a technique that is associated with a number of potential problems
Transthoracic endoscopic sympathectomy is now considered the treatment of choice for patients with upper limb hyperhidrosis requiring sympathetic ablation. This procedure requires the use of an endobronchial double lumen tube and subsequent one-lung anaesthesia, a technique that is associated with a number of potential problems. Full patient monitoring is thus required and includes pulse, ECG, non-invasive blood pressure measurement, pulse oximetry, end-tidal carbon dioxide concentration and peak inspiratory airway pressure.
Anaesthetic implications for transthoracic endoscopic sympathectomy.
PMID: 7524779 [PubMed - indexed for MEDLINE]
Eur J Surg Suppl. 1994;(572):33-6.
Hypoxaemia is of a major concern during thorascopic sympathectomy
However the pathophysiology of hypoxaemia and consequent decrease in SpO2 differs between the two anaesthetic techniques.
The normal physiological response to massive atelectasis is an increase in pulmonary vascualr resistance (hypoxic pulmonary vasoconstriction) with re-routing of blood to well ventilated lung zones and consequent improvement of in PaO2. However, during endobronchial anaesthesia for thoracic sympathectomy there is an apparent failure of this compensatory mechanism. When more than 70% of the lung is atelectatic, compensation by hypoxic pulmonary vasonstriction appears to be ineffective. Furthermore, in in vitro and animal studies, inhalation anaesthetic agent have been shown to depress hypoxic pulmonary vasoconstriction.
In a study by Hartrey and colleagues, SpO2<95% was demonstrated in 74% of cases receiving an FIO2 of 0.5. This VIQ mismatch and shunt effect was confirmed when arterial bloodgas measurements were made during one-lung ventilation and compared with baseline values during two-lung ventilation. In 25% of sympathectomies studied, PaO2<15kPa was recorded.
It should be remembered that after re-inflation of the collapsed lung, VIQ mismatch may be persistent and that time is required for the lung to recover its full oxygenation capacity.
Rapid and excessive carbon dioxide insufflatio into the closed chest cavity may create a tension pneumothorax, displace the mediastinum, and compress the lungs and great vessels with consequent haemodynamic instability. During carbon dioxide insufflation using endobronchial intubation, Hartrey and colleagues reported a decrease in systolic arterial pressure of >20 mm Hg in 21% of patients. Similarly, we have reported sudden hypotension and bradycardia after injudicious carbon dioxide insufflation.
In an interesting study of the delayed cardiac effects of T2-4 sympathectomy, Drott and colleagues demmonstrated significantly reduced heart rate at rest, and during both exercise and the recovery phase of the exercise.
Changes in the electrical axis and shortening of the QT interval have also been reported.
B. Fredman, D. Olsfanger, R. Jedeikin
British Journal of Anaesthesia 1997; 79: 113-119
The normal physiological response to massive atelectasis is an increase in pulmonary vascualr resistance (hypoxic pulmonary vasoconstriction) with re-routing of blood to well ventilated lung zones and consequent improvement of in PaO2. However, during endobronchial anaesthesia for thoracic sympathectomy there is an apparent failure of this compensatory mechanism. When more than 70% of the lung is atelectatic, compensation by hypoxic pulmonary vasonstriction appears to be ineffective. Furthermore, in in vitro and animal studies, inhalation anaesthetic agent have been shown to depress hypoxic pulmonary vasoconstriction.
In a study by Hartrey and colleagues, SpO2<95% was demonstrated in 74% of cases receiving an FIO2 of 0.5. This VIQ mismatch and shunt effect was confirmed when arterial bloodgas measurements were made during one-lung ventilation and compared with baseline values during two-lung ventilation. In 25% of sympathectomies studied, PaO2<15kPa was recorded.
It should be remembered that after re-inflation of the collapsed lung, VIQ mismatch may be persistent and that time is required for the lung to recover its full oxygenation capacity.
Rapid and excessive carbon dioxide insufflatio into the closed chest cavity may create a tension pneumothorax, displace the mediastinum, and compress the lungs and great vessels with consequent haemodynamic instability. During carbon dioxide insufflation using endobronchial intubation, Hartrey and colleagues reported a decrease in systolic arterial pressure of >20 mm Hg in 21% of patients. Similarly, we have reported sudden hypotension and bradycardia after injudicious carbon dioxide insufflation.
