Roshith Chandran1, Rupa Sreedhar2, Shrinivas Gadhinglajkar2, Prashantkumar Dash2, Jayakumar Karunakaran3, Vivek Pillai3
1 Department of Cardiac Anaesthesia, Freeman Hospital, Newcastle Upon Tyne, UK
2 Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
3 Department of CVTS, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
Background: Left stellate ganglion blockade (LSGB) may have additive effect to topical administration of papaverine on prevention of vasospasm of left internal thoracic artery (LITA). Aims: This study aims to compare LITA blood flow with topical application of papaverine alone or in combination with LSGB. Setting: Tertiary care hospital. Design: Prospective randomized controlled study. Materials and Methods: A total of 100 patients operated for coronary revascularization were randomly and equally allocated into two groups. In control Group-C, papaverine was applied topically during the dissection of LITA. In Group-S, the additional LSGB was performed. Blood flow was measured from cut end of the LITA for 15 s. Primary objectives of the evaluation were to observe differences in the LITA blood flow. Observing incidence of radial-femoral arterial pressure difference after cardiopulmonary bypass (CPB) was secondary objective. Statistical Analysis: Student's unpaired t-test and Fisher's exact test to find out a significant difference between the groups. Results: LITA flow in Group-S was insignificantly more (49.28 ± 7.88 ml/min) than Group-C (47.12 ± 7.24 ml/min), (P = 0.15). Radio-femoral arterial pressure difference remained low for 40 min after termination of CPB in the Group-S compared to the Group-C (−0.99 ± 1.85 vs. −1.92 ± 2.26). Conclusion: Combining LSGB with papaverine does not increase the LITA blood flow compared to when the papaverine is used alone. However, ganglion blockade reduces radial-femoral arterial pressure difference after CPB. Blockade can be achieved successfully under the ultrasound guidance without any complications.
Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala
Source of Support: None, Conflict of Interest: None
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