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Indian J Anaesth. 2010 Sep-Oct; 54(5): 480.
PMCID: PMC2991667

Locked-in syndrome after stellate ganglion block

Sir,

Firstly, I appreciate the prompt management of patients, which avoided catastrophe even after the intra-arterial injection of the local anaesthetic solution. However, I have to make a few comments regarding their approach and put forth a few suggestions.

  1. It is an accepted fact that the previously suggested paratracheal technique,[1] which authors’ have used, resulted in many serious complications. Therefore, fluoroscopic-guided techniques are standard practice today.
  2. During the repeat injection, the authors used fluoroscopy and contrast with a safe and effective outcome. However, their suggestion that fluoroscopy should be used in difficult cases only is not appropriate.
  3. We do not know in which patient intra-arterial injection may take place as the negative aspiration test is not foolproof.[2,3]
  4. I feel that the morbidity which occurred due to the “locked-in syndrome” and other serious side-effects that may occur during stellate ganglion block could be avoided if contrast injection and fluoroscopy are used in every patient, irrespective of subjective assessment of easy or difficult case.

REFERENCES

1. Carron H, Litwiller R. Stellate ganglion block. Anesth Analg. 1975;54:567–8. [PubMed]
2. Korevaar WC, Burney RG, Moore PA. Convulsion during stellate ganglion block. A case report. Anesth Analg. 1979;58:329–30. [PubMed]
3. Tóz M, Erodlu F, Dodru H, Uygur K, Yavuz L. Transient locked-in syndrome resulting from stellate ganglion block in the treatment of patients with sudden hearing loss. Acta Anaesthesiol Scand. 2003;47:485–7. [PubMed]

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