The Experts below are selected from a list of 288 Experts worldwide ranked by ideXlab platform
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.
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A new and easy technique to block the Stellate Ganglion.
Pain physician, 2004Co-Authors: Salahadin Abdi, Nilesh Patel, Yili Zhou, Bhupinder Saini, John NelsonAbstract:UNLABELLED The Stellate Ganglion block has been utilized in a variety of painful conditions ranging from sympathetically mediated pain in the upper extremity to the pain associated with intractable angina. A number of techniques are used to block the Stellate Ganglion. OBJECTIVE To describe a new and easy approach to block the Stellate Ganglion using an oblique view. DESCRIPTION OF A NEW TECHNIQUE The patient is placed in the supine position with the new slightly extended, and the head rotated slightly to the side opposite the side to be blocked. The fluoroscopic beam is directed in an anteroposterior direction until the C5/6 disc is well visualized. Subsequently, the fluoroscopic beam is rotated obliquely, ipsilateral to the side where blockade is desired. Under real-time imaging, a single pass is made with a 25-gauge spinal needle to contact the bone. At this point, the needle tip is contacting and resting at the junction between the uncinate process and the vertebral body. CONCLUSION We have described a new approach for Stellate Ganglion block to be performed under oblique fluoroscopy without technical difficulty or complications.
Rack Kyung Chung - One of the best experts on this subject based on the ideXlab platform.
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The changes of heart rate variability after unilateral Stellate Ganglion block.
Korean Journal of Anesthesiology, 2010Co-Authors: Rack Kyung ChungAbstract:Background: The effect of the unilateral Stellate Ganglion block (SGB) on cardiovascular regulation remains controversial. We wished to evaluate the changes in heart rate variability (HRV) after a unilateral Stellate Ganglion block in patients with head and neck pain in the present study. Methods: Patients with head and neck pain (n = 89) were studied. HRV was determined before and after a C6 unilateral Stellate Ganglion block (right-sided SGB, 40; left-sided SGB, 49) using a paratracheal technique with 1% mepivacaine (6 ml). Results: There were no significant differences in HRV indices before and after right-sided SGB. The log scale of power in the high frequency range (lnHF) was increased and ratio of power in the low frequency range (LF) to power in the high frequency range (HF) ratio was decreased after left-sided SGB. Conclusions: These results demonstrated that left-sided SGB increased parasympathetic activities in patients with head and neck pain.
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.
M Jonathan H S P Piccini - One of the best experts on this subject based on the ideXlab platform.
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autonomic modulation for the treatment of ventricular arrhythmias therapeutic use of percutaneous Stellate Ganglion blocks
Journal of Cardiovascular Electrophysiology, 2017Co-Authors: Marat Fudim, M Richard D Boortzmarx, B Chetan M D Patel, Y Albert M D Sun, M Jonathan H S P PicciniAbstract:Stellate Ganglion Block for Ventricular Arrhythmia Ventricular tachycardia (VT), ventricular fibrillation (VF), and electrical storm are commonly encountered emergency conditions in cardiac and surgical intensive care units. In most cases, recurrent ventricular arrhythmias or electrical storm are associated with a heightened sympathetic tone. These arrhythmias can be difficult to treat and may be refractory to beta-blockade, antiarrhythmic therapy, sedation, and mechanical hemodynamic support. While monomorphic ventricular tachycardia and PVC-triggered polymorphic ventricular tachycardia may sometimes be amenable to successful ablation, some patients may be too critically ill to make such an approach feasible. We present 2 cases of minimally invasive Stellate Ganglion blocks for the treatment of electrical storm in patients with advanced heart failure on mechanical life support. These cases are part of a collaborative initiative at our institution to use percutaneous Stellate Ganglion block as an adjunctive intervention to achieve control of life-threatening ventricular arrhythmias.
Erica D Wittwer - One of the best experts on this subject based on the ideXlab platform.
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effective use of percutaneous Stellate Ganglion blockade in patients with electrical storm
Circulation-arrhythmia and Electrophysiology, 2019Co-Authors: Ying Tian, Erica D Wittwer, Christopher J Mcleod, Peilin Xiao, Peter A Noseworthy, Siva K Mulpuru, Abhishek Deshmukh, Suraj Kapa, Michael J AckermanAbstract:Background: Percutaneous Stellate Ganglion blockade (SGB) has been used for drug-refractory electrical storm due to ventricular arrhythmia (VA); however, the effects and long-term outcomes have not...
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Urgent Ultrasound-Guided Bilateral Stellate Ganglion Blocks in a Patient With Medically Refractory Ventricular Arrhythmias.
Critical Care Medicine, 2015Co-Authors: Maura M. Scanlon, Shane M. Gillespie, Hartzell V. Schaff, Erica D WittwerAbstract:OBJECTIVES: To describe the successful treatment of medically refractory ventricular arrhythmias in the ICU with ultrasound-guided bilateral Stellate Ganglion blocks. DATA SOURCES: The data were gathered from the medical record. STUDY SELECTION: This case was selected as it describes the use of ultrasound in the successful termination of a recurrent, malignant arrhythmia, rather than fluoroscopy, to perform bilateral Stellate Ganglion blocks at the patient's bedside in the ICU. DATA EXTRACTION: The data were extracted from the medical record. DATA SYNTHESIS: The data were synthesized from the patient's medical record. CONCLUSIONS: Performance of Stellate Ganglion blocks at the bedside in the ICU is feasible for patients who are suffering from refractory ventricular arrhythmias. This potentially life-saving block can be performed using ultrasound guidance, sparing the patient transport to a fluoroscopy suite.