<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03042663</url>
  </required_header>
  <id_info>
    <org_study_id>StArt</org_study_id>
    <nct_id>NCT03042663</nct_id>
  </id_info>
  <brief_title>Effect of Stellate Ganglion Block on Blood Flow in the Cannulated Radial Artery</brief_title>
  <official_title>Effect of Stellate Ganglion Block on Blood Flow in the Cannulated Radial Artery in Septic Shock Patients on Vasopressors, A Feasibility Study</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Eslam Ayman Mohamed Shawki</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Cairo University</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      To evaluate the value of US-guided Stellate ganglion block for improving radial arterial&#xD;
      blood flow and peripheral perfusion in Septic shock patients on vasopressor support with an&#xD;
      indwelling radial arterial cannula, which can result in reduced incidence premature failure&#xD;
      of the catheter (due to vasospasm or thrombosis) and incidence of ischemic complications in&#xD;
      the cannulated arm.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Radial artery cannulation is a well-established procedure in the ICU, especially in&#xD;
      critically ill hemodynamically unstable patients. The first description of arterial&#xD;
      cannulation in humans dates back to 1856, when the blood pressure was measured int the&#xD;
      femoral artery. It can be used for continuous blood pressure monitoring, obtaining&#xD;
      func¬tional hemodynamic parameters derived from the arterial waveform, to predict the&#xD;
      physiologic response to fluid resuscitation and also for blood sampling.&#xD;
&#xD;
      The most common complications for the procedure are temporary radial artery occlusion&#xD;
      (19.7%), in addition to hematoma (14.4%), infection at the arterial site (0.72%), hemorrhage&#xD;
      (0.53%) or bacteremia (0.13%), pseudoaneurysm (0.09%) and finally ischemic damage (0.09%).&#xD;
      Larger catheter diameter, presence of vasospasm, female sex (probably related to smaller&#xD;
      vessel diameter) increase the risk of ischemic complications. Inadequate experience (high&#xD;
      number of attempts, multiple arterial sticks and hematoma formation) can also increase the&#xD;
      complication rate.&#xD;
&#xD;
      In a recent study by Numaguchi et al, they found that radial artery cannulation decreases the&#xD;
      distal arterial blood flow measured by power Doppler ultrasound. In another study by Kim et&#xD;
      al, they found that after radial artery cannulation ulnar artery diameters were significantly&#xD;
      increased (compensatory) and radial artery diameters were decreased after cannulation&#xD;
      compared with pre-cannulation values, then returned to pre-cannulation values 5 min after&#xD;
      cannulation. They detected radial artery vasospasm in 12 patients with 20-G cannulas used&#xD;
      (31.5%) and in 2 patients with 22-G cannulas used (5.3%) (p &lt; 0.05), which was observed&#xD;
      immediately after cannulation, and had mostly disappeared after 5 min. There was no data&#xD;
      regarding the follow up of the patients afterwards. In both studies the subjects were not&#xD;
      critically ill patients (and not on vasopressors).&#xD;
&#xD;
      Peripheral limb ischemia in ICU patients can be the result of iatrogenic injury, thrombotic&#xD;
      complications or hypoperfusion related to the underlying disease state. The patients at&#xD;
      greatest risk for acute ischemia are those with underlying peripheral artery disease (PAD),&#xD;
      but limb ischemia can also be the consequence of embolism, injury, dissection, or severe&#xD;
      vasoconstriction, even in the absence of preexisting occlusive disease. Repeated arterial&#xD;
      punctures may result in extensive hematoma formation and arterial spasm, The thick muscular&#xD;
      coat and abundance of alpha adrenoreceptors make it prone to develop spasm when traumatized.&#xD;
      Attempts to control bleeding following cannulation through local hemostasis only complicate&#xD;
