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

Sunday, August 30, 2009

blocks the cardiac sympathetic fibers and consequently decreases heart rate, cardiac output and contractility

The CEA (Cervical Epidural Anaesthesia) blocks the cardiac sympathetic fibers and consequently decreases heart rate, cardiac output and contractility. The mean blood pressure is unchanged or decreased, depending on peripheral systemic vascular resistance changes. The baroreflex activity is also partly impaired. Sympathetic blockade also decreases myocardial ischaemia. The cardiovascular changes induced by CEA are also partly due to the systemic effect of the local anaesthetic. The respiratory effects are minimal and depend on the extent of the blockade and the concentration of the local anaesthetic. A moderate restrictive syndrome occurs. Since the phrenic nerves originate from C3 to C5, ventilation may be impaired by CEA. Extension of the block may also impair intercostal muscle function, with a risk of respiratory failure when a CEA is used in patients with compromised respiratory function. The potential specific complications, mainly cardiovascular and respiratory, are the exacerbation of the effects of CEA. Side effects such as bradycardia, hypotension and acute ventilatory failure in relation to respiratory muscle paralysis, may be observed. Close monitoring of haemodynamics, respiratory rate and level blockade is required.
Ann Fr Anesth Reanim. 1993;12(5):483-92.
PMID: 8311355 [PubMed - indexed for MEDLINE

response varies depending on the degree of sympathetic tone before the block

Individual cardiovascular response to different levels of sympathetic blockade varies widely, depending on the degree of sympathetic tone before the block.
High TEA added to general anaesthesia significantly decreased the cardiac acceleration in response to decreasing blood pressure, suggesting that baroreflex-mediated heart rate response to a decrease in arterial blood pressure depends on the integrity of the sympathetic nervous system.
Anaesthesia and Intensive Care. Edgecliff: Dec 2000. Vol. 28, Iss. 6, p. 620-35 (16 pp.) Australian Society of Anaesthetists

HPA-axis plays a crucial role in the development and intensity of autoimmune diseases

Like in man, in animals the HPA-axis plays a crucial role in the development and intensity of autoimmune diseases. Corticosteroids, in particular, are known to suppress T-cell induced autoimmune reaction in animal models, at the beginning, and are capable to support spontaneous recovery.

EAE derived data support that increased HPA-axis reactivity is accompanied by enlarged capacity to secrete and produce Th-2-cytokines. While decreased HPA-reactivity is accompanied by enlarged capacity to secrete and produce Th-1-cytokines.

Sympathectomy and axanotomy were accompanied by stress-induced increases of EAE immunological responses. Transferred Th1-cells of such sympathectomized animals to healthy animals resulted in increased EAE.
In: Research Focus on Cognitive Disorders ISBN 1-60021-483-5
Editor: Valerie N. Plishe © 2007 Nova Science Publishers, Inc.

sympathectomy might suppress immune functions

It has been found that sympathectomy might influence tumorigenesis. The published data suggests that sympathectomy might suppress immune functions.

Sympathectomy might influence thermogenesis by modulating the activity the activity of the immune system in two ways - by reducing the modulatory influences of catecholamines on immune cells as well as by increasing the secretion of glucocorticoids.
Seminars in Cancer Biology 18 (2008)
Bors Mravec, Yori Gidron, Ivan Hulin

The altered pattern of the response suggests that the nitric oxide-dependent portion may be accelerated in sympathectomized limbs

J Appl Physiol. 2002 Feb;92(2):685-90.

Depression of Endothelial Nitric Oxide Synthase but Increased Expression of Endothelin-1 Immunoreactivity in Rat Thoracic Aortic Endothelium Associated With Long-term, but Not Short-term, Sympathectomy

Circulation Research. 1996;79:317-323

sympathectomy results in an increased collagen content in the vascular wall

From animal experiments, it is known that long-term sympathectomy results in an increased collagen content in
the vascular wall, suggesting a stiffening of the vessel wall (9). Giannattasio et al.

MEDICINE & SCIENCE IN SPORTS & EXERCISE®
Copyright © 2005 by the American College of Sports Medicine
DOI: 10.1249/01.mss.0000174890.13395.e7

adverse effects and complications are not systematically reported

Studies (corresponding to 5,425 patients) classified compensatory hyperhidrosis either as minor (insignificant) or major (quite disabling). In these studies, 26.3% or one quarter of patients with compensatory hyperhidrosis considered the complication major and disabling. The average time between surgical sympathectomy and the appearance of compensatory hyperhidrosis was 4 months (range 1-6 months). (82;93;118) The incidence of compensatory hyperhidrosis did not seem to be different after open or endoscopic approach.

The weighted mean incidence of gustatory sweating after upper extremity surgical sympathectomy was 32.3% (range 0-79)

The weighted mean incidence of phantom sweating was 38.6 % (range 0-59%), with data extracted from 13 papers (that specifically reported the phenomenon) and 1,539 patients.

The weighted mean incidence of neuropathic pain complications was 11.9% (range 0-87%),with data extracted from 37 papers and 1,979 patients.

Given the fact that most of the existing literature is geared towards a) assessing only the effectiveness of the surgical sympathectomy procedures, and b) publishing only studies with positive results, adverse effects and complications are not systematically reported but rather as a secondary outcome. It seems, therefore, highly likely that the complications as reported here, are truly underestimated.

The study indicates that surgical sympathectomy, irrespective of operative approach and indication, may be associated with many and potentially serious complications.

