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Swetha Simhan - One of the best experts on this subject based on the ideXlab platform.
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transient neuronal injury followed by intravascular injection during an ultrasound guided Stellate Ganglion Block
Anesthesiology and Pain Medicine, 2012Co-Authors: Hariharan Shankar, Swetha SimhanAbstract:Ultrasound guidance for pain interventions is becoming increasing recognized as a useful imaging tool. One of the common interventions where it is gaining wider acceptance is during the performance of a Stellate Ganglion Block. The following is a unique report where intravascular and neuronal injury occurred during the performance of an ultrasound guided Stellate Ganglion Block followed by dysphagia. 41 year old male, with a diagnosis of complex regional pain syndrome, was referred to our clinic for further management. He underwent a diagnostic ultrasound guided Stellate Ganglion Block after having tried conservative therapies. The Stellate Ganglion Block provided him with complete pain relief for over five weeks. During a subsequent therapeutic Stellate Ganglion Block, performed by an experienced pain medicine fellow with more than 50 ultrasound guided proceduresclinician, the patient developed a transient injury to the brachial plexus upon needle entry. Subsequent redirection and injection of an ml of injectate resulted in an intravascular injection producing tinnitus. After the tinnitus decreased, he underwent another Stellate Block using an out of plane approach without any further complications. Two days later, he reported chest and throat discomfort which resolved over the next few days possibly due to a retropharyngeal hematoma. He declined further interventions and was subsequently managed with 3 tablets of oxycodone a day. This report highlights the importance of vigilance and meticulous planning during the performance of ultrasound guided pain interventions.
Yasuhiro Shimada - One of the best experts on this subject based on the ideXlab platform.
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severe hypertension after Stellate Ganglion Block
BJA: British Journal of Anaesthesia, 2005Co-Authors: Tomomasa Kimura, Shuichi Yokota, Toru Komatsu, Kimitoshi Nishiwaki, Yasuhiro ShimadaAbstract: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.
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A case of severe hypertension caused by Stellate Ganglion Block in a patient with facial palsy
Masui. The Japanese journal of anesthesiology, 1996Co-Authors: Shuichi Yokota, Toru Komatsu, Tomomasa Kimura, Yasuhiro ShimadaAbstract:: We report a case of severe hypertension following Stellate Ganglion Block. A 61-year old woman received the left Stellate Ganglion Block with 5 ml of 1% mepivacaine for her left facial palsy. Before the Stellate Ganglion Block, blood pressure was 120/68 mmHg and heart rate was 62 b.p.m. Seven minutes after the left Stellate Ganglion Block, blood pressure increased to 230/140 mmHg, but heart rate was unchanged. Systolic blood pressure remained above 190 mmHg for 60 minutes following the Stellate Ganglion Block. We suggest that the extreme increase in blood pressure was due to the vagal nerve Block associated with the left Stellate Ganglion Block.
Ashish Suri - One of the best experts on this subject based on the ideXlab platform.
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Stellate Ganglion Block for treatment of cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage a preliminary study
Journal of Anaesthesiology Clinical Pharmacology, 2011Co-Authors: Virendra Jain, Girija P Rath, Hari H Dash, Parmod K Bithal, Rajendra S Chouhan, Ashish SuriAbstract:Background : Stellate Ganglion Block improves cerebral perfusion by decreasing the cerebral vascular tone. Its effects on cerebral vasospasm to relieve neurological deficits have not been evaluated. This prospective observational study was carried out to evaluate the effect of Stellate Ganglion Block on cerebral hemodynamics in patients with symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Materials and Methods : Fifteen patients of either sex, aged 18-75 years, who underwent surgical clipping of aneurysm and developed refractory cerebral vasospasm were included. Stellate Ganglion Block was performed using 10 ml of bupivacaine 0.5% on the side with maximum cerebral blood flow velocity. Neurological status, cerebral blood flow velocity and pulsatility index were assessed before and 10 minutes, 30 minutes, 2 hours, 6 hours, 12 hours and 24 hours after Stellate Ganglion Block. Results : Improved Glasgow coma score was observed 30 minutes after Stellate Ganglion Block. Neurological deficits reduced in 11 patients. Ipsilateral middle cerebral artery mean flow velocity decreased from 133.66 cm/sec before Stellate Ganglion Block to 110.53 cm/sec at 6 hours (P Conclusion : This study suggests Stellate Ganglion Block to be an effective modality of treatment for refractory cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
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Stellate Ganglion Block for treatment of cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage - A preliminary study.
