Cardiac Arrythmias Clinical Trial
Official title:
Effects of Stellate Ganglion Block on Hemodynamics Instability During Beating Heart Surgery
studies suggest that off-pump coronary artery bypass surgery is associated with improved
outcomes when compared to on-pump coronary artery bypass. many studies have shown that
off-pump coronary bypass surgery reduces patient morbidity and mortality.
manipulation of the coronary arteries during cardiac surgery can stimulate the adjacent
post-ganglionic sympathetic fibers and mimic stellate ganglion stimulation ,stellate ganglion
block (SGB) can interrupt this reflex by decreasing the efferent cervical sympathetic
outflows.
when adopting off-pump surgery , the cardiac surgery team must adopt new techniques to handle
a beating heart and the variations in hemodynamics that can occur when performing this type
of procedure the incidence rate of cardiac arrhythmia occurring during and after surgery is
one of the major complication in open heart surgery. in addition , intraoperative hemodynamic
disorders, caused by changes in plasma levels of epinephrine and norepinephrine after
surgical stimulation , are some of challenges for patients undergoing off-pump coronary
artery bypass surgery. hemodynamic disruption leads to myocardial ischemia, resulting in
increased incidence of cardiovascular events and mortality.
stellate ganglion is formed by the fusion of inferior cervical and first thoracic sympathetic
ganglia and is located behind the subclavian artery and anterior to the first rib. the
inferior cervical cardiac nerves arise from the medial aspect of the stellate ganglia and
provide the cardio-accelerator nerve fibers to the cardiac plexus. stellate ganglion
stimulation augments peak systolic pressure, and the enhanced myocardial contractility is
secondary to stimulation by postganglionic nerve fibers which traverse from stellate ganglion
down the great vessels and along the coronary arteries into the myocardium.the blockage of
inferior cervical cardiac nerves is responsible for the bradycardia seen following SGB. SGB
has been shown to prevent and control perioperative hypertension induced by increased
sympathetic activity.
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