Nurten İNAN, Hülya BAŞAR, Zekeriya KAPTAN, Suna TAKMAZ AKIN, Hale UYSAL YARKAN

Eff ects of right and left stellate ganglion block on blood pressure and QT-QTc intervals in patients with primary Raynaud’s phenomenon

Amaç: Primer Raynaud fenomenli hastalarda bilateral (sağ ve sol) stellat ganglion bloğu (SGB)’nun kan basıncı, RR, QT ve QTc intervali üzerine olan etkisini araştırmak. Yöntem ve gereç: Primer Raynaud fenomenli 10 hastaya 8 mL % 0,5 bupivakain ile sağ ve sol SGB uygulandı. Her hastanın sağ ve sol blokları arasında en az 1 haft a beklenildi. Kan basıncı, RR, QT interval blok öncesi ve blok sonrası 5, 10, 15, 20 ve 30. dakikalarda ölçüldü. QTc intervali ise Bazett’in formülü kullanılarak hesaplandı. Bulgular: Sağ SGB sonrası RR ve QT intervali 20. ve 30. dakikalarda blok öncesi değerlere göre daha uzundu (P = 0,037, P = 0,008 RR ve QT için sırasıyla). Sol SGB sonrası QT ve QTc intervali 20. ve 30. dakikalarda blok öncesi değerlere göre daha kısaydı (P = 0,011, P = 0,012, P = 0,013, P = 0,009 QT ve QTc için sırasıyla). Sonuç: Primer Raynaud fenomenli hastalarda sağ SGB’nin RR ve QT intervalini uzattığı, sol SGB’nin ise QT ve QTc intervalini kısalttığı sonucuna varılmıştır. Özellikle sağ SGB sonrası fatal aritmi gelişebilme ihtimali göz önünde bulundurularak, bu duruma hazırlıklı olunmalıdır.

Primer Reynaud fenomeni olan hastalarda sağ ve sol stellat gangliyon bloğunun kan basıncı ve QT-QTc interval üzerine olan etkileri

Aim: To examine the eff ects of right and left stellate ganglion block (SGB) on blood pressure and the RR, QT, and QTc intervals in patients with primary Raynaud’s phenomenon. Materials and methods: Right and left SGBs were performed with 8 mL of 0.5% bupivacaine in 10 patients with primary Raynaud’s phenomenon. Th ere was an interval of at least 1 week between the right and left blocks of each patient. Th e blood pressure and the RR and QT intervals were measured before the block and 5, 10, 15, 20, and 30 min aft er the block. Th e QTc interval was calculated using Bazett’s formula. Results: Th e RR and QT intervals were longer 20 and 30 min aft er right SGB when compared with the preblock value (P = 0.037 for RR and P = 0.008 for QT). Th e QT and QTc intervals 20 and 30 min aft er left SGB were shorter than the preblock values (P = 0.011, P = 0.012 for QT; P = 0.013, P = 0.009 for QTc). Conclusion: We conclude that right SGB prolongs the RR and QT intervals while left SGB shortens the QT and QTc intervals in patients with primary Raynaud’s phenomenon. Precautions must be taken, taking into account the risk of fatal arrhythmia following right SGB.

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1. Raynaud M. Local asphyxia and symmetrical gangrene of the extremities. Paris: L. Leclerc; 1862.
2. Bonica JJ, Bucley FP. Block of the sympathetic nervous system. In: Bonica JJ, editor. Regional analgesia with local anesthetics. Malvern (PA): Lea & Febinger; 1991. p.1931-46.
3. Magnano AR, Holleran S, Ramakrishnan R, Reiff el JA, Bloomfi eld DM. Autonomic nervous system infl uences on QT interval in normal subjects. J Am Coll Cardiol 2002; 39: 1820-6.
4. Egawa H, Okuda Y, Kitajima T, Minami J. Assessment of QT interval and QT dispersion following stellate ganglion block using computerized measurements. Reg Anesth Pain Med 2001; 26: 539-44.
5. Fujii K, Yamaguchi S, Egawa H, Hamaguchi S, KitajimaT, Minami J. Eff ects of head-up tilt aft er stellate ganglion block on QT interval and QT dispersion. Reg Anesth Pain Med 2004; 29: 317-22.
6. Masuda A, Fujiki A. Sinus arrest aft er right stellate ganglion block. Anesth Analg 1994; 79: 607.
7. Chiang CE. Congenital and acquired long QT syndrome. Current concepts and management. Cardiol Rev 2004; 12: 222-34. 8. Block JA, Sequeira W. Raynaud’s phenomenon. Lancet 2001; 357: 2042-48.
9. Bazett HC. An analysis of the time-relations of electrocardiograms. Heart 1920; 7: 353-70.
10. Kashima T, Tanaka H, Minagoe S, Toda H. Electrocardiographic changes induced by the stellate ganglion block in normal subjects. J Electrocardiol 1981; 14: 169-74.
11. Fujiki A, Masuda A, Inoue H. Eff ects of unilateral stellate ganglion block on the spectral characteristics of heart rate variability. Jap Circ J 1999; 63: 854-8.
12. Gardner MJ, Kimber S, Johnstone DE, Shukla RC, Horacek BM, Forbes C et al. Th e eff ects of unilateral stellate ganglion blockade on human cardiac function during rest and exercise. J Cardiovasc Electrophysiol 1993; 4: 2-8.
13. Cinca J, Evangelista A, Montoyo J, Barutell C, Figueras J, Valle V et al. J. Electrophysiologic eff ects of unilateral right and left stellate ganglion block on the human heart. Am Heart J 1985; 109: 46-54.
14. Saxena AK, Aggarwal B, Nakra D, Sethi AK, Aggarwal AN. Evaluation of PR, RR, QT, intervals and QT dispersion following stellate ganglion block in chronic shoulder-hand pain patients. Pain Pract 2004; 4: 91-7.
15. Yanagida H, Kemi C, Suwa K. Th e eff ects of stellate ganglion block on the idiopathic prolongation of the QT interval with cardiac arrhythmia (the Romano-Ward syndrome). Anesth Analg 1976; 55: 782-7.
16. Levy MN, Ng ML, Zieske H. Functional distribution of the peripheral cardiac sympathetic pathways. Circ Res 1966; 19: 650-61.
17. Martins JB, Zipes DP, Lund DD. Distribution of local repolarization changes produced by eff erent vagal stimulation in the canine ventricles. J Am Coll Cardiol 1983; 2: 1191-9.
18. Yokota S, Komatsu T, Kimura T, Shimada Y. A case of severe hypertension caused by stellate ganglion block in a patient with facial palsy. Masui 1996; 45: 1123-6.
19. Nakagawa M, Takahashi N, Iwao T, Yonemochi H, Ooie T, Hara M et al. Evaluation of autonomic infl uences on QT dispersion using the head-up tilt test in healthy subjects. PACE 1999; 22: 1158-63.
20. Smith JJ, Porth CM, Erickson M. Hemodynamic response to the upright posture. J Clin Pharmacol 1994; 34: 375-86.
21. Bednar MM, Harrigan EP, Ruskin JN. Torsades de pointes associated with nonantiarrhythmic drugs and observations on gender on QT. Am J Cardiol 2002; 89: 1316-9.