Effects of utrasound-guided stellate ganglion block on pulmonary shunting and cerebral oxygen metabolism in elderly patients undergoing single-lung ventilation

doi:10.3877/cma.j.issn.2095-8757.2024.02.005

Abstract

Abstract:

Objective

To observe the impact of ultrasound-guided stellate ganglion block (SGB) on intrapulmonary shunt and cerebral oxygen metabolism in elderly patients undergoing single-lung ventilation.

Methods

Ninety-six elderly patients who underwent thoracic surgery under one lung ventilation at Suzhou Hospital Affiliated to Nanjing Medical University from April 2020 to October 2022 were selected. Among them, 48 patients received SGB on the ventilation side under ultrasound guidance before general anesthesia (SGB group), and the remaining 48 patients did not receive SGB (control group). At the immediate start of the procedure (T0), before single-lung ventilation (T1), 15 min (T2), 30 min (T3), 60 min (T4) after single-lung ventilation, and 15 min after resumption of two-lung ventilation (T5), the patient's physiological indices, including the mean arterial pressure (MAP) and heart rate (HR), were monitored and recorded; arterial and jugular venous blood gases were analyzed to obtain pulmonary shunt fractionn (Qs/Qt) and oxygenation index (OI); Jugular venous oxygen saturation (SvO₂) and obstructed side cerebral oxygen saturation (rSO₂) were recorded, and cerebral oxygen consumption rate (CERO₂) was calculated. Complications related to SGB and postoperative pulmonary complications within 72 hours were documented. T test or analysis of variance was used for measurement data, and Chi-square test was used for counting data.

Results

A total of 93 patients were ultimately included in the statistical analysis, including 46 in the SGB group and 47 in the control group. The SGB group exhibited lower HR and more stable MAP during surgery compared with the control group (F=333.662, P < 0.05). After single-lung ventilation, both groups showed significantly increased intrapulmonary shunt. OI in the SGB group was higher, and Qs/Qt was lower than the control group at T2-T5 (F=793.218, 549.716; P < 0.05). At time points T2 to T4, the control group showed a significant decrease in SvO₂ and rSO₂ compared with preoperative values, accompanied by an increase in Ca-vO₂ and CERO₂. In contrast, the SGB group did not exhibit statistically significant changes in SvO₂, rSO₂, Ca-vO₂, and CERO₂ compared with the preoperative values. Intergroup comparisons revealed that at time points T2 and T3, SvO₂ and rSO₂ were higher in the SGB group than those in the control group (P < 0.05), while Ca-vO₂ and CERO₂ were lower in the SGB group than those in the control group (P < 0.05). Two cases of unilateral recurrent laryngeal nerve blockade and one case of brachial plexus blockade occurred in the SGB group, resolving within 24 hours without special treatment. No severe pulmonary complications occurred in both groups.

Conclusion

Ultrasound-guided SGB helps reduce intrapulmonary shunt during single-lung ventilation, improving intraoperative oxygenation and cerebral oxygen metabolism, providing a certain level of cerebral protection.

Key words: Stellate ganglion block, Ultrasound-guided, Single-lung ventilation, Intrapulmonary shunt, Cerebral oxygen metabolism

Yun Zhou, Li Han, Yue Zhao, Chen Yuan, Changjian Yang, Fen Yang, Yang Xie. Effects of utrasound-guided stellate ganglion block on pulmonary shunting and cerebral oxygen metabolism in elderly patients undergoing single-lung ventilation[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2024, 11(02): 20-25.

