The amount of compensatory sweating depends on the patient, the damage that the white rami communicans incurs, and the amount of cell body reorganization in the spinal cord after surgery.
Other potential complications include inadequate resection of the ganglia, gustatory sweating, pneumothorax, cardiac dysfunction, post-operative pain, and finally Horner’s syndrome secondary to resection of the stellate ganglion.
www.ubcmj.com/pdf/ubcmj_2_1_2010_24-29.pdf

After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration
After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within a year.

http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract

Thursday, April 3, 2008

Pain - increased expression of human alpha -adrenergic receptors after loss of sympathetic activity.

The hypothesis proposes the increased presence of alpha -adrenergic receptors in primary afferent neurons to result from an altered gene expression triggered by cytokines/growth factors produced by disconnection of peripheral nerve fibers from their cell bodies. These additional adrenergic receptors are suggested to make nociceptors and other primary afferent neurons excitable by local or circulating norepinephrine and epinephrine. For central pathways, the adrenergic excitation would be equivalent to that produced by noxious events and would consequently evoke pain. In support, evidence is cited for a form of denervation supersensitivity in causalgia and for increased expression of human alpha -adrenergic receptors after loss of sympathetic activity.

Edward R. Perl*

Department of Cell and Molecular Physiology, CB 7545, University of North Carolina, Chapel Hill, NC 27599

http://www.pnas.org/cgi/content/abstract/96/14/7664

Sympathectomy induces adrenergic excitability of cutaneous C-fiber nociceptors

Sympathectomy induces adrenergic excitability of cutaneous C-fiber nociceptors

D. F. Bossut, V. K. Shea and E. R. Perl
Department of Physiology, University of North Carolina at Chapel Hill 27599-7545, USA.

http://jn.physiology.org/cgi/content/abstract/75/1/514

J Neurophysiol 75: 514-517, 1996;
0022-3077/96 $5.0

Journal of Neurophysiology, Vol 75, Issue 1 514-517, Copyright © 1996 by APS

Sympathectomy IS the DAMAGE to the sympathetic nervous system, that will cause the pain.


Similarities between RSD patients and post-sympathtectomy patients

Quantitative Evaluation of Sympathetic Nervous System Dysfunction in Patients with Reflex Sympathetic Dystrophy

J. IDE, M. YAMAGA, T. KITAMURA and K. TAKAGI

From the Department of Orthopaedic Surgery, Kumamoto University School of Medicine, Kumamoto, Japan

Correspondence: J. Ide MD, Department of Orthopaedic Surgery, Kumamoto University School of Medicine 1–1–1 Honjo, Kumamoto 860, Japan.


We observed an increased blood flow but an unchanged vasoconstrictor response in the affected hand in stage 1 of the disorder, but in stage 2 there was a decreased blood flow and a stronger vasoconstriction following an inspiratory gasp. These results suggest that in RSD patients the sympathetic nervous system function is altered and is different in the various stages.

fiber degeneration following Sympathectomy

Petras JM, Cummings JF. Autonomic neurons in the spinal cord
of the rhesus monkey: a correlation of the findings of cytoarchi-
tectonics and sympathectomy with fiber degeneration following
dorsal rhizotomy. J Comp Neurol 1972;146:189 –218.

Sweating = supersensitivity to neurotransmitters and not sympathetic overactivity

These findings do not support the widely held view that autonomic disturbances in reflex sympathetic dystrophy are due to sympathetic overactivity. Rather, they suggest that sweating and changes in peripheral blood flow result from supersensitivity to sympathetic neurotransmitters. After injury, supersensitivity to noradrenaline may also contribute to spontaneous pain and allodynia by disrupting efferent sympathetic modulation of sensation. This would explain why pain and allodynia are relieved by sympathetic blockade, and why noradrenaline rekindles pain in sympathectomized skin.

