Effects of Bilateral Stellate Ganglion Block on Autonomic Cardiovascular Regulation

Song, Jae-Kwan; Hwang, Gyu‐Sam; Lee, Eun‐Ho; Leem, Jeong Gil; Lee, Chung; Park, Pyung Hwan; Shin, Jin Woo

doi:10.1253/circj.cj-09-0244

Cited by 29 publications

(18 citation statements)

References 34 publications

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“…With regard to the patient with bradycardia in the present study, bradycardia is not a usual reported side effect for right stellate ganglion block, but has been seen in patients with bilateral stellate ganglion blocks [37]. In addition, having EKG abnormalities that persisted a month after the block is not expected and may well have been influenced by her underlying predisposition for QT prolongation.…”

Section: Discussionmentioning

confidence: 59%

Pilot evaluation of a stellate ganglion block for the treatment of hot flashes

Pachman

Barton

Carns

et al. 2010

Support Care Cancer

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Purpose Hot flashes are a significant problem in breast cancer patients, especially because the most effective therapy, estrogen, is often contraindicated. Based on recent pilot data from a single group supporting the use of a stellate ganglion block for the treatment of hot flashes, the present pilot trial was done to further evaluate the hypothesis that a stellate ganglion block may be a safe and effective therapy for hot flashes. Methods In women with breast cancer who had hot flashes, a stellate ganglion block was performed after 1 week of baseline hot flash data collection. The main efficacy measures were the changes from baseline in hot flash frequency and hot flash score during the 6th week. Results Ten patients were enrolled between 4/23/2009 and 7/10/2009; eight patients were evaluable. After the stellate ganglion block, the mean hot flash frequency and score decreased from baseline values by over 60% during some of the post-treatment weeks. The mean hot flash frequency and score at week 6 decreased from baseline values by 44% and 45%, respectively. There were no significant adverse events clearly attributed to the stellate ganglion blocks. Conclusions The results of this pilot trial support that stellate ganglion blocks may be a helpful therapy for hot flashes. A prospective placebo-controlled clinical trial should be done to more definitively determine this contention.

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Section: Discussionmentioning

confidence: 59%

Pilot evaluation of a stellate ganglion block for the treatment of hot flashes

Pachman

Barton

Carns

et al. 2010

Support Care Cancer

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“…The left CTG appears to be predominant over the right with respect to their effects on the QT interval. The right CTG, however, has been noted to be predominant with respect to autonomic innervation of the sinus node (Wong, 1997; Fujiki et al, 1999; Song et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

An anatomical investigation of the cervicothoracic ganglion

et al. 2011

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Anatomical variability within the autonomic nervous system has long been accepted. This study evaluated the anatomical variability of the cervicothoracic ganglion (CTG) according to its form and, in addition, provided precise measurements between the CTG and the anterior tubercle of the transverse process of the sixth cervical vertebra (C6TP), the first costovertebral articulation, and the vertebral artery. Forty-two adult cadavers were dissected, 22 male and 20 females. Five main forms of CTG were documented; spindle (31.9%), dumbbell (23.2%), truncated (21.7%), perforated (14.5%), and inverted-L (8.7%). The means for length, width, and thickness of the CTG were 18.5 mm, 8.2 mm, and 4.5 mm, respectively. The dimensions were found to be slightly larger in the males than females and on the left sides as compared to the right. The mean shortest distance between the CTGs and the vertebral artery was found to be 2.8 mm, whilst the mean shortest distances to C6TP was 25.7 mm and to the first costovertebral articulation was 1.7 mm. There is great variability in the morphology of the CTG with five common forms consistently seen. The relation to the vertebral artery may influence the form of the ganglion. Two previously undocumented forms are recorded; the truncated which describes the important juxtaposition of the CTG and the vertebral artery and the perforated which describes the piercing of the ganglion itself by the artery. The findings are considered to be of clinical importance to anesthetists, surgeons, neurosurgeons, and anatomists.

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“…The coherence function (range 0-1) expresses the linear coupling between 2 signals in the frequency domain (50). A square coherence function greater than 0.5 was considered significant (19,51,52). The end points of both prognostic studies were all-cause and cardiovascular mortality.…”

Section: (Equation 1) (Equation 2)mentioning

confidence: 99%

Sympathetic activity–associated periodic repolarization dynamics predict mortality following myocardial infarction

Rizas¹,

Nieminen²,

Barthel³

et al. 2014

J. Clin. Invest.

145

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Background. Enhanced sympathetic activity at the ventricular myocardium can destabilize repolarization, increasing the risk of death. Sympathetic activity is known to cluster in low-frequency bursts; therefore, we hypothesized that sympathetic activity induces periodic low-frequency changes of repolarization. We developed a technique to assess the sympathetic effect on repolarization and identified periodic components in the low-frequency spectral range (≤0.1 Hz), which we termed periodic repolarization dynamics (PRD). Methods.We investigated the physiological properties of PRD in multiple experimental studies, including a swine model of steady-state ventilation (n = 7) and human studies involving fixed atrial pacing (n = 10), passive head-up tilt testing (n = 11), low-intensity exercise testing (n = 11), and beta blockade (n = 10). We tested the prognostic power of PRD in 908 survivors of acute myocardial infarction (MI). Finally, we tested the predictive values of PRD and T-wave alternans (TWA) in 2,965 patients undergoing clinically indicated exercise testing.Results. PRD was not related to underlying respiratory activity (P < 0.001) or heart-rate variability (P = 0.002). Furthermore, PRD was enhanced by activation of the sympathetic nervous system, and pharmacological blockade of sympathetic nervous system activity suppressed PRD (P ≤ 0.005 for both). Increased PRD was the strongest single risk predictor of 5-year total mortality (hazard ratio 4.75, 95% CI 2.94-7.66; P < 0.001) after acute MI. In patients undergoing exercise testing, the predictive value of PRD was strong and complementary to that of TWA. Conclusion.We have described and identified low-frequency rhythmic modulations of repolarization that are associated with sympathetic activity. Increased PRD can be used as a predictor of mortality in survivors of acute MI and patients undergoing exercise testing.Trial registration. ClinicalTrials.gov NCT00196274.Funding. This study was funded by Angewandte Klinische Forschung, University of Tübingen (252-1-0).

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Effects of Bilateral Stellate Ganglion Block on Autonomic Cardiovascular Regulation

Cited by 29 publications

References 34 publications

Pilot evaluation of a stellate ganglion block for the treatment of hot flashes

Pilot evaluation of a stellate ganglion block for the treatment of hot flashes

An anatomical investigation of the cervicothoracic ganglion

Sympathetic activity–associated periodic repolarization dynamics predict mortality following myocardial infarction

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