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References 22

[1]	Brown CH, Lewis A, Probert J, et al. Perioperative neurofilament light plasma concentrations and cognition before and after cardiac surgery: A prospective nested cohort study[J]. Anesthesiology, 2022, 137(3):303-314.
[2]	郑婉静，肖锦容，蔡宇平，等.星状神经节阻滞对老年高血压患者围手术期自主神经功能的影响[J].国际麻醉学与复苏杂志，2018，39（2）：106-111.
[3]	郭莲，陈勇，徐国海，等.星状神经节阻滞对大鼠血管性认知障碍的影响[J].中华麻醉学杂志，2019，39（5）：593-597.
[4]	De Cassai A, Calandra S, Iori D, et al. Stellate ganglion block effects on cerebral vascular tone: A missing piece of the puzzle[J]. J Neurosurg Anesthesiol, 2022, 34(1):84-85.
[5]	Kapoor MC. Neurological dysfunction after cardiac surgery and cardiac intensive care admission: A narrative review part 1: The problem; nomenclature; delirium and postoperative neurocognitive disorder; and the role of cardiac surgery and anesthesia[J]. Ann Card Anaesth, 2020, 23(4):383-390.
[6]	冯丽，贾伟丽，叶娜，等.脑白质病变患者不同程度分级与不同年龄组认知障碍临床特点的关系[J].中华老年医学杂志，2018，37（8）：851-854.
[7]	Skvarc DR, Berk M, Byrne LK, et al. Post-operative cognitive dysfunction: An exploration of the inflammatory hypothesis and novel therapies[J]. Neurosci Biobehav Rev, 2018, 84:116-133.
[8]	Mller LM, Kiefer D, Maurer F, et al. Volutrauma increases exhaled pentanal in rats: A potential breath biomarker for ventilator-induced lung injury[J]. Anesth Analg, 2021, 133(1):263-273.
[9]	赵月，韩丽，赵李红，等.超声引导下星状神经节阻滞对胸腔镜单肺通气患者的肺保护作用[J].大连医科大学学报，2022，44（6）：495-503.
[10]	Raut MS, Maheshwari A. Stellate ganglion block: Important weapon in the anesthesiologists' armamentarium[J]. Cardiothorac Vasc Anesth, 2018, 32(2):36-37.
[11]	Hou J, Pu S, Xu X, et al. Real-time ultrasound-guided stellate ganglion block for migraine: An observational study[J]. BMC Anesthesiol, 2022, 22(1):78.
[12]	Kerzner J, Liu H, Demchenko I, et al. Stellate ganglion block for psychiatric disorders: A systematic review of the clinical research landscape[J]. Chronic Stress (Thousand Oaks), 2021, 5:24705470211055176.
[13]	Wu CN, Wu XH, Yu DN, et al. A single-dose of stellate ganglion block for the prevention of postoperative dysrhythmias in patients undergoing thoracoscopic surgery for cancer: A randomised controlled double-blind trial[J]. Eur J Anaesthesiol, 2020, 37(4):323-331.
[14]	Ouyang R, Li X, Wang R, et al. Effect of ultrasound-guided right stellate ganglion block on perioperative atrial fibrillation in patients undergoing lung lobectomy: A randomized controlled trial[J]. Braz J Anesthesiol, 2020, 70(3):256-261.
[15]	Naskar S, Bhoi D, Garg H, et al. A comparison of analgesic efficacy and safety of clonidine and methylprednisolone as additives to 0.25% ropivacaine in stellate ganglion block for the treatment of complex regional pain syndrome: A prospective randomised single blind study[J]. Korean J Pain, 2023, 36(2):216-229.
[16]	Qian M, Yuan C, Jiang W, et al. Effects of ultrasound-guided stellate ganglion block on the balance of the supply and demand of cerebral oxygen during permissive hypercapnia in patients undergoing shoulder arthroscopy in beach chair position[J]. Am J Transl Res, 2022, 14(9):6678-6688.
[17]	Jiang H, Kang Y, Ge C, et al. One-lung ventilation patients: Clinical context of administration of different doses of dexmedetomidine[J]. J Med Biochem, 2022, 41(2):230-237.
[18]	Xu B, Gao H, Li D, et al. Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics during one-lung ventilation: A randomized clinical controlled trial[J/OL]. Peer J, 2020, 8:e9247.
[19]	古翠方，翟明见，吕爱俊，等.超声引导下的星状神经节阻滞可改善老年肺癌患者胸腔镜术后早期睡眠：86例前瞻性随机对照试验[J].南方医科大学学报，2022，42（12）：1807-1814.
[20]	Li P, Gu L, Bian Q, et al. Effects of prostaglandin E1 nebulization of ventilated lung under 60% O₂ one lung ventilation on patients' oxygenation and oxidative stress: A randomised controlled trial[J]. Respir Res, 2020, 21(1):113.
[21]	Xiang X, Zhou H, Wu Y, et al. Impact of supraglottic device with assist ventilation under general anesthesia combined with nerve block in uniportal video-assisted thoracoscopic surgery[J/OL]. Medicine (Baltimore), 2020, 99(10):e19240.
[22]	Chen C, Zhang Z, Tan F, et al. Stabilizing mast cells improves acute lung injury after orthotopic liver transplantation via promotion of apoptosis in polymorpho nuclear neutrophils[J]. Am J Physiol Lung Cell Mol Physiol, 2021, 320(2):266-275.

