Retropharyngeal Hematoma After Stellate Ganglion Block: Analysis of 27 Patients Reported in the Literature
Kazuo Higa, Kazuhiko Hirata, Kazunori Hirota, Keiichi Nitahara, Shinjiro Shono
(Anesthesiology, 105:1238-1245, 2006)
Department of Anesthesiology, Fukuoka University School of Medicine, Fukuoka, Japan.
Retropharyngeal hematoma (RPH) is rare, but it causes airway obstruction and can be fatal. Stellate ganglion block (SGB) can cause RPH. Reports of patients with RPH after SGB were analyzed to clarify the initial symptoms and signs and the urgency of airway management. MEDLINE and Japana Centra Revuo Medicina were searched for reports of RPH after SGB using the terms SGB, complication, hematoma, and RPH. Twenty-seven patients with RPH after SGB in the past 40 years were found. Initial symptoms included neck pain (n = 10), dyspnea (n = 10), neck swelling (n = 8), and hoarseness (n = 5). The symptoms occurred 2 hours or more after SGB in 14 patients (52%). Emergency airway management was required in 21 patients (78%) because of airway obstruction. Among the 21 patients, orotracheal intubation was attempted first in 17 patients, but it was unsuccessful in 5 patients, who immediately needed an emergency tracheostomy. Tracheal intubation was impossible because of distortion of the anatomy of the markedly edematous pharyngolarynx. Failure of airway intubation caused 1 death. No statistically significant predictors of the initial symptoms and signs for later emergency airway management were seen. Retropharyngeal hematoma after SGB requires emergency airway management, the tools for which should be at hand because such obstruction cannot be predicted by the initial symptoms or signs. The patency of the airway should be continuously evaluated after the onset of SGB.