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CARDIOVASCULAR ANESTHESIA

Left Stellate Ganglion Block Has Only Small Effects on Left Ventricular Function in Awake Dogs Before and After Induction of Heart Failure

Jost Müllenheim, MD^*, Benedikt Preckel, MD, Detlef Obal, MD, Marc Heiderhoff, cand med^*, Juliane Hoff, cand med^*, Volker Thämer, MD, PhD^*, and Wolfgang Schlack, MD, PhD, DEAA

*Institut für Herz- und Kreislaufphysiologie and Institut für Klinische Anaesthesiologie, Heinrich-Heine-Universität, Düsseldorf, Germany

Address correspondence and reprint requests to Wolfgang Schlack, MD, DEAA, Institut für Klinische Anaesthesiologie, Heinrich-Heine-Universität, Postfach 10 10 07, D-40001 Düsseldorf, Germany. Address e-mail to wolfgang{at}herzkreis.uni-duesseldorf.de

Left stellate ganglion block (LSGB) results in acute sympathetic denervation of the left ventricular (LV) posterobasal wall. We investigated the effects of LSGB in chronically instrumented awake dogs before and after the induction of pacing-induced congestive heart failure. Twelve dogs were instrumented for measurement of global hemodynamics [LV pressure (LVP)], its first derivative (dP/dt), cardiac output (CO), and regional myocardial function (systolic posterobasal segment length shortening, mean velocity [SLmv]). Before the induction of heart failure (n = 12), LSGB did not affect CO [3.2 ± 1.4 (control, mean ± SD) vs 3.3 ± 1.6 L/min (LSGB, P = 0.45)] and SLmv (11.1 ± 4.0 vs 10.8 ± 4.0 mm/s, P = 0.16), but slightly reduced LVP (130 ± 12 vs 125 ± 14 mm Hg, P = 0.04), dP/dt_max (3614 ± 755 vs 3259 ± 644 mm Hg/s, P = 0.003) and dP/dt_min (-3153 ± 663 vs -2970 ± 725 mm Hg/s, P = 0.03). During heart failure (n = 8), global hemodynamics [CO (2.8 ± 1.2 vs 2.7 ± 1.2 L/min, P = 0.04), LVP (119 ± 6 vs 112 ± 9 mm Hg, P = 0.01), dP/dt_max (1945 ± 520 vs 1824 ± 554 mm Hg/s, P = 0.03) and dP/dt_min (-2402 ± 678 vs -2243 ± 683 mm Hg/s, P = 0.04)], as well as regional myocardial function, were significantly different after LSGB [SLmv] (8.0 ± 3.8 vs 6.9 ± 3.4 mm/s, P = 0.02)]. In conclusion, even during heart failure, the hemodynamic changes after LSGB are small, confirming its broad margin of safety.

Implications: Left stellate ganglion blockade with local anesthetic produces only very small global hemodynamic and regional myocardial function changes in awake dogs, even in the presence of pacing-induced heart failure.

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