组别	例数	年龄（岁）	性别（男/女）	身高（cm）	体质量（kg）	ASA分级（Ⅰ/Ⅱ/Ⅲ）	麻醉时间（min）	手术时间（min）	单肺通气时间（min）
对照组	47	69±11	25/22	168±10	68±11	10/31/6	123±24	113±18	103±13
SGB组	46	69±11	27/19	171±10	70±12	9/30/7	125±21	119±17	100±13
检验值		t=-0.398	χ²=0.286	t=-1.157	t=-0.861	χ²=0.135	t=-0.626	t=-1.690	t=0.782
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	年龄（岁）	性别（男/女）	身高（cm）	体质量（kg）	ASA分级（Ⅰ/Ⅱ/Ⅲ）	麻醉时间（min）	手术时间（min）	单肺通气时间（min）
对照组	47	69±11	25/22	168±10	68±11	10/31/6	123±24	113±18	103±13
SGB组	46	69±11	27/19	171±10	70±12	9/30/7	125±21	119±17	100±13
检验值		t=-0.398	χ²=0.286	t=-1.157	t=-0.861	χ²=0.135	t=-0.626	t=-1.690	t=0.782
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	MAP（mmHg）	心率（次/min）	Qs/Qt（%）	氧合指数（mmHg）	PaO₂（mmHg）	PaCO₂（mmHg）	SpO₂（%）
对照组	47
T0		94.4±5.9	78.5±5.2	1.5±0.3	427.1±43.3	89.4±10.7	38.4±5.0	98.4±1.4
T1		84.5±6.4^a	67.6±4.9^a	1.3±0.5	562.7±45.4^a	270.8±45.6^a	36.4±5.2	97.6±1.8
T2		81.3±7.3^a	68.8±3.3^a	26.7±5.7^a	206.2±31.4^a	121.1±53.7^a	39.2±5.8	96.3±3.3
T3		82.3±6.1^a	68.5±5.2^a	29.2±3.6^a	195.1±34.4^a	104.2±43.2^a	40.8±6.6	96.4±2.4
T4		91.5±4.9	77.4±7.2	18.2±4.8^a	252.8±44.6^a	147.7±38.1^a	39.2±6.3	96.5±3.5
T5		92.7±6.1	75.6±6.9	14.3±5.1^a	311.5±38.5^a	213.3±55.6^a	37.3±6.1	97.3±2.3
SGB组	46
T0		93.2±6.4	76.0±5.2	1.6±0.4	431.6±45.9	89.9±11.2	38.4±5.4	97.7±1.3
T1		76.4±7.3^ab	65.2±7.3^a	1.4±0.5	560.1±47.2^a	270.8±51.7^a	36.8±5.6	96.6±1.3
T2		73.8±6.3^ab	53.2±5.5^ab	19.9±4.6^ab	247.4±34.2^ab	157.4±44.6^ab	37.5±6.3	96.1±1.7
T3		73.8±5.2^ab	54.4±4.9^ab	19.3±4.2^ab	290.8±35.2^ab	148.1±35.9^ab	38.2±5.8	96.7±2.4
T4		90.2±5.3	70.2±6.1	10.5±4.1^ab	367.4±43.5^ab	165.2±42.6^a	39.4±5.5	96.4±1.1
T5		92.1±5.4	73.3±5.7	9.2±4.3^ab	381.2±42.7^ab	235.4±53.5^a	39.6±6.3	98.3±1.5
F₁值		40.820	36.814	427.555	608.379	122.012	1.315	1.780
P₁值		<0.01	<0.01	<0.01	<0.01	<0.01	>0.05	>0.05
F₂值		114.117	250.246	243.965	324.705	105.570	1.573	1.486
P₂值		<0.01	<0.01	<0.01	<0.01	<0.01	>0.05	>0.05
F₃值		181.123	332.662	549.716	793.218	213.079	1.472	1.581
P₃值		<0.01	<0.01	<0.01	<0.01	<0.01	>0.05	>0.05