A Systematic Literature Review of Late Complications

Andrea Furlana,c MD, Angela Mailisa,bMD, MSc, FRCPC

(PhysMed) and Marios Papagapioua Msc

unable to establish the etiology of redistribution

Regarding the incidence of anhidrosis by anatomical location, statistically significant changes were recorded in the head, hands, axillas, and soles ( p < 0.001).
Bilateral upper thoracic sympathicolysis is followed by redistribution of body perspiration, with a clear decrease in the zones regulated by mental or emotional stimuli, and an increase in the areas regulated by environmental stimuli, though we are unable to establish the etiology of this redistribution.
Surgical Endoscopy; Nov2007, Vol. 21 Issue 11

migration of adventitial fibroblasts and loss of medial smooth muscle cells

In a previous study, we showed that after sympathectomy, the femoral (FA) but not the basilar (BA) artery from non-pathological rabbits manifests migration of adventitial fibroblasts (FBs) into the media and loss of medial smooth muscle cells (SMCs). The aim of the present study was to verify whether similar behaviour of arteries occurred in the pathological context of atherosclerosis.
Our results show that in the media of FAs hypercholesterolemia induces changes similar to those observed in sympathectomized rabbits in non-pathological conditions, i.e., migration of adventitial FBs to the media and loss of medial SMCs. These latter changes, which can be ascribed to pathological events, were accentuated after sympathectomy in the hypercholesterolemic rabbits. The present study reveals that pathological events, including migration and phenotypic modulation of vascular FBs and loss of SMCs, may be under the influence of sympathetic nerves.
Acta Histochemica; Jul2008, Vol. 110 Issue 4, p302-313, 12p

elevated susceptibility to ventricular fibrillation after sympathectomy

We conclude that chemical sympathectomy downregulates the expression of selective Kv channel subunits and decreases myocardial Ito channel activities, contributing to the elevated susceptibility to ventricular fibrillation.
Canadian Journal of Physiology & Pharmacology; Oct2008, Vol. 86 Issue 10,

Side effect of elective surgery - disastrous proportions

Compensatory hyperhidrosis (CHH) remains an unexplained sequel of this treatment, attaining in a small percentage of cases disastrous proportions.

The search identified 42 techniques of sympathetic ablation. However, pertinent data for the present study were reported for only 23 techniques with multiple publications found only for 10. The only statistically valid results from this review point that T2 resection and R2 transection of the chain (over the second rib) ensue in less CHH than does electrocoagulation of T2. Further comparisons were probably prevented due to the enormous disparity in the reported results, indicating lack of standardization in definitions. The compiled results published so far in the literature do not support the claims that lowering the level of sympathetic ablation, using a method of ablation other than resection, or restricting the extend of sympathetic ablation for primary palmar hyperhidrosis result in less CHH. In the future, standardization of the methods of retrieving and reporting data are necessary to allow such a comparison of data.
World Journal of Surgery; Nov2008, Vol. 32 Issue 11, p2343-2356, 14p

High incidence of nausea and vomiting after sympathectomy

Although complications are rare, patients should be clearly warned that it is not a minor procedure [1,4]. Nevertheless, effective analgesia, radiologie follow-up and strict antiemetic prophylaxis measures are recommended [6].
Because of the high Incidence of nausea and vomiting in our study, we have reconsidered antiemetic prophylaxis in patients at moderate risk (two risk factors). We also recommend strategies for lowering underlying risk such as using total intravenous anaesthesia, keeping opioid use to a minimum and intravenously administering a large volume of preoperative balanced salt solution [6]. We found no reason to explain the high incidence of nausea and vomiting in these patients other than failure to implement these measures. There might have been an effect of starting to drink in the postoperative intensive care area;
however, we could not establish a correlation between start of drinking and the onset of nausea and vomiting.
Thoracic sympathectomy by videothoracoscopy on an outpatient basis can be performed safely if strict control
of pain is established and vomiting and surgical complications are avoided. Nevertheless, the anaesthesiologist
should be alert to the possibility of serious complications associated with this type of surgery.

European Journal of Anaesthesiology 2009, Vol 26 No 4

SNS regulates cerebral blood flow

Thus, in the conscious dog, stimulation of the carotid chemoreceptor reflex elicits significant sympathetically mediated vasoconstriction in cerebral vessels.
Am J Physiol. 1980 Apr;238(4):H594-8.Click here to read

sympathetic denervation-hypersensitivity and migraine

Regional cerebral blood flow (rCBF) and cerebral vasomotor responses to 5% CO2 inhalation were measured before and after pharmacologic μ- or β-adrenoceptor manipulation in Migraine (M) and Cluster headaches (C).
There appears to be an asymmetrical adrenoceptor disorder in M and C possibly due to sympathetic denervation-hypersensitivity.

Headache: The Journal of Head and Face Pain

Volume 20 Issue 6, Pages 321 - 335

Published Online: 22 Jun 2005

http://www3.interscience.wiley.com/journal/119584269/abstract

Complications of endoscopic sympathectomy


Alan E. P. Cameron

Abstract
Four cases are presented in which complications occurred during or after thoracic endoscopic sympathectomy (TES). In one patient inappropriate TES resulted in disabling hyperhidrosis. In one patient laceration of the subclavian artery required major surgery. In two cases intraoperative cerebral damage occurred. Training in TES is essential.

European Journal of Surgery

See Also:

Volume 164 Issue S1, Pages 33 - 35

Published Online: 2 Dec 2003