Thorac Cardiovasc Surg 2010; 58(1): 59
DOI: 10.1055/s-0029-1186270
Letter to the Editor

© Georg Thieme Verlag KG Stuttgart · New York

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

Thorac Cardiovasc Surg 2009; 57: 309–314R. L. Fisher1
  • 1Interventional Pain Management, National Capital Consortium, National Naval Medical Center, Uniformed Services University, Bethesda, MD, USA
Further Information

Publication History

received August 31, 2009

Publication Date:
13 January 2010 (online)

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:

Rick L. Fisher, DO, Physician Fellow

Interventional Pain Management
National Capital Consortium
National Naval Medical Center
Uniformed Services University

4301 Jones Bridge Road

Bethesda, MD 20889


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