In an interesting study of the delayed cardiac effects of T2-4 sympathectomy, Drott and colleagues demmonstrated significantly reduced heart rate at rest, and during both exercise and the recovery phase of the exercise.
Changes in the electrical axis and shortening of the QT interval have also been reported.
B. Fredman, D. Olsfanger, R. Jedeikin
British Journal of Anaesthesia 1997; 79: 113-119
Loss of coordinated autonomic responses to demands on heart rate and vascular tone
Autonomic dysreflexia - Spinal cord injuries (SCI) above T6 may be complicated by a phenomenon known as autonomic dysreflexia, a manifestation of the loss of coordinated autonomic responses to demands on heart rate and vascular tone [5,6]. Uninhibited or exaggerated sympathetic responses to noxious stimuli lead to diffuse vasoconstriction and hypertension. A compensatory parasympathetic response produces bradycardia and vasodilation above the level of the lesion, but this is not sufficient to reduce elevated blood pressure. SCI lesions lower than T6 do not produce this complication, because intact splanchnic innervation allows for compensatory dilatation of the splanchnic vascular bed.
The estimated frequency of this complication is quite variable, ranging from 20 to 70 percent of patients with SCI lesions above T6 [5,6]. Autonomic dysreflexia is unusual within the first month of SCI but usually appears within the first year [7,8].
Common clinical manifestations are headache, diaphoresis, and increased blood pressure [7]. Flushing, piloerection, blurred vision, nasal obstruction, anxiety, and nausea may also occur. Bradycardia is common; however, some patients have tachycardia instead. The severity of attacks ranges from asymptomatic hypertension to hypertensive crisis complicated by profound bradycardia and cardiac arrest or intracranial hemorrhage and seizures. The severity of the SCI influences both the frequency and severity of attacks.
CAD mortality also appears to be higher among SCI patients [4]. One contributing factor may be that SCI lesions above the T5 level may lead to atypical presentations for cardiac ischemia; manifestations may include autonomic dysreflexia or changes in spasticity rather than typical chest pain.
The autonomic nervous system dysfunction that results from SCI disrupts normal cardiovascular hemostasis. With SCI above the T6 level, baseline blood pressure is usually reduced, and baseline heart rate may be as low as 50 to 60 beats per minute [12,16]. This is generally not a clinical problem, but may contribute to hemodynamic instability and exercise intolerance.
Acute cervical SCI is associated with a risk of cardiac arrhythmia due to excess vagal tone, as well as complicating hypoxia, hypotension, and fluid and electrolyte imbalances.
http://www.uptodate.com/patients/content/topic.do?topicKey=~VwAwFq7EG6jGfV
bradycardia as likely, compensatory sweating as obligatory after Sympathectomy
- Clin Auton Res. 2003 Dec;13 Suppl 1:I36-9.
Sequelae of endoscopic sympathetic block.
Schick CH, Horbach T.
Dept. of Surgery, University of Erlangen-Nürnberg, Krankenhausstrasse 12, 91054, Erlangen, Germany. schick@hyperhidrosis.de
Endoscopic sympathetic block as a treatment for primary hyperhidrosis is associated with certain sequelae. The reported occurrence of side effects still varies in the literature. As the majority of patients describe sequelae after sympathetic surgery, the frequency and importance of these persisting changes are still underestimated. Patient's informed consent should include and define side effects like gustatory sweating, olfactory sweating and bradycardia as likely, and compensatory sweating as obligatory.
PMID: 14673671 [PubMed - indexed for MEDLINE]
Räf L, Claes G. Complications are frequent after surgery for excessive hand sweating. Patients should be informed about the risks
Lakartidningen 1999;96:930-2. (In Swedish.)
ETS for palmar HH results in systemic (non-localized) changes of the ANS function
In contrast
Associated change in plantar temperature and sweating after transthoracic
PMID: 11453433 [PubMed - indexed for MEDLINE]
Associated change in plantar temperature and sweating after transthoracic
PMID: 11453433 [PubMed - indexed for MEDLINE]
Forced vital capacity, forced expiratory volume were all slightly but significantly decreased after sympathectomy
J Clin Neurosci 2001 Nov;8(6):539-41
Palmar hyperhidrosis, probably caused by an over-reactivity of sympathetic
baroreflex response for maintaining cardiovascular stability is suppressed in the patients who received the ETS
Our results indicated that T2-3 sympathectomy suppressed baroreflex control of heart rate
in both pressor and depressor tests in the patients with palmar hyperhidrosis. We should
note that baroreflex response for maintaining cardiovascular stability is suppressed in the
patients who received the ETS.