Journal of Anaesthesiology Clinical Pharmacology, 2011Co-Authors: Virendra Jain, Girija P Rath, Hari H Dash, Parmod K Bithal, Rajendra S Chouhan, Ashish SuriAbstract:Background : Stellate Ganglion Block improves cerebral perfusion by decreasing the cerebral vascular tone. Its effects on cerebral vasospasm to relieve neurological deficits have not been evaluated. This prospective observational study was carried out to evaluate the effect of Stellate Ganglion Block on cerebral hemodynamics in patients with symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Materials and Methods : Fifteen patients of either sex, aged 18-75 years, who underwent surgical clipping of aneurysm and developed refractory cerebral vasospasm were included. Stellate Ganglion Block was performed using 10 ml of bupivacaine 0.5% on the side with maximum cerebral blood flow velocity. Neurological status, cerebral blood flow velocity and pulsatility index were assessed before and 10 minutes, 30 minutes, 2 hours, 6 hours, 12 hours and 24 hours after Stellate Ganglion Block. Results : Improved Glasgow coma score was observed 30 minutes after Stellate Ganglion Block. Neurological deficits reduced in 11 patients. Ipsilateral middle cerebral artery mean flow velocity decreased from 133.66 cm/sec before Stellate Ganglion Block to 110.53 cm/sec at 6 hours ( P P P P =0.008) and anterior cerebral artery ( P =0.041) for 12 hours. Conclusion : This study suggests Stellate Ganglion Block to be an effective modality of treatment for refractory cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
Hariharan Shankar - One of the best experts on this subject based on the ideXlab platform.
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transient neuronal injury followed by intravascular injection during an ultrasound guided Stellate Ganglion Block
Anesthesiology and Pain Medicine, 2012Co-Authors: Hariharan Shankar, Swetha SimhanAbstract:Ultrasound guidance for pain interventions is becoming increasing recognized as a useful imaging tool. One of the common interventions where it is gaining wider acceptance is during the performance of a Stellate Ganglion Block. The following is a unique report where intravascular and neuronal injury occurred during the performance of an ultrasound guided Stellate Ganglion Block followed by dysphagia. 41 year old male, with a diagnosis of complex regional pain syndrome, was referred to our clinic for further management. He underwent a diagnostic ultrasound guided Stellate Ganglion Block after having tried conservative therapies. The Stellate Ganglion Block provided him with complete pain relief for over five weeks. During a subsequent therapeutic Stellate Ganglion Block, performed by an experienced pain medicine fellow with more than 50 ultrasound guided proceduresclinician, the patient developed a transient injury to the brachial plexus upon needle entry. Subsequent redirection and injection of an ml of injectate resulted in an intravascular injection producing tinnitus. After the tinnitus decreased, he underwent another Stellate Block using an out of plane approach without any further complications. Two days later, he reported chest and throat discomfort which resolved over the next few days possibly due to a retropharyngeal hematoma. He declined further interventions and was subsequently managed with 3 tablets of oxycodone a day. This report highlights the importance of vigilance and meticulous planning during the performance of ultrasound guided pain interventions.
Nilesh Patel - One of the best experts on this subject based on the ideXlab platform.
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ultrasound guided Stellate Ganglion Block successfully prevented esophageal puncture
Pain Physician, 2007Co-Authors: Samer Narouze, Amaresh Vydyanathan, Nilesh PatelAbstract:Stellate Ganglion Block is utilized in the diagnosis and management of various vascular disorders and sympathetically mediated pain in the upper extremity, head and neck. The cervical sympathetic chain is composed of superior, middle, intermediate, and inferior cervical ganglia. However, in approximately 80% of the population, the inferior cervical Ganglion is fused with the first thoracic Ganglion, forming the Stellate Ganglion also known as cervicothoracic Ganglion. The Stellate Ganglion lies medial to the scalene muscles, lateral to the longus coli muscle, esophagus and trachea along with the recurrent laryngeal nerve, anterior to the transverse processes and prevertebral fascia, superior to the subclavian artery and the posterior aspect of the plura, and posterior to the vertebral vessels at C7 level. Consequently, inadvertent placement of the needle into the vertebral artery, thyroid, neural tissues, or esophagus can occur with the fluoroscopic or blind approach. While fluoroscopy is a reliable method for identifying boney structures, ultrasound may identify the vertebral vessels, thyroid gland and vessels, longus coli muscles, nerve roots and the esophagus. Thus, ultrasound may prevent inadvertent placement of the needle into these structures as might happen with either the blind technique or fluoroscopic technique. A patient with complex regional pain syndrome type I of the left upper extremity was scheduled for left Stellate Ganglion Block with the anterior paratracheal approach under fluoroscopy. Real-time ultrasound imaging prevented inadvertent injury to the esophagus as well as the thyroid gland and vessels.
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Stellate Ganglion Block emphasis on the new oblique fluoroscopic approach
Techniques in Regional Anesthesia and Pain Management, 2005Co-Authors: Yili Zhou, Salahadin Abdi, Rajiv R Doshi, Nilesh PatelAbstract:Stellate Ganglion Block is utilized both as a diagnostic as well as a therapeutic procedure for certain types of chronic neuropathic pain conditions, namely sympathetically mediated and/or sympathetically maintained pain syndrome. There are various techniques available to successfully Block this Ganglion. This article discusses the techniques used to Block the Stellate Ganglion. However, special emphasis is given to our new oblique approach to successfully Block this Ganglion. Additionally, our article discusses among others, the anatomy of the Ganglion, indications and contraindications for the Block, drug selections and complications.