Seo JH, Cho SY, Park JH, Seo JY, Lee HY, Kim DJ. Intraoperative sudden arrhythmias in cervical spine surgery adjacent to the stellate ganglion: A case report. World J Clin Cases 2023; 11(24): 5789-5796 [PMID: 37727714 DOI: 10.12998/wjcc.v11.i24.5789]
Corresponding Author of This Article
Dong-Joon Kim, MD, PhD, Associate Professor, Doctor, Department of Anesthesiology and Pain Medicine, College of Medicine, Chosun University, 365 Pilmun-daero, Dong-gu, Gwangju 61453, South Korea. djkim@chosun.ac.kr
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 26, 2023; 11(24): 5789-5796 Published online Aug 26, 2023. doi: 10.12998/wjcc.v11.i24.5789
Intraoperative sudden arrhythmias in cervical spine surgery adjacent to the stellate ganglion: A case report
Jong-Hun Seo, Su-Yeon Cho, Ji-Hwan Park, Jin-Young Seo, Hyun-Young Lee, Dong-Joon Kim
Jong-Hun Seo, Department of Neurosurgery, Chosun University Hospital, Gwangju 61453, South Korea
Su-Yeon Cho, Ji-Hwan Park, Jin-Young Seo, Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju 61453, South Korea
Hyun-Young Lee, Dong-Joon Kim, Department of Anesthesiology and Pain Medicine, College of Medicine, Chosun University, Gwangju 61453, South Korea
Author contributions: Kim DJ and Seo JH conceived the article; Park JH and Seo JY collected the data; Cho SY and Lee HY assembled the data; Seo JH, Cho SY, Park JH, Seo JY, Lee HY and Kim DJ provided the study materials, write the manuscript, and approved the manuscript.
Supported byThe Research fund from Chosun University Hospital.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong-Joon Kim, MD, PhD, Associate Professor, Doctor, Department of Anesthesiology and Pain Medicine, College of Medicine, Chosun University, 365 Pilmun-daero, Dong-gu, Gwangju 61453, South Korea. djkim@chosun.ac.kr
Received: May 24, 2023 Peer-review started: May 24, 2023 First decision: July 3, 2023 Revised: July 7, 2023 Accepted: August 2, 2023 Article in press: August 2, 2023 Published online: August 26, 2023 Processing time: 92 Days and 22.6 Hours
Abstract
BACKGROUND
Atrial arrhythmias such as paroxysmal supraventricular tachycardia (PSVT) and atrial flutter (AF) are common in the perioperative setting. They commonly resolve spontaneously. However, occasionally, they may continually progress to fatal arrhythmias or cause complications. Therefore, prompt and appropriate management is important.
CASE SUMMARY
A 46-year-old female patient diagnosed with cervical C6-7 radiculopathy characterized by decreased sensation in the right third, fourth and fifth fingers underwent C6-7 anterior cervical disc fusion surgery. Electrocardiography showed PSVT and ventricular tachycardia during C6-7 disc retraction. However, the patient remained stable. Initial treatment with esmolol and lidocaine for ventricular tachycardia was ineffective. Carotid massage and Valsalva maneuver were attempted but PSVT did not resolve. The surgery was paused, and the patient’s fraction of inspired oxygen was set to 100%. Adenosine was administered for pharmacological management of PSVT. The arrhythmia temporarily resolved. However, it then transformed into AF. Diltiazem was administered, which briefly decreased blood pressure, which immediately recovered. Surgery resumed while the patient was in normal sinus rhythm. She was discharged safely on postoperative day 6 without complications or abnormalities. Currently, she is living a healthy life without arrhythmia recurrence.
CONCLUSION
Ganglia associated with cardiac arrhythmias in the surgical site should be identified during cervical spine surgery.
Core Tip: Paroxysmal supraventricular tachycardia and atrial flutter can occur without structural heart disease and are present at any age. In the current case, the arrhythmia was caused by the surgical stimulation of the stellate ganglion in a patient without a significant medical history. Electrocardiography results were similar, making it difficult to identify the type of arrhythmia. Hence, another arrhythmia was observed even after appropriate treatment. In such a case, if an arrhythmia occurs in the context of stimulation of the right stellate ganglion during cervical spine surgery, identification of triggers to consider, correction of the appropriate triggers, and prevention of migration to fatal arrhythmias should be considered.