Anesthesiology 2001; 95:A160
in both pressor and depressor tests in the patients with palmar hyperhidrosis. We should
note that baroreflex response for maintaining cardiovascular stability is suppressed in the
patients who received the ETS.
Anesthesiology 2001; 95:A160
PAROTID DEGENERATION SECRETION FOLLOWING SYMPATHECTOMY
January 1, 1982 Experimental Physiology, 67, 7-15.
Correspondingly the acini were loaded with secretory granules at 12 and 48 hours but were extensively depleted of granules at 24 hours. This loss of granules is considered to be due to sympathetic "degeneration secretion" caused by the release of noradrenaline from the degenerating adrenergic nerves between 12 and 24 hours after ganglionectomy. This is thought to be the first example of morphological change resulting from "degeneration activation" to be recorded microscopically.
Cell Tissue Res. 1975 Sep 16;162(1):1-12.
Degeneration Secretion and Supersensitivity in Salivary Glands following Denervations, and the Effects on Choline Acetyltransferase Activity.
Garrett JR, Ekstr�m J, Anderson LC (eds): Neural Mechanisms of Salivary Gland Secretion.Front Oral Biol. Basel, Karger, 1999, vol 11, pp 166-184
(DOI: 10.1159/000061117)
Circulating catecholamines, however, influence the amount of amylase and peroxidase secreted by the rat parotid gland in response to parasympathetic nerve stimulation and account for most of the increased secretion of these enzymes following chronic sympathectomy.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1193204
There was a reduction in all proline-rich proteins (PRP) in the saliva following sympathectomy.
http://www.find-health-articles.com/rec_pub_2450385-influences-short-term-sympathectomy-composition-proteins-rat-parotid.htm
Correspondingly the acini were loaded with secretory granules at 12 and 48 hours but were extensively depleted of granules at 24 hours. This loss of granules is considered to be due to sympathetic "degeneration secretion" caused by the release of noradrenaline from the degenerating adrenergic nerves between 12 and 24 hours after ganglionectomy. This is thought to be the first example of morphological change resulting from "degeneration activation" to be recorded microscopically.
Cell Tissue Res. 1975 Sep 16;162(1):1-12.
Degeneration Secretion and Supersensitivity in Salivary Glands following Denervations, and the Effects on Choline Acetyltransferase Activity.
Garrett JR, Ekstr�m J, Anderson LC (eds): Neural Mechanisms of Salivary Gland Secretion.Front Oral Biol. Basel, Karger, 1999, vol 11, pp 166-184
(DOI: 10.1159/000061117)
Circulating catecholamines, however, influence the amount of amylase and peroxidase secreted by the rat parotid gland in response to parasympathetic nerve stimulation and account for most of the increased secretion of these enzymes following chronic sympathectomy.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1193204
There was a reduction in all proline-rich proteins (PRP) in the saliva following sympathectomy.
http://www.find-health-articles.com/rec_pub_2450385-influences-short-term-sympathectomy-composition-proteins-rat-parotid.htm
Sympathectomy decreases the release of tissue plasminogen activator (t-PA) from blood vessels
Sympathectomy decreases and adrenergic stimulation increases the release of tissue plasminogen activator (t-PA) from blood vessels: Functional evidence for a neurologic regulation of plasmin production within vessel walls and other tissue matrices
http://www3.interscience.wiley.com/journal/63500193/abstract
http://www3.interscience.wiley.com/journal/63500193/abstract
Left cardiac sympathectomy prevents exercise-induced QTc prolongation in congenital long QT syndrome
Exp Clin Cardiol. 2003 Spring; 8(1): 31–32. | PMCID: PMC2716198 |
Copyright © 2003, Pulsus Group Inc. All rights reserved
School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, Australia
Correspondence and reprints: Dr Lexin Wang, School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW 2650, Australia. Telephone +61-2-6933-2909, fax +61-2-6933-2587, e-mail, lwang@csu.edu.au ability of blood platelets to aggregate is significantly lower
It is shown that the ability of blood platelets to aggregate in partially and completely sympathectomized rats is significantly lower than in intact animals. The blood clotting system of sympathectomized rats is hyperactive. The sympathectomy-provoked changes may be due to the increased content of adrenaline in the blood.
