Introduction: Inadvertent sympathectomy might lead to significant hemodynamic and electric instability. Sympathectomy can happen because of stellate ganglion block after interscalene nerve block (ISB) for shoulder surgery analgesia. In this study we aim to provide definitive evidence of QTc prolongation after right-ISB, thus leading to practical considerations that might affect daily clinical practice.
Material and Methods:A single center, non-blinded, perspective observational study has been performed. ECG analysis and QTc measurement were performed before and after 60 right-ISB and 47 left-ISB for shoulder surgery. Sub-analysis of the patients developing Horner syndrome was also performed.Results: QTc results significantly prolonged after right-ISB (482 ± 56 MS) with respect to the basal value of the same patients (425 ± 44ms, p-value = 3.68x10 -10 ) and with respect to those patients receiving left-ISB (420±41ms, p-value = 3.38x10 -8 ). After right-ISB a higher proportion of patients (38 over 60) resulted with a dangerous QTc (>450ms) than after left-ISB (9 over 47, p-value = 2.07x10 -4 ). These observations were significantly more evident in the subgroup of patients developing Horner syndrome after ISB. Despite not reaching statistical significance, we observed that all clinically relevant intraoperative hypotension-bradycardia events happened in the right-ISB group and that after left-ISB a tendency in QTc shortening was present.
Conclusion:Right and left stellate ganglions have asymmetric sympathetic activity in regulating cardiac repolarization. Right-ISB patients are theoretically exposed to an increased risk of arrythmias and hemodynamic instability. This finding confirms important hypothesis on cardiac physiology and should lead to deeper preoperative evaluation and perioperative management also of low-risk candidates to shoulder surgery.
Inmovilidad Nómada, una mirada a las prácticas zen en Colombia, es un texto dividido en cuatro capítulos que se titulan, la Gran razón, La vía del pájaro, Los pliegues subjetivos, y Un loto que nace en el fuego. Va de la noción de cuerpo en la filosofía occidental a las prácticas zen, de las prácticas a la res de tecnologías de subjetivación ante las cuales emergen esas prácticas zen configuran. Se centra especialmente es las propuesta teóricas de Friedrich Nietzsche, Michael Foucault, Gilles Deleuze, autores reconocidos en la tradición filosófica occidental, y Taisen Deshimaru y André Lemort maestros Zen del siglo XX. Propone una alternativa ética y política ante la administración de la vida en el capitalismo contemporáneo.
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