title: Retropharyngeal hematoma after stellate ganglion block: Analysis of 27 patients reported in the literature.
abstract: BACKGROUND
  Retropharyngeal hematoma (RPH) is rare; however, it causes airway obstruction and can be fatal. Stellate ganglion block (SGB) can cause RPH. The authors analyzed reports of patients with RPH after SGB to clarify the initial symptoms and signs, and the urgency of airway management.
  
  
  METHODS
  MEDLINE and Japana Centra Revuo Medicina were searched for reports of RPH after SGB using the following terms and key words: stellate ganglion block, complication, hematoma, and retropharyngeal hematoma.
  
  
  RESULTS
  The authors found 27 patients with RPH after SGB in the past 40 yr. The initial symptoms included neck pain (n = 10), dyspnea (n = 10), neck swelling (n = 8), and hoarseness (n = 5). The symptoms occurred 2 h or more after SGB in 14 patients (52%). Emergency airway management was needed in 21 patients (78%) because of airway obstruction. Among the 21 patients, orotracheal intubation was attempted first in 17 patients; however, it was unsuccessful in 5 patients who immediately needed emergency tracheostomy. Tracheal intubation was impossible by distortion of the anatomy of the markedly edematous pharyngolarynx. Failed airway management caused one death. There were no statistically significant predictors of the initial symptoms or signs for later emergency airway management.
  
  
  CONCLUSIONS
  RPH after SGB necessitates emergency airway management. Because airway obstruction cannot be predicted by the initial symptoms or signs, emergency airway management tools should be at hand, and the patency of the airway should be continuously evaluated after onset of RPH after SGB.
authors.affiliation: Department of Anesthesiology, Fukuoka University School of Medicine, 45-1, 7-chome, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan. higa@fukuoka-u.ac.jp
authors.forename: Kazuo
authors.initials: K
authors.lastname: Higa
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Hirata
authors.forename: Kazunori
authors.initials: K
authors.lastname: Hirota
authors.forename: Keiichi
authors.initials: K
authors.lastname: Nitahara
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Shono
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D001344:Autopsy; D001777:Blood Coagulation / Q000187:drug effects; D004347:Drug Interactions; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006406:Hematoma / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology; D009407:Nerve Block / Q000009:adverse effects*; D010608:Pharyngeal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D010612:Pharyngitis / Q000209:etiology; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013233:Stellate Ganglion; D014057:Tomography, X-Ray Computed