      matters. While, normally, the likelihood of serious ischemia is minimized by the presence of&#xD;
      the palmar arterial arch.&#xD;
&#xD;
      The use of vasopressors especially nor-epinephrine with its potent α1-adrenergic receptor&#xD;
      agonist activity can aggravate the condition more. We didn't find in the literature any&#xD;
      reliable data regarding the effect of using vasopressors (particularly nor-epinephrine) in&#xD;
      any dosage on the incidence of peripheral arterial vasospasm or ischemic complications&#xD;
      following arterial cannulation. But there were mixed case reports linking both or one of&#xD;
      them: high dose vasopressors and arterial cannulation, to ischemic complications. Such as&#xD;
      developing peripheral gangrene after starting high dose vasopressors, or developing complex&#xD;
      regional pain syndrome (CRPS) following radial artery cannulation.&#xD;
&#xD;
      It is believed that blocking the Stellate ganglion with Local anesthetics can interfere with&#xD;
      the sympathetic out flow to the upper limb resulting in abolishing its vasoconstrictor action&#xD;
      on the arteries thus decreasing arterial spasm and promoting better blood flow in the&#xD;
      peripheral circulation.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Unknown status</overall_status>
  <last_known_status>Recruiting</last_known_status>
  <start_date type="Actual">March 1, 2016</start_date>
  <completion_date type="Anticipated">October 4, 2017</completion_date>
  <primary_completion_date type="Anticipated">September 1, 2017</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>N/A</allocation>
    <intervention_model>Single Group Assignment</intervention_model>
    <intervention_model_description>The study will recruit septic shock patients with hemodynamic instability on vasopressor support and on direct arterial blood pressure monitoring through a radial arterial cannula that is not older than 12 hours.</intervention_model_description>
    <primary_purpose>Prevention</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>change in Perfusion Index (PI)</measure>
    <time_frame>After 30 minutes then every hour for 6 hours</time_frame>
    <description>change in Perfusion Index (PI) in the cannulated limb before and after the Stellate ganglion block.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Perfusion Index (PI) after cannulation</measure>
    <time_frame>3 hours</time_frame>
    <description>Perfusion Index (PI) values bilaterally after radial arterial cannulation</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Perfusion Index (PI) after Stellate ganglion block</measure>
    <time_frame>6 hours</time_frame>
    <description>Perfusion Index (PI) values bilaterally after Stellate ganglion block in the cannulated side.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Doppler Blood flow values after cannulation</measure>
    <time_frame>3 hours</time_frame>
    <description>Doppler Blood flow values in the both Radial arteries after cannulation of one of them.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Doppler Blood flow after Stellate ganglion block</measure>
    <time_frame>6 hours</time_frame>
    <description>Doppler Blood flow values in the both Radial arteries after Stellate ganglion block in the cannulated side.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Vasopressor drug dose</measure>
    <time_frame>6 hours</time_frame>
    <description>Doses of vasopressor drugs used.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Incidence of complications</measure>
    <time_frame>6 hours</time_frame>
    <description>Incidence of complications related to the Stellate ganglion block (Hematoma, Intravascular injection, Intrathecal injection, pneumothorax).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Incidence of ischemic complications</measure>
    <time_frame>6 hours</time_frame>
    <description>Incidence of ischemic complications related to the arterial cannula (Unilateral) or Vasopressors and general condition of the patient (Bilateral) (changes in the form of either color changes or definite gangrene).</description>
  </secondary_outcome>
  <number_of_arms>1</number_of_arms>
