KMID : 0356920230760020116
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Korean Journal of Anesthesiology 2023 Volume.76 No. 2 p.116 ~ p.127
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Assessment of the changes in cardiac sympathetic nervous activity using the pupil size changes measured in seated patients whose stellate ganglion is blocked by interscalene brachial plexus block
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Kim Eu-Gene
Lim Jung-A Choi Chang-Hyuk Lee So-Young Kwak Seong-Mi Kim Jong-Hae
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Abstract
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Background: As a side effect of interscalene brachial plexus block (ISBPB), stellate ganglion block (SGB) causes reductions in pupil size (Horner¡¯s syndrome) and cardiac sympathetic nervous activity (CSNA). Reduced CSNA is associated with hemodynamic instability when patients are seated. Therefore, instantaneous measurements of CSNA are important in seated patients presenting with Horner¡¯s syndrome. However, there are no effective tools to measure real-time CSNA intraoperatively. To evaluate the usefulness of pupillometry in measuring CSNA, we investigated the relationship between pupil size and CSNA.
Methods: Forty-two patients undergoing right arthroscopic shoulder surgery under ISBPB were analyzed. Pupil diameters were measured at 30 Hz for 2 s using a portable pupillometer. Bilateral pupil diameters and CSNA (natural-log-transformed low-frequency power [0.04?0.15 Hz] of heart rate variability [lnLF]) were measured before ISBPB (pre-ISBPB) and 15 min after transition to the sitting position following ISBPB (post-sitting). Changes in the pupil diameter ([right pupil diameter for post-sitting ? left pupil diameter for post-sitting] ? [right pupil diameter for pre-ISBPB ? left pupil diameter for pre-ISBPB]) and CSNA (lnLF for post-sitting ? lnLF for pre-ISBPB) were calculated.
Results: Forty-one patients (97.6%) developed Horner¡¯s syndrome. Right pupil diameter and lnLF significantly decreased upon transition to sitting after ISBPB. In the linear regression model (R2 =0.242, P=0.001), a one-unit decrease (1 mm) in the extent of changes in the pupil diameter reduced the extent of changes in lnLF by 0.659 ln(ms2/Hz) (95% CI [0.090, 1.228]).
Conclusions: Pupillometry is a useful tool to measure changes in CSNA after the transition to sitting following ISBPB.
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KEYWORD
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Arthroscopy, Brachial plexus block, Heart rate, Linear models, Pupil, Shoulder, Sitting position, Stellate ganglion, Sympathetic nervous system
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