Effect Of Ipsilateral Stellate Ganglion Block On Intraoperative Cerebral Oxygen Metabolism,Energy Metabolism And S100-? Protein In Patients With Moyamoya Disease

Objective:To observe the changes of serum S100-?protein,cerebral oxygen supplement and demand,as well as energy metabolism after stellate ganglion block?SGB?in patients with moyamoya disease during superficial temporal artery-middle cerebral artery?MCA?branch anastomosis.Methods:A total of 42 patients with superficial temporal artery-MCA anastomosis under general anesthesia were selected.These patients?ASA grade I-II?were randomly divided into two groups:stellate ganglion block?SGB?group and control group?C group?-21 cases for each group.SGB patients underwent ultrasound-guided ipsilateral SGB before general anesthesia induction,and no SGB in control group.Post-canalization of the internal jugular vein and retrograde ultrasound of the right internal jugular vein after intubation in both groups.We observed and recorded the average arterial pressure?MAP?and heart rate?HR?of the patients for five time points,namely ventricular insertion?T₀?,endotracheal intubation?T₁?,skin incision?T₂?,30 min?T₃?after dural opening,and immediate end of surgery?T₄?;values of JBP at T₂,T₃ and T₄ were recorded as well.We collected arterial and venous blood at T₂,T₃,and T₄ for blood gas analysis to calculate the blood oxygen saturation?SjvO₂?in the jugular vein,the difference in oxygen content in the arteriovenous blood?A-VDO₂?,cerebral oxygen intake rate?CERO₂?,lactate production rate?LacPR?,and lactic acid production index?Loi?.The serum S100-?protein the internal jugular vein at T₂,T₃,and T₄ measured with ELISA.Results:1.Comparison of MAP and HR at each time point and JBP at T₂,T₃,and T₄between the two groups:During the induction of anesthesia and surgery,HR in SGB group was slower than that in control group.MAP and HR in SGB group were more stable than that in control group at endotracheal intubation and skin incision?P<0.05?.The JBP values in the two groups were not significantly different during the operation.2.Comparison of SjvO₂,A-VDO₂,and CERO₂ at the corresponding time points in two groups:In SGB group the SjvO₂,A-VDO₂,CERO₂ did not change siganificantly at T₂and T₃,SjvO₂ increased at T₄,but A-VDO₂,CERO₂ decreased at T₄;In control group SjvO₂ decreased at T₃,then slight rebound at T₄,A-VDO₂,CERO₂ decreased at first and then increased.SjvO₂ value of the SGB group was higher than that in the control group at the same time,and the difference was statistically significant?P<0.05?.A-VDO₂ and CERO₂ decreased by the time in two groups.Values of the A-VDO₂ and`CERO₂ at the corresponding time points in control group were higher than those in SGB group at the same time,and the difference was statistically significant?P<0.05?.3.Comparison of LacPR and Loi at each time point in two groups:The values ofLacPR and Loi in two groups were the highest at T₃ between T₂-T₄and then decreased at T₄.There was significant difference between T₄ and T₂ in C group?P<0.05?.The corresponding time points in the C group were higher than those in SGB group?P<0.05?.4.Comparison of serum S100-?protein concentrations at each time point in two groups:The serum concentration of S100-?protein increased at first and then decreased at each time point in both groups.The values of each time point in SGB group were significantly lower than that in the control group.The difference between two groups was statistically significant?P<0.05?.Conclusion:1.In moyamoya surgery,preoperative SGB can suppress stress responses,maintains hemodynamic stability,and reduce hypertension as well as tachycardia during surgery.2.SGB can improve intraoperative brain tissue oxygen supplement3.SGB can reduce intraoperative brain damage and play a certain role in brain protection...