| Cellular and Molecular Life Sciences | |
| Publisher | Birkhäuser Basel |
| ISSN | 1420-682X (Print) 1420-9071 (Online) |
| Issue | Volume 36, Number 7 / July, 1980 |
esidual pneumothorax is common,gas exchange may be impaired and the lung is at some risk of recollapse
Editor- Cameron may not advocate that bilateral thoracoscopic sympathectomy should be staged but I certainly do .It may be eccentric but it is safe.Immediate sustained full reexpansion and perfect functioning of a lung that was completely deflated a few minutes before cannot be guaranteed. Residual pneumothorax is common,gas exchange may be impaired and the lung is at some risk of recollapse.To collapse the contralateral normal lung in such circumstances might be the practice of a majority of surgeons but it is still unwise.Collapse of one lung is a misfortune, collapse of both lungs is not compatible with life.
Cameron`s claim that there has been only one death attributable to synchronous bilateral thoracoscopic sympathectomy is implausible. Surgeons and anaesthetists are reticent in publicizing such events and Civil Law Reports of settled cases are an inadequate measure of the current running total. The custom of a majority is no guarantee of safety and is seldom a guide to best medical practice.
Jack Collin,
Consultant Surgeon
Oxford
http://www.bmj.com/cgi/eletters/320/7244/1221
Cameron`s claim that there has been only one death attributable to synchronous bilateral thoracoscopic sympathectomy is implausible. Surgeons and anaesthetists are reticent in publicizing such events and Civil Law Reports of settled cases are an inadequate measure of the current running total. The custom of a majority is no guarantee of safety and is seldom a guide to best medical practice.
Jack Collin,
Consultant Surgeon
Oxford
http://www.bmj.com/cgi/eletters/320/7244/1221
After unilateral sympathectomy the incidence of medial calcinosis on the operated side was significantly higher than on the non-operated side
Six to eight years after uni- or bilateral lumbar sympathectomy 60 patients were investigated radiologically for medial calcinosis of foot arteries. Of 60 patients, 55 had Mönckeberg's sclerosis. In 93% of the patients who had undergone bilateral operation medial calcification was seen in both feet. After unilateral sympathectomy the incidence of medial calcinosis on the operated side was significantly higher than on the non-operated side (88% versus 18%, p less than 0.01). There was no significant difference between diabetics and non-diabetics. These findings suggest that medial calcification is related to autonomic neuropathy of peripheral vessels. Fifty-two of 160 patients (32.5%) with severe arterial occlusive disease of the lower limbs showed medial calcification of foot arteries. Mönckeberg's sclerosis was significantly associated with the peripheral type of vascular disease (p less than 0.025).
Klin Wochenschr. 1985 Mar 1;63(5):211-6.
PMID: 3990163 [PubMed - indexed for MEDLINE
Medial arterial calcification (MAC) is a frequent vascular finding in patients with type II diabetes mellitus. Morphologically distinct from focal calcifications of atherosclerosis its radiographically distinct tramline pattern is frequently encountered in the arteries of the lower extremities. MAC is inconsistently related to age, duration and therapy of diabetes. In contrast, a strong association with diabetic polyneuropathy and familial aggregation have been documented. Although initially considered benign MAC is now recognized as a strong predictor of cardiovascular morbidity and mortality in diabetic patients. Investigations into MAC pathogenes and into its role in vascular pathophysiology are underway.
Klin Wochenschr. 1985 Mar 1;63(5):211-6.