  <enrollment type="Anticipated">34</enrollment>
  <condition>Stellate Ganglion Block</condition>
  <condition>Radial Artery Cannulation</condition>
  <arm_group>
    <arm_group_label>Intervention group</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>In patients meeting the inclusion criteria and with absence of any exclusion criteria, and after taking PI and Doppler Blood flow values hourly for 3 hours (control values), the procedure for administering the USG Stellate ganglion block on the side of the arterial cannula will be started</description>
  </arm_group>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>USG stellate ganglion block</intervention_name>
    <description>After verification of proper needle position and aspiration to exclude vascular spread, 1mL of the injectate will be injected to see proper tissue spread as well as patient response. After one minute the remaining volume will be injected under real time ultrasound imaging.</description>
    <arm_group_label>Intervention group</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Age range of 18-80 years.&#xD;
&#xD;
          -  Septic shock patients on vasopressor support (Nor-epinephrine or epinephrine).&#xD;
&#xD;
          -  Presence of an indication for an arterial cannula.&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Coagulopathies (with prothrombin concentration less than 60% or international&#xD;
             normalized ratio INR more than 1.5)&#xD;
&#xD;
          -  In-ability to postpone anti-coagulation medications.&#xD;
&#xD;
          -  Infection or injury or a lesion at the block site.&#xD;
&#xD;
          -  Suspected cervical vertebral column injury necessitating using a neck collar.&#xD;
&#xD;
          -  Bradycardia with heart rate less than 60 beat per minute.&#xD;
&#xD;
          -  A compromised lung on the contralateral side of the arterial cannula (Pneumothorax,&#xD;
             hemothorax or Pneumonectomy).&#xD;
&#xD;
          -  Recent cardiac insult (cardiogenic shock) (Due to blockage of the sympathetic cardiac&#xD;
             accelerator fibers by the block).&#xD;
&#xD;
          -  Traumatic vascular injuries or operative interventions (Surgical harvesting) involving&#xD;
             arteries of the upper limb on either side.&#xD;
&#xD;
          -  Peripheral vascular disease, atherosclerosis, atrial fibrillation, previous history of&#xD;
             ischemic injuries, hypercoagulable syndromes.&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>80 Years</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_contact>
    <last_name>Eslam A Shawki, M.D.</last_name>
    <phone>+201225771017</phone>
    <email>eslam.ayman@kasralainy.edu.eg</email>
  </overall_contact>
  <location>
    <facility>
      <name>Faculty of medicine, Cairo University teaching hospitals (Kasr Alainy)</name>
      <address>
        <city>Cairo</city>
        <country>Egypt</country>
      </address>
    </facility>
    <status>Recruiting</status>
    <contact>
      <last_name>Eslam A Shawki, M.D</last_name>
      <phone>'+201225771017</phone>
      <email>eslam.ayman@kasralainy.edu.eg</email>
    </contact>
    <investigator>
      <last_name>Shereen M Amin, M,D</last_name>
      <role>Principal Investigator</role>
    </investigator>
    <investigator>
      <last_name>Ahmed Z Fouad, M.D</last_name>
      <role>Sub-Investigator</role>
    </investigator>
    <investigator>
      <last_name>Ahmed S Abd El-Hameed</last_name>
      <role>Sub-Investigator</role>
    </investigator>
  </location>
  <location_countries>
    <country>Egypt</country>
  </location_countries>
  <reference>
    <citation>Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009 Sep;37(9):2642-7. doi: 10.1097/CCM.0b013e3181a590da.</citation>
    <PMID>19602972</PMID>
  </reference>
  <reference>
    <citation>Gershengorn HB, Garland A, Kramer A, Scales DC, Rubenfeld G, Wunsch H. Variation of arterial and central venous catheter use in United States intensive care units. Anesthesiology. 2014 Mar;120(3):650-64. doi: 10.1097/ALN.0000000000000008.</citation>
    <PMID>24424071</PMID>
  </reference>
  <reference>
