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

Abstract

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.

The Relationship between Paroxysmal Atrial Fibrillation and Coronary Artery Spasm

“…21 However, cases of drug-resistant coronary artery spasm have also been noted, 22,23 and the effectiveness of sympathectomy or stellate ganglion block were noted for such cases. [24][25][26] This phenomenon suggests a close relationship between cardiac autonomic nervous activity and coronary artery spasm. Examination of the gross and microscopic anatomy of the human intrinsic cardiac nervous system has shown that ventricular ganglionated plexuses are located in fat surrounding the aortic root (26%), at the origin of the left coronary artery (extending to the origins of the left anterior descending and circumflex coronary arteries) (24%), at the origin of the right coronary artery (18%), at the anterior descending coronary artery (13%), adjacent to the origin of the right acute marginal coronary artery (7%), at the origin of the posterior descending coronary artery (6%), and at the origin of the left obtuse marginal coronary artery (6%).…”

“…Coronary artery spasm has been related to coronary endothelial dysfunction, and the benefits of calcium channel blocker use in the therapy of coronary artery spasm have been reported . However, cases of drug‐resistant coronary artery spasm have also been noted, and the effectiveness of sympathectomy or stellate ganglion block were noted for such cases . This phenomenon suggests a close relationship between cardiac autonomic nervous activity and coronary artery spasm.…”