PMID: 3990163 [PubMed - indexed for MEDLINE
Medial arterial calcification (MAC) is a frequent vascular finding in patients with type II diabetes mellitus. Morphologically distinct from focal calcifications of atherosclerosis its radiographically distinct tramline pattern is frequently encountered in the arteries of the lower extremities. MAC is inconsistently related to age, duration and therapy of diabetes. In contrast, a strong association with diabetic polyneuropathy and familial aggregation have been documented. Although initially considered benign MAC is now recognized as a strong predictor of cardiovascular morbidity and mortality in diabetic patients. Investigations into MAC pathogenes and into its role in vascular pathophysiology are underway.
| Zeitschrift für Kardiologie | |
| Publisher | Steinkopff |
| ISSN | 0300-5860 (Print) 1435-1285 (Online) |
| Issue | Volume 89, Number 14 / February, 2000 |
| DOI | 10.1007/s003920070107 |
Reduced brain perfusion and cognitive performance
Chronically low blood pressure is accompanied by a variety of complaints including fatigue, reduced drive, faintness, dizziness, headaches, palpitations, and increased pain sensitivity [1–4]. In addition, hypotensive individuals report cognitive impairment, above all deficits in attention and memory. Nevertheless, it is generally the case that in research, as well as in clinical practice, relatively little importance is ascribed to hypotension. One reason for this is that, despite mental symptoms, cerebral dysfunction generally is not taken into account [1]. This is a consequence of the current doctrine that low systemic blood pressure is compensated by autoregulatory processes which prevent reduced blood perfusion of the brain [5, 6].
Some recent findings challenge this doctrine: reduced cognitive performance in hypotension has been demonstrated by neuropsychological testing, and EEG studies have revealed diminished cortical activity. Moreover, the assumption of unimpaired brain perfusion in hypotension no longer holds. In the present review the necessity of a reappraisal concerning hypotension is discussed in light of the relationship between blood pressure and cerebral functioning.
Clin Auton Res. 2007 April; 17(2): 69–76. Published online 2006 November 14. doi: 10.1007/s10286-006-0379-7. | PMCID: PMC1858602 |
and Rainer SchandryStefan Duschek, Phone: +49-89/2180-5297, Fax: +49-89/2180-5233, Email: duschek@psy.uni-muenchen.de
Only 20.3% suffered from severe CH
Sympathectomy is the treatment of choice for primary hyperhidrosis. One curious occurrence that is difficult to explain from an anatomophysiological point of view in cases of video-assisted thoracoscopic sympathectomy (VATS) for the treatment of palmar hyperhidrosis (PH) is the observed improvement in plantar hyperhidrosis (PLH). Nevertheless, current reports on VATS rarely describe the effect on PLH or just give superficial data. The aim of this study was to prospectively investigate, how surgery affects PLH in patients with PH and PLH over one-year period. From May 2003 to January 2004, 70 consecutive patients with combined PH and PLH underwent VATS at the T2, T3, or T4 ganglion level (47 women and 23 men, with mean age of 23 years). Immediately after the operation, all the patients said they were free from PH episodes, except for two patients (2.8%) who suffered from continued PH. Compensatory hyperhidrosis (CH) of various degrees was observed in 58 (90.6%) patients after one year. Only 13 (20.3%) suffered from severe CH. There was a great initial improvement in PLH in 50% of the cases, followed by progressive regression, such that only 23.4% still presented that improvement after one year. The number of cases without overall improvement increased progressively (from 17.1% to 37.5%) and the numbers with slight improvement remained stable (32.9–39.1%). Of the 24 patients with no improvement after one year, 6 patients graded plantar sweating worse.
- Wolosker, Nelson1 nwolosker@yahoo.com.br
Yazbek, Guilherme1
Milanez de Campos, José2
Kauffman, Paulo1
Ishy, Augusto2
Puech-Leão, Pedro1 - Source:
- Clinical Autonomic Research; Jun2007, Vol. 17 Issue 3, p172-176, 5p, 1 chart
statistically significant changes were recorded in the head, hands, axillas, and soles
Redistribution of perspiration as reported by the patients comprised significant reduction in the palms, axillas, and soles, and an increase in the abdomen, back, and gluteal and popliteal regions. 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, p2030-2033, 4p, 2 charts
Surgical Endoscopy; Nov2007, Vol. 21 Issue 11, p2030-2033, 4p, 2 charts
Elimination of the dominant signal (e.g., surgical sympathectomy) may allow a secondary- signal to control phase
Sympathetic input modulates, but does not determine, phase of peripheral circadian oscillators.
