Effects of head-up tilt after stellate ganglion block on QT interval and QT dispersion

Fujii, Koichi; Yamaguchi, Shigeki; Egawa, Hirotoshi; Hamaguchi, Shinsuke; Kitajima, Toshimitsu; Minami, Junichi

doi:10.1016/j.rapm.2004.03.009

Cited by 11 publications

(12 citation statements)

References 19 publications

(17 reference statements)

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“…Rogers et al [39] demonstrated a significantly slowed heart rate after right SGB but not after a left-sided block. Fujii et al [44] reported that right SGB induces significant increases in the QT interval and rate-corrected QT (QTc) interval for 50 minutes after the block, but left SGB induces a significant decrease in the QT interval and the QTc interval. They suggested that autonomic innervation to the sinus node is mainly through the right-sided stellate ganglion.…”

Section: New Contributing Factors For Hbesmentioning

confidence: 99%

Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks

Song

Roh

2012

Korean J Anesthesiol

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Sudden, profound hypotensive and bradycardic events (HBEs) have been reported in more than 20% of patients undergoing shoulder arthroscopy in the sitting position. Although HBEs may be associated with the adverse effects of interscalene brachial plexus block (ISBPB) in the sitting position, the underlying mechanisms responsible for HBEs during the course of shoulder surgery are not well understood. The basic mechanisms of HBEs may be associated with the underlying mechanisms responsible for vasovagal syncope, carotid sinus hypersensitivity or orthostatic syncope. In this review, we discussed the possible mechanisms of HBEs during shoulder arthroscopic surgery, in the sitting position, under ISBPB. In particular, we focused on the relationship between HBEs and various types of syncopal reactions, the relationship between HBEs and the Bezold-Jarisch reflex, and the new contributing factors for the occurrence of HBEs, such as stellate ganglion block or the intraoperative administration of intravenous fentanyl.

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Section: New Contributing Factors For Hbesmentioning

confidence: 99%

Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks

Song

Roh

2012

Korean J Anesthesiol

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“…13 However, the stellate ganglion block, depending on the side of administration, causes either prolongation (following the right ganglion block) or shortening (following the left ganglion block) of the QTc interval. 14 Despite application of various techniques of regional anesthesia, including spinal anesthesia, in patients with the congenital long QT syndrome (LQTS), 15,16 there are no prospective trials concerning the effects of the block on the QTc interval. The aim of the study was to verify the hypothesis that spinal anesthesia may influence the QTc interval and therefore may predispose to ventricular arrhythmias.…”

mentioning

confidence: 99%

Influence of Spinal Anesthesia on Corrected QT Interval

Owczuk

Sawicka

Wujtewicz

et al. 2005

Regional Anesthesia and Pain Medicine

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“…Left-sided stellate ganglion blockade may even lead to a shortening of the QT interval [39,40]. Left cardiac sympathetic denervation -LCSD's antifibrillatory effect -has been well described.…”

Section: The Effect Of Regional Anaesthesia Techniques On the Period mentioning

confidence: 99%

“…What also remains important is the impact of baroreceptor stimulation and the effect of hypotension resulting from extensive sympathetic blockade. The adrenergic blockade as a result of spinal or epidural, not including T1-4 fibres, causes severe adrenergic activity above the level of the block and consequently prolongs repolarization [37,38].Left-sided stellate ganglion blockade may even lead to a shortening of the QT interval [39,40]. Left cardiac sympathetic denervation -LCSD's antifibrillatory effect -has been well described.…”

mentioning

confidence: 99%

The influence of regional anaesthesia and local anaesthetics on cardiac repolarization

Biernawska

Kaźmierczak

Kotfis

et al. 2016

Anaesthesiol Intensive Ther

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The normal function of the heart muscle is the result of electro-mechanic and hemodynamic coupling. Modification of the structure and activity of ion channels within the cardiomyocytes may induce cardiac arrhythmias. Electrophysiological mechanisms of arrhythmia, generated by a prolonged period of repolarization, result either from conduction disturbances (reentry mechanism) and/or the induction of beats (early after-depolarizations). Local anaesthetic drug deposition does not affect the repolarization period, as long as the concentration of the free drug in the plasma does not reach the critical value to cause toxic effects in the cardiomyocytes. When analyzing the effect of regional anaesthesia on the repolarization period it is essential to acknowledge the activity or blockade of adrenergic fibres. Blocking the sympathetic fibres' , including level T1 to T4, leads to a shortening of the QT interval and a reduction of QT dispersion. Adrenergic blockade as a result of spinal anaesthesia causes severe adrenergic activity above the level of the block and therefore prolongs repolarization. Stellate ganglion block on the right side causes a significant prolongation of the QT interval and QT dispersion. Regardless of the reasons for prolongation of the repolarization period (congenital or acquired), vigilance is required within the perioperative anaesthetic management of a patient, so as not to lead to the occurrence of ventricular arrhythmias. Regional anaesthesia techniques and properly used local anaesthetic drugs are regarded as being safe in these patients.Key words: long QT syndromes, cardiac repolarization, regional anaesthesia, local anaesthetics Anaesthesiology Intensive Therapy 2016, vol. 48, no 2, 135-141 CARDIAC ELECTROPHYSIOLOGYNormal function of the heart muscle is the result of electro-mechanic and haemodynamic coupling. When considering cardiac electrical activity from the point of view of a working myocardial cell, the following must be acknowledged: the relaxed state (polarization of the cell membrane) and active state (depolarization-repolarization) occurring after activation by the conduction system. Changes in the phases of action potential and the resting potential are the result of a synchronized movement of ionic currents through the ion channels, pumps and cardiomyocyte cell membrane carriers. The period of depolarization is initiated by an inward sodium current (I Na ), supported by an inward calcium current (I Ca-L ). During repolarization the flow of current occurs through the channels conducting the potassium current (I Kr , I Ks , I to , I K (ATP) ) and to a lesser extent by the sodium current (I Na ), calcium current (I Ca-L ) and non-selective cation channel (I NS ). This is depicted in Figure 1.The intracellular influx of calcium ions during the plateau phase enables a calcium dependent calcium release from the sarcoplasmic reticulum, leading to a contraction of the working myocardial cell. Under such physiological conditions during repolarization, potassium I Kr and I Ks...

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Effects of head-up tilt after stellate ganglion block on QT interval and QT dispersion

Cited by 11 publications

References 19 publications

Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks

Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks

Influence of Spinal Anesthesia on Corrected QT Interval

The influence of regional anaesthesia and local anaesthetics on cardiac repolarization

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