组别	例数	MAP（mmHg）	心率（次/min）	Qs/Qt（%）	氧合指数（mmHg）	PaO₂（mmHg）	PaCO₂（mmHg）	SpO₂（%）
对照组	47
T0		94.4±5.9	78.5±5.2	1.5±0.3	427.1±43.3	89.4±10.7	38.4±5.0	98.4±1.4
T1		84.5±6.4^a	67.6±4.9^a	1.3±0.5	562.7±45.4^a	270.8±45.6^a	36.4±5.2	97.6±1.8
T2		81.3±7.3^a	68.8±3.3^a	26.7±5.7^a	206.2±31.4^a	121.1±53.7^a	39.2±5.8	96.3±3.3
T3		82.3±6.1^a	68.5±5.2^a	29.2±3.6^a	195.1±34.4^a	104.2±43.2^a	40.8±6.6	96.4±2.4
T4		91.5±4.9	77.4±7.2	18.2±4.8^a	252.8±44.6^a	147.7±38.1^a	39.2±6.3	96.5±3.5
T5		92.7±6.1	75.6±6.9	14.3±5.1^a	311.5±38.5^a	213.3±55.6^a	37.3±6.1	97.3±2.3
SGB组	46
T0		93.2±6.4	76.0±5.2	1.6±0.4	431.6±45.9	89.9±11.2	38.4±5.4	97.7±1.3
T1		76.4±7.3^ab	65.2±7.3^a	1.4±0.5	560.1±47.2^a	270.8±51.7^a	36.8±5.6	96.6±1.3
T2		73.8±6.3^ab	53.2±5.5^ab	19.9±4.6^ab	247.4±34.2^ab	157.4±44.6^ab	37.5±6.3	96.1±1.7
T3		73.8±5.2^ab	54.4±4.9^ab	19.3±4.2^ab	290.8±35.2^ab	148.1±35.9^ab	38.2±5.8	96.7±2.4
T4		90.2±5.3	70.2±6.1	10.5±4.1^ab	367.4±43.5^ab	165.2±42.6^a	39.4±5.5	96.4±1.1
T5		92.1±5.4	73.3±5.7	9.2±4.3^ab	381.2±42.7^ab	235.4±53.5^a	39.6±6.3	98.3±1.5
F₁值		40.820	36.814	427.555	608.379	122.012	1.315	1.780
P₁值		<0.01	<0.01	<0.01	<0.01	<0.01	>0.05	>0.05
F₂值		114.117	250.246	243.965	324.705	105.570	1.573	1.486
P₂值		<0.01	<0.01	<0.01	<0.01	<0.01	>0.05	>0.05
F₃值		181.123	332.662	549.716	793.218	213.079	1.472	1.581
P₃值		<0.01	<0.01	<0.01	<0.01	<0.01	>0.05	>0.05

组别	例数	SvO₂（%）	rSO₂（%）	Ca-vO₂（ml/L）	CERO₂（%）
对照组	47
T0		67.4±4.5	76.8±3.1	48.2±7.5	29.9±4.3
T1		66.7±4.3	71.2±4.3	56.9±8.4	36.6±5.4
T2		56.8±3.8^a	64.3±3.7^a	61.7±9.3^a	42.6±5.7^a
T3		58.5±4.2^a	65.8±3.5^a	63.1±8.5^a	39.5±5.8^a
T4		61.2±4.5^a	67.4±4.3^a	60.9±8.3^a	38.1±5.6^a
T5		67.4±5.4	73.7±5.4	53.3±8.2	33.7±5.2
SGB组	46
T0		67.4±4.8	75.5±3.4	49.9±7.6	28.3±4.3
T1		66.5±4.5	73.6±3.7	52.4±7.7	34.4±4.2
T2		64.3±4.3^b	71.3±4.4^b	53.5±7.8^b	35.7±4.7^b
T3		66.4±4.6^b	73.5±4.4^b	52.6±7.3^b	32.6±5.2^b
T4		67.7±4.6	72.3±5.2	56.7±7.9	34.5±4.5
T5		68.1±4.7	75.6±4.3	53.4±8.2	32.7±4.3
F₁值		53.637	65.531	22.057	32.708
P₁值		<0.01	<0.01	<0.01	<0.01
F₂值		4.083	7.357	3.700	15.046
P₂值		<0.05	<0.05	<0.05	<0.01
F₃值		44.278	56.377	21.061	27.357
P₃值		<0.01	<0.01	<0.01	<0.01

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