REFLEX SYMPATHETIC DYSTROPHY: THE SIGNIFICANCE OF DIFFERING PLASMA CATECHOLAMINE CONCENTRATIONS IN AFFECTED AND UNAFFECTED LIMBS

PETER D. DRUMMOND1,, PHILIP M. FINCH2 and GEORGE A. SMYTHE3
http://brain.oxfordjournals.org/cgi/content/abstract/114/5/2025
Brain, Vol. 114, No. 5, 2025-2036, 1991
© 1991 Guarantors of Brain


unavoidable consequence of sympathectomy

Pathological gustatory sweating and flushing can develop after injury to preganglionic cervico-thoracic sympathetic fibres, an unavoidable consequence of resecting that part of the sympathetic chain. The mechanism of this abnormal response is uncertain; conceivably, though, regeneration of injured salivatory fibres or collateral sprouting from nearby intact fibres creates aberrant connections between salivatory fibres and denervated vasomotor and sudomotor neurons in the superior cervical ganglion.(7) Commands to salivate would then be translated into commands to sweat and flush in the distribution of sympathetic denervation. Cross-innervation lower down in the stellate ganglion can also produce unusual and potentially distressing autonomic disturbances in the sympathetically-denervated arm (e.g., piloerection while eating).(8)
Drummond PD. A caution about surgical treatment for facial blushing. British Journal of Dermatology 2000; volume 142: pages 194-195.

Rhinitis - relative nasal sympathetic hyposensitivity

The exact pathophysiology of intrinsic rhinitis is not fully understood. The generally held belief is that it is due to an imbalance between the outflow of the nasal sympathetic and parasympathetic nervous systems, perhaps due to excessive parasympathetic or reduced sympathetic activity. In this study the nasal airway response to a predominantly sympathetic stimulus, isometric exercise, was studied in 19 patients with intrinsic rhinitis and compared with 16 normal patients.
The study shows that there is an abnormal response to isometric exercise in intrinsic rhinitis, perhaps due to relative nasal sympathetic hyposensitivity.

The nasal response to isometric exercise in non-eosinophilic intrinsic rhinitis

  • 1Department of Otolaryngology, Royal Liverpool University Hospital, Liverpool, UK
2Mr A. Wilde, Department of Otolaryngology, Royal Liverpool University Hospital, Prescott Street, Liverpool, L69 3BX, UK.

Clinical Otolaryngology

Volume 21 Issue 1 Page 84-86, February 1996



http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2273.1996.tb01031.x?journalCode=coa

changes in phrenic nerve activity, blood pressure and nasal patency.

A role for the ventral surface of the medulla in regulation of nasal resistance

M. A. Haxhiu, K. P. Strohl, M. P. Norcia, E. van Lunteren, E. C. Deal Jr and N. S. Cherniack

Nasal resistance is known to be affected by changes in nasal blood volume and hence to depend on sympathetic discharge to nasal blood vessels. Structures located superficially near the ventrolateral surface of the medulla significantly affect respiratory and sympathetic activity and the tone of the trachea. To assess the importance of these structures on nasal patency, we measured transnasal pressure at a constant flow and examined the change in pressure produced by topically applied N-methyl-D-aspartic acid (NMDA). Experiments were performed in chloralose-anesthetized, paralyzed, and artificially ventilated cats. NMDA administered on the intermediate area of the ventral surface of the medulla decreased transnasal pressure and increased phrenic nerve activity. The response to NMDA could be diminished or abolished by application to the ventral medullary surface of the NMDA antagonist 2-amino-5-phosphonovalerate (2-APV) or the local anesthetic lidocaine. Carotid sinus denervation and posthypothalamic decerebration did not alter the nasal and phrenic nerve responses to NMDA; however, cervical sympathetic denervation decreased these responses, both in intact and in bilaterally adrenalectomized animals. Therefore, activation of NMDA receptors on structures near the ventral surface of the medulla increases tone in the nasal vasculature and leads to a response pattern that includes changes in not only phrenic nerve activity and blood pressure but also nasal patency.
http://ajpregu.physiology.org/cgi/content/abstract/253/3/R494

Am J Physiol Regul Integr Comp Physiol 253: R494-R500, 1987;
0363-6119/87 $5.00

AJP - Regulatory, Integrative and Comparative Physiology, Vol 253, Issue 3 494-R500, Copyright © 1987 by American Physiological Society

Gustatory sweating and pilomotor changes

Gustatory sweating and pilomotor changes
W. B. Ashby
Powly Surgical Registrar, David Lewis Northsrn Hospital, Lnerpool

British Journal of Surgery

British Journal of Surgery
Volume 47, Issue 204 , Pages 406 - 410

Published Online: 6 Dec 2005

Copyright © 1960 British Journal of Surgery Society Ltd.