    <citation>Scheer B, Perel A, Pfeiffer UJ. Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. Crit Care. 2002 Jun;6(3):199-204. doi: 10.1186/cc1489. Epub 2002 Apr 18.</citation>
    <PMID>12133178</PMID>
  </reference>
  <reference>
    <citation>Glockner E, Harych H. [Guidelines for planning concerning physicians and stomatologists up to 1980]. Z Gesamte Hyg. 1970 Oct;16(10):811-22. No abstract available. German.</citation>
    <PMID>5516161</PMID>
  </reference>
  <reference>
    <citation>Kim SY, Lee JS, Kim WO, Sun JM, Kwon MK, Kil HK. Evaluation of radial and ulnar blood flow after radial artery cannulation with 20- and 22-gauge cannulae using duplex Doppler ultrasound. Anaesthesia. 2012 Oct;67(10):1138-45. doi: 10.1111/j.1365-2044.2012.07235.x. Epub 2012 Jul 16.</citation>
    <PMID>22804619</PMID>
  </reference>
  <reference>
    <citation>Lazaro RP. Complex regional pain syndrome and acute carpal tunnel syndrome following radial artery cannulation: a neurological perspective and review of the literature. Medicine (Baltimore). 2015 Jan;94(3):e422. doi: 10.1097/MD.0000000000000422.</citation>
    <PMID>25621693</PMID>
  </reference>
  <reference>
    <citation>Rasmy I, Mohamed H, Nabil N, Abdalah S, Hasanin A, Eladawy A, Ahmed M, Mukhtar A. Evaluation of Perfusion Index as a Predictor of Vasopressor Requirement in Patients with Severe Sepsis. Shock. 2015 Dec;44(6):554-9. doi: 10.1097/SHK.0000000000000481.</citation>
    <PMID>26529657</PMID>
  </reference>
  <reference>
    <citation>Yamazaki H, Nishiyama J, Suzuki T. Use of perfusion index from pulse oximetry to determine efficacy of stellate ganglion block. Local Reg Anesth. 2012;5:9-14. doi: 10.2147/LRA.S30257. Epub 2012 Mar 13.</citation>
    <PMID>22915896</PMID>
  </reference>
  <verification_date>June 2017</verification_date>
  <study_first_submitted>February 1, 2017</study_first_submitted>
  <study_first_submitted_qc>February 2, 2017</study_first_submitted_qc>
  <study_first_posted type="Estimate">February 3, 2017</study_first_posted>
  <last_update_submitted>June 19, 2017</last_update_submitted>
  <last_update_submitted_qc>June 19, 2017</last_update_submitted_qc>
  <last_update_posted type="Actual">June 21, 2017</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor-Investigator</responsible_party_type>
    <investigator_affiliation>Cairo University</investigator_affiliation>
    <investigator_full_name>Eslam Ayman Mohamed Shawki</investigator_full_name>
    <investigator_title>Lecturer of anesthesia, SICU &amp; Pain Management</investigator_title>
  </responsible_party>
  <keyword>stellate ganglion block</keyword>
  <keyword>arterial cannula</keyword>
  <keyword>ischemia</keyword>
  <keyword>septic shock</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Ganglion Cysts</mesh_term>
    <mesh_term>Synovial Cyst</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03042663
org study id: StArt
nct id: NCT03042663
lead sponsor: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
To evaluate the value of US-guided Stellate ganglion block for improving radial arterial
      blood flow and peripheral perfusion in Septic shock patients on vasopressor support with an
      indwelling radial arterial cannula, which can result in reduced incidence premature failure
      of the catheter (due to vasospasm or thrombosis) and incidence of ischemic complications in
      the cannulated arm.
Radial artery cannulation is a well-established procedure in the ICU, especially in
      critically ill hemodynamically unstable patients. The first description of arterial
      cannulation in humans dates back to 1856, when the blood pressure was measured int the
      femoral artery. It can be used for continuous blood pressure monitoring, obtaining
      func¬tional hemodynamic parameters derived from the arterial waveform, to predict the
      physiologic response to fluid resuscitation and also for blood sampling.

      The most common complications for the procedure are temporary radial artery occlusion
      (19.7%), in addition to hematoma (14.4%), infection at the arterial site (0.72%), hemorrhage
      (0.53%) or bacteremia (0.13%), pseudoaneurysm (0.09%) and finally ischemic damage (0.09%).
