Ganglio Estelar 1
3
8/22/2019 Ganglio Estelar 1 http://slidepdf.com/reader/full/ganglio-estelar-1 1/3 Retropharyngeal hematoma after stellate ganglion block: analysis of 27 patients reported in the literature Higa K, Hirata K, Hirota K, Nitahara K, Shono S CRD summary The authors concluded that retropharyngeal haematoma after stellate ganglion block necessitates emergency airway management. Since airway obstruction cannot be predicted by initial symptoms, emergency airway management tools should be at hand and the openness of the airway should be continuously evaluated. There were limitations to this review but, overall, the authors’ conclusions appear to reflect the limitations of the evidence presented. Authors' objectives To determine symptoms, signs and urgency of airway management of retropharyngeal haematoma (RPH) after stellate ganglion block (SGB). Searching MEDLINE (1966 to 2006) and Japana Centra Revuo Medicina (1983 to 2006) were searched; the keywords were reported. The reference lists in identified studies were screened. Study selection Study designs of evaluations included in the review Inclusion criteria were not specified in terms of the study design. The included studies were case reports. Specific interventions included in the review Reports of patients who developed RPH after SGB were eligible for inclusion. Ten patients were receiving drugs that could affect haemostasis: aspirin, ticlopidine, dextran, urokinase, batroxobin, loxoprofen, trapidil and non-steroidal anti-inflammatory drugs. Participants included in the review Reports of patients who developed RPH after SGB were eligible for inclusion. Patients varied widely with respect to the disease for which SGB was administered: such diseases included facial palsy, sudden deafness, neck and/or shoulder pain, allergic rhinitis, retinal vein thrombosis, headache, whiplash injury, central post stroke pain, trigeminal herpetic pain and upper limb pain. Concurrent diseases among participants included chronic renal failure, chronic renal failure on haemodialysis, diabetes mellitus, hypertension, ischaemic heart disease, obesity, hyperthyroidism, cerebral infarction and idiopathic thrombocytopenic purpura. Some patients had no concurrent diseases. The mean age was 54.5 (+/- 14.6) years (range: 26 to 76) and both male and female patients were included. Most of the included studies (83%) were reported in Japanese language journals. Outcomes assessed in the review Reports of RPH subsequent to SGB were eligible for inclusion. The review reported, time of onset of initial signs and symptoms, initial signs and symptoms, results of imaging tests of the neck and/or mediastinum, timing and method of emergency airway management, and surgical findings on evacuation of the haematoma or autopsy, as well as a number of variables which may be associated with the development of RPH. How were decisions on the relevance of primary studies made? The authors did not state how the papers were selected for the review, or how many reviewers performed the selection. Assessment of study quality The authors did not state that they assessed validity. Data extraction The authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction. For each study, extracted data included details of concurrent diseases, characteristics of the neck, coagulation studies and use of drugs that could influence coagulation, as well as RPH-related outcomes. Methods of synthesis How were the studies combined? The studies were combined in a narrative. Each study was described in the text and additional descriptive information was tabulated. Any statistical comparisons were performed using an unpaired t-test or chi-squared test with Yates
-
Upload
mariellyta123 -
Category
Documents
-
view
212 -
download
0
Transcript of Ganglio Estelar 1
8/22/2019 Ganglio Estelar 1
http://slidepdf.com/reader/full/ganglio-estelar-1 1/3
Retropharyngeal hematoma after stellate ganglion block: analysis of 27
patients reported in the literature
Higa K, Hirata K, Hirota K, Nitahara K, Shono S
CRD summaryThe authors concluded that retropharyngeal haematoma after stellate ganglion block necessitates emergency airwaymanagement. Since airway obstruction cannot be predicted by initial symptoms, emergency airway management toolsshould be at hand and the openness of the airway should be continuously evaluated. There were limitations to this reviewbut, overall, the authors’ conclusions appear to reflect the limitations of the evidence presented.
Authors' objectives
To determine symptoms, signs and urgency of airway management of retropharyngeal haematoma (RPH) after stellateganglion block (SGB).
SearchingMEDLINE (1966 to 2006) and Japana Centra Revuo Medicina (1983 to 2006) were searched; the keywords werereported. The reference lists in identified studies were screened.
Study selectionStudy designs of evaluations included in the reviewInclusion criteria were not specified in terms of the study design. The included studies were case reports.
Specific interventions included in the reviewReports of patients who developed RPH after SGB were eligible for inclusion. Ten patients were receiving drugs thatcould affect haemostasis: aspirin, ticlopidine, dextran, urokinase, batroxobin, loxoprofen, trapidil and non-steroidalanti-inflammatory drugs.
Participants included in the reviewReports of patients who developed RPH after SGB were eligible for inclusion. Patients varied widely with respect to thedisease for which SGB was administered: such diseases included facial palsy, sudden deafness, neck and/or shoulder pain, allergic rhinitis, retinal vein thrombosis, headache, whiplash injury, central post stroke pain, trigeminal herpetic painand upper limb pain. Concurrent diseases among participants included chronic renal failure, chronic renal failure onhaemodialysis, diabetes mellitus, hypertension, ischaemic heart disease, obesity, hyperthyroidism, cerebral infarction andidiopathic thrombocytopenic purpura. Some patients had no concurrent diseases. The mean age was 54.5 (+/- 14.6)years (range: 26 to 76) and both male and female patients were included. Most of the included studies (83%) werereported in Japanese language journals.
