Effects of stellate ganglion block anesthesia on cognition and biomarkers in patients undergoing gastrointestinal surgery

Abstract

BACKGROUND

Surgery is a common treatment for gastrointestinal tumors. General anesthesia (GA), while effective, can cause oxidative stress reactions and neuroinflammation, potentially leading to postoperative cognitive dysfunction and gastrointestinal dysfunction. The stellate ganglion block (SGB) can reduce sympathetic excitability and stress responses. This study aims to investigate whether combining SGB with GA can mitigate these adverse effects in patients undergoing gastrointestinal surgery.

AIM

To analyze the effects of SGB plus GA on hemodynamic stability, oxidative stress, neuroinflammation, cognitive function, and gastrointestinal function in patients undergoing gastrointestinal surgery.

METHODS

Patients undergoing gastrointestinal surgery between October 2022 and December 2024 were divided into two groups: A single GA group and an SGB combined with GA group (40 patients each). Hemodynamics, oxidative stress response, laboratory indices, cognitive function, and gastrointestinal function were compared preoperatively and 24 hours postoperatively between the two groups. Pain levels and complications were also recorded.

RESULTS

Before anesthesia induction, no significant differences were found in various indexes (including hemodynamics, oxidative stress indicators, laboratory indices, cognitive function scores, and gastrointestinal function indicators) between the two groups (P > 0.05). At tracheal intubation, 3 minutes after, and extubation, the GA-only group had significantly higher mean arterial pressure and heart rate postoperatively than preoperatively and compared to the SGB-GA combined group (P < 0.05). Twenty-four hours postoperatively, oxidative stress indicators (malondialdehyde and nitric oxide) were significantly higher and superoxide dismutase was significantly lower in the GA group than in the SGB-GA combined group (P < 0.05). Cognitive function scores [Mini-Mental State Examination and Montreal Cognitive Assessment (MoCA)] and gastrointestinal function indicators (motilin) were also significantly better in the SGB-GA combined group (P < 0.05). The 24-hour postoperative MoCA score was 0.98 points higher in the SGB-GA combined group. No significant differences were found in the time of first postoperative ambulation, catheter removal time, and 24-hour postoperative pain between groups (P > 0.05).

CONCLUSION

Combining SGB with GA can maintain perioperative hemodynamic stability, reduce oxidative stress and neuroinflammatory injury, and attenuate postoperative cognitive decline and gastrointestinal dysfunction in patients undergoing gastrointestinal surgery.

Keywords: Stellate ganglion block anesthesia; Gastrointestinal surgery; Hemodynamics; Oxidative stress; Cognitive function; Gastrointestinal function

Core Tip: Stellate ganglion block (SGB) anesthesia has remarkable advantages when used in gastrointestinal surgery. In contrast to general anesthesia, SGB effectively stabilizes patient hemodynamics throughout the perioperative phase. Our results showed that using SGB significantly reduced oxidative stress, as evidenced by lower levels of related biomarkers. This not only safeguards cognitive function, but also actively promotes the recovery of gastrointestinal function, presenting a more optimal choice for enhancing patient management and postoperative outcomes.