Sympathectomy and Parotid Glands

THULIN, A. & GARRETr, J. R. (1976). Secretory and structural effects of 6-hydroxydopamine on normal
parotid glands of rats and at different times after surgical sympathectomy. Quarterly Journal of
Experimental Physiology 61, 15-21.

Stellate Ganglion Block in Atrophic Rhinitis

The Journal of Laryngology & Otology (1966), 80:184-186 Cambridge University Press
Copyright © JLO (1984) Limited 1966
doi:10.1017/S0022215100065129

Clinical Records

Stellate Ganglion Block in Atrophic Rhinitis


A. N. Sharmaa1 and D. S. Sardanaa1
a1 E.N.T. Department, G.S.V.M. Medical College, Kanpur.

GUSTATORY SWEATING AND OTHER RESPONSES AFTER CERVICO-THORACIC SYMPATHECTOMY

Cover PDF
GUSTATORY SWEATING AND OTHER RESPONSES AFTER CERVICO-THORACIC SYMPATHECTOMY
BLOOR Brain.1969; 92: 137-146

Medication you can not take after you had sympathectomy

Moducren tablets

WHAT ELSE SHOULD YOU KNOW ABOUT TAKING YOUR TABLETS?

You should check with your doctor before taking ‘Moducren’ if:

A surgeon has destroyed (sic!) one of your nerves in order to either improve the blood supply to a limb or relieve chronic pain. This operation is called a sympathectomy.

http://xpil.medicines.org.uk/ViewPil.aspx?DocID=5926

Loosing Nerves - article in Time Magazine, 1947

Sympathectomy, cutting of the sympathetic nerves, is causing the most violent arguments of all. The operation is now prescribed for a wide variety of ailments, from excessive sweating to high blood pressure. Nobody knows how many thousands of sympathectomies surgeons perform each year; there are an estimated 1,000 in Manhattan alone. Admittedly the operation is a life-saver in many cases of gangrene, angina pectoris, hypertension. But some sympathectomies may make men sterile. And because a sympathectomy reduces pain, some doctors consider it insidiously dangerous, e.g., a patient could have a perforating ulcer without pain. The experts agree that sympathectomy, like the other nerve-cutting operations, is getting out of hand.

Jun. 30, 1947
Loosing Nerves, article in TIME MAGAZINE

rhinitis significantly affects nasal airflow

During sleep there is a discrete fall in minute ventilation and an associated increase in upper airway resistance. In normal subjects, the nasal part of the upper airway contributes only little to the elevation of the total resistance, which is mainly the consequence of pharyngeal narrowing. Yet, swelling of the nasal mucosa due to congestion of the submucosal capacitance vessels may significantly affect nasal airflow. In many healthy subjects an alternating pattern of congestion and decongestion of the nasal passages is observed. Some individuals demonstrate congestion of the ipsilateral half of the nasal cavity when lying down on the side. Nasal diseases, including structural anomalies and various forms of rhinitis, tend to increase nasal resistance, which typically impairs breathing via the nasal route in recumbency and during sleep. A role of nasal obstruction in the pathogenesis of sleep-disordered breathing has been implicated by many authors.

Sleep, breathing and the nose

Dirk A. Pevernagiea, , Micheline M. De Meyerb and Sofie Claeysc
Department of Respiratory Diseases, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium
Available online 19 October 2005

All patients except one suffered from compensatory sweating

OBJECTIVE: To assess the complications in a group of patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. The extraordinarily high incidence of postoperative compensatory hyperhidrosis in our series is stressed and explained. METHODS: The retrospective study included chart reviews and outpatient assessments. Seventy-two patients underwent T2 or T2-T3 endoscopic sympathectomy for primary palmar hyperhidrosis. Patients' hyperhidrosis severity, precipitating factors, postoperative complications, surgical results, and satisfaction were assessed. Severity of palmar hyperhidrosis and compensatory hyperhidrosis was classified by two grading scales. RESULTS: The success rate of sympathectomy was 93%. All patients except one suffered from compensatory sweating, which was the main cause of patients' dissatisfaction postoperatively. Seventeen percent of the patients (12 of 72 patients) experienced new symptoms of gustatory sweating (facial sweating associated with eating). Twenty-one patients experienced other complications, including pneumothorax, Horner's syndrome, nasal obstruction, and intercostal neuralgia.