Effects of stellate ganglion block on cardiac coronary circulation
I Sasaki1, T Kaneko, N Iwatsuki
1Department of Anesthesiology, Tohoku University School of Medicine, 1-1 Seiryomachi, Aoba-ku, 980, Sendai, Japan.
Insights
Stellate ganglion block (SGB) can negatively impact cardiac hemodynamics, reducing coronary blood flow and myocardial oxygen supply. However, inhaling 100% oxygen can counteract these adverse effects.
Area of Science:
- Cardiovascular Physiology
- Autonomic Nervous System
- Anesthesiology
Background:
- The stellate ganglion plays a role in cardiac sympathetic innervation.
- Stellate ganglion block (SGB) is used clinically, but its effects on cardiac hemodynamics require further investigation.
Purpose of the Study:
- To investigate the influence of stellate ganglion block (SGB) on cardiac and coronary hemodynamics.
- To assess the impact of SGB on myocardial oxygen supply and demand.
Main Methods:
- Measurements of heart rate, coronary blood flow, left ventricular pressure, cardiac output, myocardial oxygen consumption, and myocardial oxygen extraction ratio were performed in nine dogs.
- SGB was induced using 2 ml of 1% mepivacaine injection.
Main Results:
- Left SGB decreased coronary blood flow (CBF) by 10% and left ventricular pressure increase rate (LV max dP/dt) by 15%.
- Right SGB decreased CBF by 30%, LV max dP/dt by 25%, heart rate (HR) by 20%, cardiac output (CO) by 15%, and myocardial oxygen consumption (MVO2) by 25%.
- SGB on either side increased myocardial oxygen extraction ratio (MOER), indicating a relative deficit in CBF, which was reversed by 100% oxygen inhalation.
Conclusions:
- Stellate ganglion block can impair the myocardial oxygen supply-demand relationship.
- The negative effects of SGB on myocardial oxygenation can be mitigated by 100% oxygen administration.
Abstract:
Since the stellate ganglion contains cardiac sympathetic nerves, stellate ganglion block (SGB) may influence cardiac and coronary hemodynamics. We investigated this influence of SGB by measuring the heart rate (HR), the left circumflex coronary artery blood flow (CBF), the maximum rate of increase of the left ventricular pressure (LV max dP/dt), the cardiac output (CO), the myocardial oxygen consumption (MVO2), and the myocardial oxygen extraction ratio (MOER) in nine dogs before and after performing SGB by means of injection of 2 ml 1% mepivacaine. Left SGB resulted in a decrease of 10% in CBF and a decrease of 15% in LV max dP/dt, but HR, CO, and MVO2 remained unchanged. On the other hand, right SGB resulted in a decrease of 30% in CBF and a decrease of 25% in LV max dP/dt, as well as a decrease of 20% in HR, 15% in CO, and 25% in MVO2. SGB on either side resulted in an increase in MOER that was slight but nonetheless significant (P<0.05) in that it suggested a relative deficit in CBF with respect to MVO2. Inhalation of 100% oxygen decreased MOER to the pre-SGB level in either side, thus improving the myocardial oxygen supply-demand relationship. This study suggests the possibility that SGB has deteriorative effects on the myocardial oxygen supply-demand relationship. Those effects were counteracted by the inhalation of 100% oxygen.
Related Concept Videos
01:28Drugs Acting on Autonomic Ganglia: Blockers
01:25Antianginal Drugs: Calcium Channel Blockers and Ranolazine
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...
01:29Pathophysiology of Cardiac Performance
01:16Antianginal Drugs: Nitrates and β-Blockers
Organic nitrates, such as nitroglycerin, play a pivotal role. Once metabolized, they liberate nitric oxide, a molecular marvel. Nitric oxide triggers guanylyl cyclase and augments cGMP production. This biochemical cascade orchestrates the relaxation of vascular smooth muscles, ushering in vasodilation and enhancing coronary blood flow. Administered...
01:22Mitral Stenosis I: Introduction
01:30Acute Coronary Syndrome I: Introduction