Different Effects of Right and Left Stellate Ganglion Block on Systolic Blood Pressure and Heart Rate

Abstract

<p class="MsoNormal"> <b><span lang="EN-US" style="font-family:Verdana;">Purpose: </span></b><span lang="EN-US" style="font-family:Verdana;">Whether or not right and left stellate ganglion blocks (SGB) affect blood pressure (BP) and heart rate (HR) differently has been controversial. The aim of this study was to analyze BP and HR changes after large numbers of right or left SGBs.</span><span lang="EN-US"> </span><b><span lang="EN-US" style="font-family:Verdana;">Methods: </span></b><span lang="EN-US" style="font-family:Verdana;">A total of 16,404 right SGBs and 13,766 left SGBs were performed with 6 ml of 1% mepiva</span><span lang="EN-US"><span style="font-family:Verdana;">caine using the anterior paratracheal approach at C6. Changes in systolic BP and HR 30 min after SGBs were compared to the baseline values. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Systolic BP decreased by 25 to 49 mmHg in 10.93% and more than 50 mmHg in 0.67% of 16,404 right SGBs. Those percentages were significantly higher than corresponding percentages; 8.43% and 0.49% of 13,766 left SGBs (P < 0.0001 and P < 0.05, respectively). On the other hand, systolic BP increased by 25</span></span><span lang="EN-US" style="font-family:Verdana;">-</span><span lang="EN-US" style="font-family:Verdana;">49 mmHg in 5.74% and more than 50 mmHg in 0.52% of left SGBs, and in 4.15% and 0.18% of right SGBs (P < 0.0001and P < 0.0001 between left and right SGBs, respectively).</span><span lang="EN-US"> </span><span lang="EN-US" style="font-family:Verdana;">Right SGB caused marked reduction in HR (greater than 30 beats/min), more than left SGB (4.22% versus 2.70%, P < 0.0001).</span><span lang="EN-US"> </span><b><span lang="EN-US" style="font-family:Verdana;">Conclusions: </span></b><span lang="EN-US" style="font-family:Verdana;">Both right and left SGBs could pro</span><span lang="EN-US" style="font-family:Verdana;">duce clinically significant hypertension and hypotension, and also severe bradycardia. However, right SGB produces a higher incidence of significant reductions in systolic BP and HR, compared to left SGB. On the other hand, left SGB produces a significant increase in systolic BP compared to right SGB. Those differences likely stem from the hemi</span><span lang="EN-US" style="font-family:Verdana;">spheric asymmetry in autonomic cardiovascular control.</span><span lang="EN-US"><o:p></o:p></span> </p

Transection of the cervical sympathetic trunk inhibits the progression of pulmonary arterial hypertension via ERK-1/2 Signalling

“…In addition, no negative effect on the HR and systemic blood pressure was observed in the experimental rats undergoing TCST. Na et al reported that a left cervical ganglion block could be used to treat PAH by increasing the availability of nitric oxide [30], but there are several limitations to their results as follows: 1) the mPAP was not measured, 2) due to the predominance of the right stellate ganglion in the sympathetic control of the heart [31], it is better to block the right superior cervical ganglion than the left, and 3) according to our experience, it is too late to block the sympathetic nerve starting at day 14 after the MCT injection (Additional file 1).…”

Risk factors associated with hypotensive bradycardic events during open shoulder surgery in the beach chair position

“…Its association with HBEs has been proposed by many investigators [ 3 , 6 , 7 , 9 ]; they suggested that the ISB procedure, or the use of epinephrine as an additive to the local anesthetic solution, might contribute to the development of HBEs in the beach chair position. Notably, ipsilateral stellate ganglion block is frequently accompanied by ISB (in up to 75% of cases); subsequent stellate ganglion block induces a reduced sympathetic and/or increased parasympathetic influence, thereby increasing the risk of HBEs [ 14 , 15 ]. However, one prospective randomized study revealed a similar incidence of HBEs between patients who underwent general anesthesia alone and those who underwent general anesthesia combined with ISB [ 10 ].…”

“…Depending on the ISB side, differences in hypotension and/or bradycardia develop due to hemispheric lateralization of autonomic cardiovascular control (i.e., sympathetic predominance in the right hemisphere and parasympathetic predominance in the left hemisphere) [ 15 ]. Based on this theory, one retrospective study proposed right-side ISB as a possible contributing factor to the occurrence of HBEs [ 9 ].…”

Effects of Stellate Ganglion Block on the Peri-operative Vasomotor Cytokine Content and Intrapulmonary Shunt in Patients with Esophagus Cancer

“…Left SGB can induce the significant increase in left ventricular diastolic pressure and oxygen consumption of heart muscle, while the right SCG can reduce the myocardial oxygen consumption (Yildirim et al, 2007). The right SGB is more easily apt to induce hypotension, the effect of slowing heart rate is relatively strong, and the possibility of significantly elevated blood pressure induced by left SGB is higher than the right SGB (Yokota et al, 2013). However, some reports also demonstrated that in animal experiments and clinical applications, the left SGB did not exert significant effects on hemodynamics, but had a possibility of improving the heart function (Liu et al, 2010).…”