USG-guided bilateral sphenopalatine ganglion block: A useful anesthetic adjuvant for trans nasal trans sphenoidal pituitary surgery in a patient with severely low ejection fraction
Trans-Nasal Trans-Sphenoidal (TNTS) route has become the preferred conduit for operating on a surgically amenable pathology of pituitary gland. The procedure necessitates close monitoring of perioperative hemodynamic stability, especially in patients with impaired heart function. Patients with coron...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-01-01
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| Series: | Saudi Journal of Anaesthesia |
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| Online Access: | https://journals.lww.com/10.4103/sja.sja_388_24 |
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| author | Ravi Chaudhary Yashwant S. Payal Bishnupriya Mohapatra Sony Sony Shivam Shekhar |
| author_facet | Ravi Chaudhary Yashwant S. Payal Bishnupriya Mohapatra Sony Sony Shivam Shekhar |
| author_sort | Ravi Chaudhary |
| collection | DOAJ |
| description | Trans-Nasal Trans-Sphenoidal (TNTS) route has become the preferred conduit for operating on a surgically amenable pathology of pituitary gland. The procedure necessitates close monitoring of perioperative hemodynamic stability, especially in patients with impaired heart function. Patients with coronary artery disease (CAD) and compromized cardiac function with very low ejection fraction increase the risk of perioperative major adverse cardiac events (MACE). In this case, a 54-year-old obese female, a known case of CAD post-PTCA with left ventricular systolic dysfunction with apical hypokinesia, complete left bundle branch block with an ejection fraction of 30% with hypertension and diabetes in the last 5 years under medication posted for TNTS excision. A combination of regional and general anesthesia was adopted to curb the sympathetic stimulus, blunt the surgical stress response and pressor response at various stimulating time points, and minimize sympathetic stimulation in the perioperative period. Minimal fluctuation in heart rate and blood pressure during the surgery was observed, which was supposedly attributed to sphenopalatine ganglion (SPG) block and lignocaine. This case underscores the importance of implementation of USG-guided bilateral SPG block and lignocaine infusion and represents a novel approach in perioperative anesthetic management, particularly for cardiac patients undergoing TNTS surgery with low ejection fraction. |
| format | Article |
| id | doaj-art-0aa3d32899334e5c833c2f6123b0f074 |
| institution | Kabale University |
| issn | 1658-354X 0975-3125 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Saudi Journal of Anaesthesia |
| spelling | doaj-art-0aa3d32899334e5c833c2f6123b0f0742025-02-06T07:24:16ZengWolters Kluwer Medknow PublicationsSaudi Journal of Anaesthesia1658-354X0975-31252025-01-0119110210410.4103/sja.sja_388_24USG-guided bilateral sphenopalatine ganglion block: A useful anesthetic adjuvant for trans nasal trans sphenoidal pituitary surgery in a patient with severely low ejection fractionRavi ChaudharyYashwant S. PayalBishnupriya MohapatraSony SonyShivam ShekharTrans-Nasal Trans-Sphenoidal (TNTS) route has become the preferred conduit for operating on a surgically amenable pathology of pituitary gland. The procedure necessitates close monitoring of perioperative hemodynamic stability, especially in patients with impaired heart function. Patients with coronary artery disease (CAD) and compromized cardiac function with very low ejection fraction increase the risk of perioperative major adverse cardiac events (MACE). In this case, a 54-year-old obese female, a known case of CAD post-PTCA with left ventricular systolic dysfunction with apical hypokinesia, complete left bundle branch block with an ejection fraction of 30% with hypertension and diabetes in the last 5 years under medication posted for TNTS excision. A combination of regional and general anesthesia was adopted to curb the sympathetic stimulus, blunt the surgical stress response and pressor response at various stimulating time points, and minimize sympathetic stimulation in the perioperative period. Minimal fluctuation in heart rate and blood pressure during the surgery was observed, which was supposedly attributed to sphenopalatine ganglion (SPG) block and lignocaine. This case underscores the importance of implementation of USG-guided bilateral SPG block and lignocaine infusion and represents a novel approach in perioperative anesthetic management, particularly for cardiac patients undergoing TNTS surgery with low ejection fraction.https://journals.lww.com/10.4103/sja.sja_388_24cad patientlignocaine infusionlow ejection fractionperioperative arrhythmia riskpost ptcaspg blocktnts surgery |
| spellingShingle | Ravi Chaudhary Yashwant S. Payal Bishnupriya Mohapatra Sony Sony Shivam Shekhar USG-guided bilateral sphenopalatine ganglion block: A useful anesthetic adjuvant for trans nasal trans sphenoidal pituitary surgery in a patient with severely low ejection fraction Saudi Journal of Anaesthesia cad patient lignocaine infusion low ejection fraction perioperative arrhythmia risk post ptca spg block tnts surgery |
| title | USG-guided bilateral sphenopalatine ganglion block: A useful anesthetic adjuvant for trans nasal trans sphenoidal pituitary surgery in a patient with severely low ejection fraction |
| title_full | USG-guided bilateral sphenopalatine ganglion block: A useful anesthetic adjuvant for trans nasal trans sphenoidal pituitary surgery in a patient with severely low ejection fraction |
| title_fullStr | USG-guided bilateral sphenopalatine ganglion block: A useful anesthetic adjuvant for trans nasal trans sphenoidal pituitary surgery in a patient with severely low ejection fraction |
| title_full_unstemmed | USG-guided bilateral sphenopalatine ganglion block: A useful anesthetic adjuvant for trans nasal trans sphenoidal pituitary surgery in a patient with severely low ejection fraction |
| title_short | USG-guided bilateral sphenopalatine ganglion block: A useful anesthetic adjuvant for trans nasal trans sphenoidal pituitary surgery in a patient with severely low ejection fraction |
| title_sort | usg guided bilateral sphenopalatine ganglion block a useful anesthetic adjuvant for trans nasal trans sphenoidal pituitary surgery in a patient with severely low ejection fraction |
| topic | cad patient lignocaine infusion low ejection fraction perioperative arrhythmia risk post ptca spg block tnts surgery |
| url | https://journals.lww.com/10.4103/sja.sja_388_24 |
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