Outcomes assessed in the reviewReports of RPH subsequent to SGB were eligible for inclusion. The review reported, time of onset of initial signs andsymptoms, initial signs and symptoms, results of imaging tests of the neck and/or mediastinum, timing and method of emergency airway management, and surgical findings on evacuation of the haematoma or autopsy, as well as a number
of variables which may be associated with the development of RPH.
How were decisions on the relevance of primary studies made?The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.
Assessment of study qualityThe authors did not state that they assessed validity.
Data extractionThe authors did not state how the data were extracted for the review, or how many reviewers performed the dataextraction. For each study, extracted data included details of concurrent diseases, characteristics of the neck, coagulationstudies and use of drugs that could influence coagulation, as well as RPH-related outcomes.
Methods of synthesisHow were the studies combined?The studies were combined in a narrative. Each study was described in the text and additional descriptive informationwas tabulated. Any statistical comparisons were performed using an unpaired t-test or chi-squared test with Yates
8/22/2019 Ganglio Estelar 1
http://slidepdf.com/reader/full/ganglio-estelar-1 2/3
correction.
How were differences between studies investigated?Differences between the studies were discussed with respect to the characteristics of the patients.
Results of the reviewTwenty-seven case reports (n=27) were included.
Initial symptoms and signs.
The included studies reported neck pain (n=10), dyspnoea (n=10), neck swelling (n=8), hoarseness (n=5), sore throat
(n=4), pressure sensation in the neck (n=3), back pain (n=3), chest pain (n=3), ecchymosis in the neck (n=3), feeling of suffocation (n=2), dysphagia (n=2), abnormal sensation in the neck (n=1), chest oppression (n=1) and occipital pain(n=1). Symptoms occurred 2 hours or more after SGB in 14 patients (52%).
Method of airway management.
Emergency airway management was needed in 21 patients (78%) because of airway obstruction. There were nostatistically significant predictors of later emergency airway management. Among these 21 patients, orotrachealintubation was attempted first in 17 patients, nasotracheal intubation with a bronchofibrescope in 1 patient andtracheostomy in 3 patients. Orotracheal intubation was successful in 12 of the 17 patients in whom it was attempted, butextremely difficult in the remaining 5 patients. The technique failed in 5 patients, despite multiple attempts, and thesepatients received an emergency tracheostomy. Failed airway management caused one death. There were no statisticallysignificant predictors of later emergency airway management amongst the initial signs and symptoms reported, and therewas no significant difference in the time of onset of symptoms between those who later needed emergency managementand those who did not. The speed with which airway compromise worsened was unpredictable and varied greatly among
patients.
Authors' conclusionsRPH after SGB necessitates emergency airway management. Since airway obstruction cannot be predicted by initialsymptoms or signs, emergency airway management tools should be at hand, and the patency of the airway should becontinuously evaluated after onset of RPH after SGB.
CRD commentaryThe review question was clear in terms of the intervention, outcomes, participants and study design. Only two databaseswere searched and, although no language restrictions were specified, it appears that only studies in English andJapanese were included; it is therefore possible that cases from other geographic locations might have been missed. Themethods used to select studies and extract the data were not described, so it is not known whether any efforts weremade to reduce error and bias. The included studies were case series which do not provide robust evidence. Given theheterogeneity of the disease state of the population and the small number of case reports available, a narrative synthesiswas appropriate. There were limitations to this review but, overall, the authors’ conclusions appear to reflect the
limitations of the evidence presented.
Implications of the review for practice and researchPractice: The authors stated that RPH after SGB necessitates emergency airway management. Emergency airwaymanagement tools should be at hand since airway obstruction cannot be predicted by initial symptoms or signs, and thepatency of the airway should be continuously evaluated after onset of RPH after SGB.
Research: The authors did not state any implications for further research.
FundingInstitutional and/or departmental sources.
Bibliographic detailsHiga K, Hirata K, Hirota K, Nitahara K, Shono S. Retropharyngeal hematoma after stellate ganglion block: analysis of 27patients reported in the literature. Anesthesiology 2006; 105(6): 1238-1245
PubMedID17122587
Original Paper URLhttp://www.anesthesiology.org
Indexing StatusSubject indexing assigned by NLM
MeSH Adult; Aged; Airway Obstruction /diagnosis /etiology /pathology; Autopsy; Blood Coagulation /drug effects; DrugInteractions; Dyspnea /etiology; Hematoma /diagnosis /etiology /pathology; Hoarseness /etiology; IntraoperativeComplications /diagnosis /etiology /pathology; Magnetic Resonance Imaging; Middle Aged; Neck Pain /etiology; NerveBlock /adverse effects; Pharyngeal Diseases /diagnosis /etiology /pathology; Pharyngitis /etiology; Respiration, Artificial;Retrospective Studies; Stellate Ganglion; Tomography, X-Ray Computed
8/22/2019 Ganglio Estelar 1
http://slidepdf.com/reader/full/ganglio-estelar-1 3/3
AccessionNumber 12006009331
Database entry date01/12/2008
Record StatusThis is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstractcontains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment onthe reliability of the review and the conclusions drawn.
Database of Abstracts of Reviews of Effects (DARE)Produced by the Centre for Reviews and Dissemination
Copyright © 2012 University of York
