Effect of ultrasound-guided stellate ganglion block on cerebral oxygen metabolism and S100B protein during carotid endarterectomy

Fen Yang; Yulong Du; Chen Yuan; Li Han; Yue Zhao; Yang Xie; Wenyong Peng

doi:10.62347/RXRN7802

Effect of ultrasound-guided stellate ganglion block on cerebral oxygen metabolism and S100B protein during carotid endarterectomy

Am J Transl Res. 2024 Mar 15;16(3):1018-1028. doi: 10.62347/RXRN7802. eCollection 2024.

Authors

Fen Yang¹, Yulong Du^{2

3}, Chen Yuan¹, Li Han¹, Yue Zhao¹, Yang Xie¹, Wenyong Peng³

Affiliations

¹ Department of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital Suzhou 215002, Jiangsu, China.
² School of Medicine, Shaoxing University Shaoxing 312000, Zhejiang, China.
³ Department of Anesthesiology, Jinhua Municipal Central Hospital, Jinhua Hospital, Zhejiang University School of Medicine Jinhua 321000, Zhejiang, China.

Abstract

Objective: To investigate the effect of ultrasound-guided stellate ganglion block (SGB) on cerebral oxygen metabolism and serum S100B during carotid endarterectomy (CEA).

Methods: Patients who were prospectively enrolled to receive CEA under elective general anesthesia were randomized into an SGB group and a control group (ChiCTR2000033385). Before anesthesia, the SGB group underwent ipsilateral SGB under ultrasound guidance, while the control group did not. Ultrasound-guided right subclavian internal jugular vein catheterization was performed under general anesthesia. Mean arterial pressure (MAP) and heart rate (HR) were monitored at various time points (T0-T4). Arterial and internal jugular venous bulb blood were collected for blood gas analysis, determining jugular venous oxygen saturation (SjvO₂), arteriovenous oxygen difference (AVDO₂), cerebral oxygen extraction ratio (COER), lactate production rate (LPR), and lactate-oxygen index (LOI). The serum concentration of S100B in the internal jugular venous bulb at each time point was measured.

Results: The results revealed significantly lower HR during anesthesia induction and surgery in the SGB group, with more stable MAP and HR during endotracheal intubation and surgery compared to the control group (P<0.05). The control group exhibited decreases at T3 and a slight increase at T4. SjvO₂ was significantly higher in the SGB group, while AVDO₂ and COER gradually decreased over time, but they were significantly higher in the control group (P<0.05). LPR and LOI in both groups peaked at T3 and were significantly different between T4 and T2 (P<0.05). Serum S100B levels in both groups rose and then decreased at each time point, but they were consistently lower in the SGB group (P<0.05).

Conclusion: SGB before CEA effectively suppresses the stress response, maintains intraoperative hemodynamic stability, improves brain tissue oxygen supply, and demonstrates a neuroprotective effect.

Keywords: Carotid endarterectomy; S100 calcium binding protein β subunit; autonomic nerve block; interventional; lactate; oxygen; stellate ganglion; ultrasound.