+)-Ca(2+) exchange. Current experiments were conducted to identify additional steps in the signaling pathways. In Ca(2+)-loaded neurons, Ang II-induced decreases in [Ca(2+)]i were attenuated by phospholipase C inhibition (U73122) or nitric oxide (NO) synthase inhibition (L-NMMA) and were mimicked by the cGMP analogue 8-Br-cGMP. Protein kinase C (PKC) inhibition (bisindolylmaleimide I or Go6976) and protein kinase G (PKG) inhibition (KT5823) partially blocked Ang II-mediated decreases in [Ca(2+)]i, but complete blockade of Ang II effects was obtained with combined PKC and PKG inhibition. Modulation of inositol triphosphate (IP(3))-inducible ER Ca(2+) release by [Ca(2+)]i was investigated using furaptra, an ER-retaining dye. IP(3)-mediated ER Ca(2+) release in beta-escin-permeabilized neurons was measured after clamping of [Ca(2+)]i from 50 nM to 800 nM. Maximal ER Ca(2+) release was observed at approximately 200 nM [Ca(2+)]i, with noted blunting of release at higher [Ca(2+)]i. Steady-state mRNA transcript and protein levels revealed that the principal IP(3)R isoform expressed was IP(3)R-II. These results suggest that Ca(2+) loading in stellate ganglion neurons promotes Ang II-mediated decreases in [Ca(2+)]i via PKC and NO/cGMP/PKG pathways and inhibits IP(3)R-II-mediated ER Ca(2+) release.

Angiotensin II↗
PubMed1987

Biochemical and immunocytochemical characterization and distribution of phosphorylated and nonphosphorylated subunits of neurofilaments in squid giant axon and stellate ganglion.

Monoclonal antibodies to squid neurofilament (aNFP) and intermediate filament (aIFA) proteins were used as probes for the biochemical and immunocytochemical analyses of neurofilament structure and distribution in the squid giant axon and stellate ganglion. On Western blots the aNFP antibody stained exclusively the 220 kDa and high-molecular-weight (HMW) components of neurofilaments in the giant axon, whereas the aIFA antibody primarily labeled the 60 kDa protein in the giant axon and the 60 and 65 kDa proteins in the stellate ganglion. Dephosphorylation of axoplasmic proteins by alkaline phosphatase resulted in a decrease in the molecular weights of both the 220 kDa and HMW neurofilament proteins and a concomitant loss of reactivity with the aNFP antibody on Western blots. This indicated that the aNFP antibody is specific for a phosphorylated epitope in the neurofilament. Increased dephosphorylation of the 220 kDa protein led to an enhanced immunostaining of the resultant 190 kDa polypeptide by the aIFA antibody, suggesting that the phosphorylated epitope may mask the conserved epitope recognized by aIFA. Light and electron microscopic immunocytochemical studies show intense labeling by the aNFP antibody in the giant axon. In contrast, the aIFA antibody labeled the glial cells around the giant axon intensely, while labeling of the giant axon itself was considerably less than that with the aNFP antibody. Since the 60 kDa protein in axoplasm is intensely stained by the aIFA antibody on Western blots, the relatively low amounts of labeling seen on semithin and thin sections of the giant axon by this antibody may be due to the masking of the 60 kDa protein by in situ fixed axoplasmic proteins. However, the aIFA antibody intensely labeled glial cells within the stellate ganglion and "islands" of filaments and nuclear membranes within ganglion cells. No reactivity for either antibody was seen in synapses. The aNFP antibody specifically labeled "beadlike" portions and cross-bridges on the axonal neurofilaments, suggesting that these components consist of the 220 kDa and HMW proteins. In contrast, the aIFA antibody labeled relatively smooth filaments in ganglion and glial cells. These data suggest that the 65 kDa protein represents the squid glial filament protein and that the 60 kDa protein found in axoplasm represents the low-molecular-weight subunit in the axonal neurofilament. The latter appears to be formed and/or organized in "islands" of filaments within ganglion cells.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2003

Stellate ganglion block increases blood flow into the optic nerve head and the peripapillary retina in human.

The effects of stellate ganglion block (SGB) on the blood flow of the optic nerve head (ONH) and the peripapillary retina, which plays an important role in the pathogenesis of a major blinding disease, e.g. glaucoma, are unclear. The aim of this study was to evaluate the effects of a sympathetic block on the blood flow of the ONH and the peripapillary retina. Heidelberg Retinal Flowmetry, which is a system incorporating a noninvasive confocal scanning laser Doppler flow meter, was used to measure the retinal blood flow. A unilateral stellate ganglion block was performed in 11 healthy subjects. The retinal blood flows were measured before, 30 and 120 min after SGB. On each occasion, three scans were obtained and the blood flow was analyzed. The systemic blood pressure (BP) and the intraocular pressure (IOP) were also measured at the set time points. The blood flow of the ONH and the peripapillary retina of the ipsilateral retina was significantly increased (P=0.001) by 106.8% and 98.7%, respectively, 30 min after SGB without accompanying significant changes in BP and IOP when compared to their baseline values; while those of the contralateral eyes did not change. The effect of SGB on blood flow in these areas disappeared 120 min after SGB. In conclusion, SGB may have a beneficial effect on ocular diseases associated with ischemia of the ONH and the peripapillary retina, e.g. glaucoma.

Adult↗
PubMed1978

Effect of the stellate ganglion blockade upon the electrical systole (Q-T interval) of the heart.

The effect of the Novocain blockade of the stellate ganglion upon the duration of the electrical systole (Q-T) of the heart was studied in 38 patients. Basic Q-T was normal in 17 patients; in these cases stellate ganglion blockade did not influence the Q-T interval. Of the 21 cases with Q-T prolongation, in 10 the Q-T interval became considerably shorter upon the effect of blockade. In the 11 cases that did not respond to the blockade, ECG repolarization was regular, and there was no arrhythmia. Of the 10 responsive cases with Q-T prolongation, in 9 the repolarization was pathological, and in 6 there was no chronic arrhythmia. The authors discuss the role of the sympathetic nervous system in certain forms of Q-T prolongation.

Adult↗