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Fischer L, Barop H, Ludin SM, et al. Regulation of acute reflectory hyperinflammation in viral and other diseases by means of stellate ganglion block. A conceptual view with a focus on Covid-19. Auton Neurosci. 2021;237:102903doi: 10.1016/j.autneu.2021.102903.
Fischer, L., Barop, H., Ludin, S. M., & Schaible, H. G. (2021). Regulation of acute reflectory hyperinflammation in viral and other diseases by means of stellate ganglion block. A conceptual view with a focus on Covid-19. Autonomic neuroscience : basic & clinical, 237102903. https://doi.org/10.1016/j.autneu.2021.102903
Fischer, Lorenz, et al. "Regulation of acute reflectory hyperinflammation in viral and other diseases by means of stellate ganglion block. A conceptual view with a focus on Covid-19." Autonomic neuroscience : basic & clinical vol. 237 (2021): 102903. doi: https://doi.org/10.1016/j.autneu.2021.102903
Fischer L, Barop H, Ludin SM, Schaible HG. Regulation of acute reflectory hyperinflammation in viral and other diseases by means of stellate ganglion block. A conceptual view with a focus on Covid-19. Auton Neurosci. 2021 Nov 10;237:102903. doi: 10.1016/j.autneu.2021.102903. Epub 2021 Nov 10. PMID: 34894589.
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Auton Neurosci. 2021 Nov 10;237:102903. doi: 10.1016/j.autneu.2021.102903. Epub 2021 Nov 10.

Regulation of acute reflectory hyperinflammation in viral and other diseases by means of stellate ganglion block. A conceptual view with a focus on Covid-19.

Autonomic neuroscience : basic & clinical

Lorenz Fischer, Hans Barop, Sabina Maria Ludin, Hans-Georg Schaible

Affiliations

  1. University of Bern, Interventional Pain Management, General Internal Medicine, Schwanengasse 5/7, 3011 Bern, Switzerland. Electronic address: [email protected].
  2. Neural Therapy, Friedrich-Legahn-Str. 2, 22587 Hamburg, Germany.
  3. University of Bern, IKIM, Inselspital PH 4, 3010 Bern, Switzerland. Electronic address: [email protected].
  4. University Hospital Jena, Institute of Physiology1/Neurophysiology, Teichgraben 8, 07743 Jena, Germany. Electronic address: [email protected].

PMID: 34894589 DOI: 10.1016/j.autneu.2021.102903

Abstract

Whereas the autonomic nervous system (ANS) and the immune system used to be assigned separate functions, it has now become clear that the ANS and the immune system (and thereby inflammatory cascades) work closely together. During an acute immune response (e. g., in viral infection like Covid-19) the ANS and the immune system establish a fast interaction resulting in "physiological" inflammation. Based on our knowledge of the modulation of inflammation by the ANS we propose that a reflectory malfunction of the ANS with hyperactivity of the sympathetic nervous system (SNS) may be involved in the generation of acute hyperinflammation. We believe that sympathetic hyperactivity triggers a hyperresponsiveness of the immune system ("cytokine storm") with consecutive tissue damage. These reflectory neuroimmunological and inflammatory cascades constitute a general reaction principle of the organism under the leadership of the ANS and does not only occur in viral infections, although Covid-19 is a typical current example therefore. Within the overreaction several interdependent pathological positive feedback loops can be detected in which the SNS plays an important part. Consequently, there is a chance to regulate the hyperinflammation by influencing the SNS. This can be achieved by a stellate ganglion block (SGB) with local anesthetics, temporarily disrupting the pathological positive feedback loops. Thereafter, the complex neuroimmune system has the chance to reorganize itself. Previous clinical and experimental data have confirmed a favorable outcome in hyperinflammation (including pneumonia) after SGB (measurable e. g. by a reduction in proinflammatory cytokines).

Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.

Keywords: Autonomic nervous system; Covid-19; Cytokine storm; Hyperinflammation; Local anesthetics; Stellate ganglion block

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