Effect of stellate ganglion block on cardiac rhythm in patients with acute aneurysmal sub-arachnoid hemorrhage with vasospasm: a holter-based preliminary study.

Use of SGB been reported for the managementof cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH).Treggiari andcolleagues (2003) suggested use of superior cervical sympathetic block torelieve cerebral vasospasm in patients with subarachnoid hemorrhage (SAH) anddemonstrated improved cerebral perfusion without change in vessel diameter atcerebral angiography. Subarachnoid hemorrhage (SAH) has long been known tobe associated with abnormalities of ‘R’ and ‘T’ waves, S-T segment changes andpresence of ‘U’ waves in the electrocardiogram.In addition,cardiac rhythm abnormalities in the form of sinus bradycardia and sinustachycardia, wandering atrial pacemaker and atrial fibrillation are alsocommonly encountered after aneurysmal SAH. Di Pasquale and co-researchers (1987) performed holter monitoring insubarachnoid hemorrhage patients up to about 72 hours after ictus and reported arrhythmias in96 (90%) of the 107 patients.However, a recent study reported that about 8%patients with SAH had an arrhythmia sometime during their hospital stay. Half of these arrhythmias were clinically significantand developed a median of 3 days after ictus. Efforts have been made to study effects of modulatingsympathetic supply to the heart through stellate ganglion block, though not in patients suffering fromaSAH, but theresults are not clear. Malik and associates (2014) reported percutaneous inferiorcervical sympathetic ganglion blockade effective  for the treatment of ventricular tachycardiastorm.Efforts have been made to study effects of modulatingsympathetic supply to the heart through stellate ganglion block, though not in patients suffering fromaSAH, but theresults are not clear.Malik and associates (2014) reported percutaneous inferiorcervical sympathetic ganglion blockade effective  for the treatment of ventricular tachycardiastorm. Chen andcolleagues (2015), reported protective effect of SGB on the myocardium andsuppression of stress responses during anesthetic induction and trachealintubation.We hypothesizethat SGB can reduce incidence of cardiac arrythmias in patients with aSAH.

At the All India Institute of Medical Sciences, about150 patients are admitted with aneurysmal subarachnoid hemorrhage (aSAH) annually andtwo thirds of these undergo surgical clipping. During the postoperative course, in several of thesepatients stellate ganglion block is performed for the management of symptomaticcerebral vasospasm.

Till date, effect of SGB on cardiac rhythm has notbeen studied in patients with aneurysmal SAH, therefore, we planned to prospectively studyeffect of SGB on cardiac rhythm with holter monitoring in patients suffering from cerebralvasospasm following acute aneurysmal SAH.

Primary objective

To study effects of stellate ganglion block (SGB) usedfor treatment of cerebral vasospasm following acute aneurysmal subarachnoidhemorrhage (aSAH) on cardiac rhythm with Holter monitoring.

Secondary objectives

ØTo studyhemodynamic parameters after stellate ganglion block (SGB) for treatment of cerebralvasospasm following acute aneurysmal subarachnoid hemorrhage (aSAH).

ØTo studyneurological outcome after treatment of cerebral vasospasm with stellate ganglionblock (SGB) following acute aneurysmal subarachnoid hemorrhage (aSAH).