      Larger catheter diameter, presence of vasospasm, female sex (probably related to smaller
      vessel diameter) increase the risk of ischemic complications. Inadequate experience (high
      number of attempts, multiple arterial sticks and hematoma formation) can also increase the
      complication rate.

      In a recent study by Numaguchi et al, they found that radial artery cannulation decreases the
      distal arterial blood flow measured by power Doppler ultrasound. In another study by Kim et
      al, they found that after radial artery cannulation ulnar artery diameters were significantly
      increased (compensatory) and radial artery diameters were decreased after cannulation
      compared with pre-cannulation values, then returned to pre-cannulation values 5 min after
      cannulation. They detected radial artery vasospasm in 12 patients with 20-G cannulas used
      (31.5%) and in 2 patients with 22-G cannulas used (5.3%) (p < 0.05), which was observed
      immediately after cannulation, and had mostly disappeared after 5 min. There was no data
      regarding the follow up of the patients afterwards. In both studies the subjects were not
      critically ill patients (and not on vasopressors).

      Peripheral limb ischemia in ICU patients can be the result of iatrogenic injury, thrombotic
      complications or hypoperfusion related to the underlying disease state. The patients at
      greatest risk for acute ischemia are those with underlying peripheral artery disease (PAD),
      but limb ischemia can also be the consequence of embolism, injury, dissection, or severe
      vasoconstriction, even in the absence of preexisting occlusive disease. Repeated arterial
      punctures may result in extensive hematoma formation and arterial spasm, The thick muscular
      coat and abundance of alpha adrenoreceptors make it prone to develop spasm when traumatized.
      Attempts to control bleeding following cannulation through local hemostasis only complicate
      matters. While, normally, the likelihood of serious ischemia is minimized by the presence of
      the palmar arterial arch.

      The use of vasopressors especially nor-epinephrine with its potent α1-adrenergic receptor
      agonist activity can aggravate the condition more. We didn't find in the literature any
      reliable data regarding the effect of using vasopressors (particularly nor-epinephrine) in
      any dosage on the incidence of peripheral arterial vasospasm or ischemic complications
      following arterial cannulation. But there were mixed case reports linking both or one of
      them: high dose vasopressors and arterial cannulation, to ischemic complications. Such as
      developing peripheral gangrene after starting high dose vasopressors, or developing complex
      regional pain syndrome (CRPS) following radial artery cannulation.

      It is believed that blocking the Stellate ganglion with Local anesthetics can interfere with
      the sympathetic out flow to the upper limb resulting in abolishing its vasoconstrictor action
      on the arteries thus decreasing arterial spasm and promoting better blood flow in the
      peripheral circulation.
allocation: N/A
intervention model: Single Group Assignment
intervention model description: The study will recruit septic shock patients with hemodynamic instability on vasopressor support and on direct arterial blood pressure monitoring through a radial arterial cannula that is not older than 12 hours.
primary purpose: Prevention
masking: None (Open Label)
measure: change in Perfusion Index (PI)
time frame: After 30 minutes then every hour for 6 hours
description: change in Perfusion Index (PI) in the cannulated limb before and after the Stellate ganglion block.
measure: Perfusion Index (PI) after cannulation
time frame: 3 hours
description: Perfusion Index (PI) values bilaterally after radial arterial cannulation
measure: Perfusion Index (PI) after Stellate ganglion block
time frame: 6 hours
description: Perfusion Index (PI) values bilaterally after Stellate ganglion block in the cannulated side.
measure: Doppler Blood flow values after cannulation
time frame: 3 hours
description: Doppler Blood flow values in the both Radial arteries after cannulation of one of them.
measure: Doppler Blood flow after Stellate ganglion block
time frame: 6 hours
description: Doppler Blood flow values in the both Radial arteries after Stellate ganglion block in the cannulated side.
measure: Vasopressor drug dose
time frame: 6 hours
description: Doses of vasopressor drugs used.
