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BJA Advance Access published online on September 9, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei230
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oxfordjournals.org
Accepted July 11, 2005

Clinical Investigation

Effects of stellate ganglion block on cerebral haemodynamics as assessed by transcranial Doppler ultrasonography

M. M. Gupta 1, P. K. Bithal 1*, H. H. Dash 1, A. Chaturvedi 1, and R. P. Mahajan 2

1 Department of Neuroanaesthesiology, All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi, India
2 University Department of Anaesthesia and Intensive Care, Queen's Medical Centre, Nottingham, UK

* To whom correspondence should be addressed.
P. K. Bithal, E-mail: pkbithal{at}hotmail.com


  Abstract

Background. Stellate ganglion block (SGB) causes vasodilatation in the skin of the head and neck because of regional sympathetic block. Its effects on cerebral haemodynamics, in health or in disease, are not clear. We evaluated the effects of SGB on ipsilateral middle cerebral artery flow velocity (MCAFV), estimated cerebral perfusion pressure (eCPP), zero flow pressure (ZFP), carbon dioxide reactivity (CO2R) and cerebral autoregulation using transcranial Doppler ultrasonography (TCD).

Methods. Twenty male patients, with pre-existing brachial plexus injury, and undergoing SGB for the treatment of complex regional pain syndrome of the upper limb, were studied. For SGB, 10 ml of plain lidocaine 2% was used and the onset of block was confirmed by presence of ipsilateral Horner's syndrome. The MCAFV, eCPP, ZFP, CO2R, and cerebral autoregulation were assessed before and after SGB using established TCD methods. The changes in these variables were analysed using Wilcoxon's signed rank test.

Results. The block caused a significant decrease in MCAFV from median (inter-quartile range) value of 61 (53, 67) to 55 (46, 60) cm s-1, a significant increase in eCPP from 59 (51, 67) to 70 (60, 78) mm Hg, and a significant decrease in ZFP from 32 (26, 39) to 25 (16, 30) mm Hg. There were no significant changes in CO2R or cerebral autoregulation.

Conclusion. The increase in eCPP, decrease in ZFP, and no changes in CO2R or cerebral autoregulation suggest that the SGB decreases cerebral vascular tone without affecting the capacity of the vessels to autoregulate. These effects may be of therapeutic advantage in relieving cerebral vasospasm in certain clinical settings.

Keywords: anaesthetic techniques, regional, stellate ganglion; autoregulation, cerebral; blood, flow, cerebral; blood, transient hyperaemic response test; brain, cerebral perfusion pressure; carbon dioxide, reactivity; measurement techniques, transcranial Doppler; zero flow pressure.
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