Comment on: Takanami et al. Life-Threatening Airway Obstruction

Esteemed Editor

I read with great interest the article by Takanami et al. in Vol. 57, pages 309–314 of the Thoracic and Cardiovascular Surgeon. Dr. Takanami relates a case of an individual suffering the unfortunate sequelae of a retropharyngeal hematoma (RPH) with consequent airway compromise some 3 days after a stellate ganglion block (SGB). As a Fellow of the Interventional Pain Management at the National Capital Consortium, Uniformed Services University in Bethesda, Maryland, complications associated with a stellate ganglion block are of particular interest when trying to establish an approach so as to minimize such morbidity. After a review of the literature, I agree with Dr. Takanami that RPH is an exceedingly rare event and the delayed and variable nature of airway compromise should make every interventional pain practitioner consider this, counsel patients accordingly and have an established and reliable means for the patient to be followed up after the procedure. I appreciate the manner in which they closely observed this patient and the unusual progression with a high index of suspicion and meticulous care. What I would like to point out is an apparent discrepancy in the comment made in the article regarding the delayed presentation of the patient as being unique in the literature. Dr. Takanami states, “There are no reports describing airway management…more than 24 hours after SGB.” He goes on to reference an article by Higa et al. in Anesthesiology 2006; 105: 1238–1245. I reviewed this article by Higa and the following three articles are referenced:

• 1 Hirose Y, Kouyama A, Kitahata H, Kimura H, Morishita T. Three cases with giant hematoma after stellate ganglion block.  Pain Clinic (Tokyo). 1995;  16 701-704
• 2 Masuda Y, Yatsushiro R, Nakamura A, Nakajima H, Okamoto M. Airway stenosis caused by hematoma after stellate ganglion block: Report of a case.  Pain Clinic (Tokyo). 1987;  8 443-446
• 3 Matsumoto H, Shiraishi M, Kamiyama Y, Fukui S. Cervical hematoma after stellate ganglion block: a case report.  Jpn J Emerg Med (Kanto). 1991;  12 188-189