measure: Incidence of complications
time frame: 6 hours
description: Incidence of complications related to the Stellate ganglion block (Hematoma, Intravascular injection, Intrathecal injection, pneumothorax).
measure: Incidence of ischemic complications
time frame: 6 hours
description: Incidence of ischemic complications related to the arterial cannula (Unilateral) or Vasopressors and general condition of the patient (Bilateral) (changes in the form of either color changes or definite gangrene).
arm group label: Intervention group
arm group type: Experimental
description: In patients meeting the inclusion criteria and with absence of any exclusion criteria, and after taking PI and Doppler Blood flow values hourly for 3 hours (control values), the procedure for administering the USG Stellate ganglion block on the side of the arterial cannula will be started
intervention type: Procedure
intervention name: USG stellate ganglion block
description: After verification of proper needle position and aspiration to exclude vascular spread, 1mL of the injectate will be injected to see proper tissue spread as well as patient response. After one minute the remaining volume will be injected under real time ultrasound imaging.
arm group label: Intervention group
criteria: 
gender: All
minimum age: 18 Years
maximum age: 80 Years
healthy volunteers: No
last name: Eslam A Shawki, M.D.
phone: +201225771017
email: eslam.ayman@kasralainy.edu.eg
facility: 
status: Recruiting
contact: 
investigator: 
investigator: 
investigator: 
country: Egypt
citation: Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009 Sep;37(9):2642-7. doi: 10.1097/CCM.0b013e3181a590da.
PMID: 19602972
citation: Gershengorn HB, Garland A, Kramer A, Scales DC, Rubenfeld G, Wunsch H. Variation of arterial and central venous catheter use in United States intensive care units. Anesthesiology. 2014 Mar;120(3):650-64. doi: 10.1097/ALN.0000000000000008.
PMID: 24424071
citation: Scheer B, Perel A, Pfeiffer UJ. Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. Crit Care. 2002 Jun;6(3):199-204. doi: 10.1186/cc1489. Epub 2002 Apr 18.
PMID: 12133178
citation: Glockner E, Harych H. [Guidelines for planning concerning physicians and stomatologists up to 1980]. Z Gesamte Hyg. 1970 Oct;16(10):811-22. No abstract available. German.
PMID: 5516161
citation: Kim SY, Lee JS, Kim WO, Sun JM, Kwon MK, Kil HK. Evaluation of radial and ulnar blood flow after radial artery cannulation with 20- and 22-gauge cannulae using duplex Doppler ultrasound. Anaesthesia. 2012 Oct;67(10):1138-45. doi: 10.1111/j.1365-2044.2012.07235.x. Epub 2012 Jul 16.
PMID: 22804619
citation: Lazaro RP. Complex regional pain syndrome and acute carpal tunnel syndrome following radial artery cannulation: a neurological perspective and review of the literature. Medicine (Baltimore). 2015 Jan;94(3):e422. doi: 10.1097/MD.0000000000000422.
PMID: 25621693
citation: Rasmy I, Mohamed H, Nabil N, Abdalah S, Hasanin A, Eladawy A, Ahmed M, Mukhtar A. Evaluation of Perfusion Index as a Predictor of Vasopressor Requirement in Patients with Severe Sepsis. Shock. 2015 Dec;44(6):554-9. doi: 10.1097/SHK.0000000000000481.
PMID: 26529657
citation: Yamazaki H, Nishiyama J, Suzuki T. Use of perfusion index from pulse oximetry to determine efficacy of stellate ganglion block. Local Reg Anesth. 2012;5:9-14. doi: 10.2147/LRA.S30257. Epub 2012 Mar 13.
PMID: 22915896
responsible party type: Sponsor-Investigator
investigator affiliation: Cairo University
investigator full name: Eslam Ayman Mohamed Shawki
investigator title: Lecturer of anesthesia, SICU & Pain Management
mesh term: Ganglion Cysts
mesh term: Synovial Cyst
sharing ipd: No