American Journal of Physiology: Regulatory, Integrative & Comparative Physiology; Jul2008, Vol. 64 Issue 1, pR355-R360, 6p, 2 charts, 2 graphs
American Journal of Physiology: Regulatory, Integrative & Comparative Physiology; Jul2008, Vol. 64 Issue 1, pR355-R360, 6p, 2 charts, 2 graphs
Similar pathological effects of sympathectomy and hypercholesterolemia on arterial smooth muscle cells and fibroblasts
Acta Histochemica; Jul2008, Vol. 110 Issue 4, p302-313, 12p
Six percent of the patients regret the surgery because of severe CS
European Journal of Cardio-Thoracic Surgery; Sep2008, Vol. 34 Issue 3, p514-519, 6p
Pulmonary Function and Bronchial Hyperresponsiveness.
Of 46 patients who had a negative result for methacholine challenge preoperatively, 12 (26%) became positive after surgery. In terms of the level of sympathectomy, T3 sympathectomy significantly increased the ratio of patients exhibiting a positive response to methacholine (from 19% to 34%, respectively) (p <>sympathectomy can adversely affect lung function early after surgery, although the clinical significance is uncertain. It may also exert an influence on the development of bronchial hyperresponsiveness, especially when performed at the T3 level.
Journal of Asthma; Apr2009, Vol. 46 Issue 3, p276-279, 4p, 3 charts
Journal of Asthma; Apr2009, Vol. 46 Issue 3, p276-279, 4p, 3 charts
sympathectomy can produce capillary abnormalities in the retina similar to those seen in early diabetes
Diabetes can cause damage to sympathetic nerves, and we have previously shown that experimental sympathectomy can produce capillary abnormalities in the retina similar to those seen in early diabetes.
Experimental Eye Research; Jun2009, Vol. 88 Issue 6, p1014-1019, 6p
Experimental Eye Research; Jun2009, Vol. 88 Issue 6, p1014-1019, 6p
- Steinle, Jena J.1 jsteinl1@utmem.edu
Kern, Timothy S.2
Thomas, Steven A.3
McFadyen-Ketchum, Lisa S.4
Smith, Christopher P.4
Bilateral surgical sympathectomy provides a valuable tool for future investigations of the cellular basis of supersensitivity in the myocardium
Volume 234, Issue 1, pp. 280-287, 07/01/1985
Copyright © 1985 by American Society for Pharmacology and Experimental Therapeutics
Long-Term Denervation of Vascular Smooth Muscle Causes Not Only Functional but Structural Change
Rosemary D. Bevan, Hiromichi Tsuru
Department of Pharmacology, School of Medicine, University of California, Los Angeles, Calif.
Address of Corresponding Author
Blood Vessels 1979;16:109-112 (DOI: 10.1159/000158197)
Bilateral cervical sympathectomies should be avoided because of the destruction of cardioaccelerator tone
http://www.hiesiger.com/physicians/physicianrfl.html
Receptor hypersensitivity is a common problem after significant sympathetic injury
Because of their size and location, injuries to the sympathetic ganglia or chain is rarely indicated or performed. Receptor hypersensitivity is a common problem after significant sympathetic injury, including clammy hands, erythema, and allodynia. When sympathetic nerves regenerate, they may establish aberrant connections to sensory receptors, muscles, or other sympathetics receptors; this may lead to an over-response or abnormal response.
http://wiki.cns.org/wiki/index.php/Injury,_Sympathetic_Nerve
http://wiki.cns.org/wiki/index.php/Injury,_Sympathetic_Nerve
Long-term cardiopulmonary function after thoracic sympathectomy
Lung function tests revealed a significant decrease in forced expiratory volume in 1 second (FEV(1)) and forced expiratory flow between 25% and 75% of vital capacity (FEF(25%-75%)) in both groups (FEV(1) of -6.3% and FEF(25%-75%) of -9.1% in the conventional thoracic sympathectomy group and FEV(1) of -3.5% and FEF(25%-75%) of -12.3% in the simplified thoracic sympathectomy group). Dlco and heart rate at rest and maximal values after exercise were also significantly reduced in both groups (Dlco of -4.2%, Dlco corrected by alveolar volume of -6.1%, resting heart rate of -11.8 beats/min, and maximal heart rate of -9.5 beats/min in the conventional thoracic sympathectomy group and Dlco of -3.9%, Dlco corrected by alveolar volume of -5.2%, resting heart rate of -10.7 beats/min, and maximal heart rate of -17.6 beats/min in the simplified thoracic sympathectomy group).
J Thorac Cardiovasc Surg 2009 Jun 25.
J Thorac Cardiovasc Surg 2009 Jun 25.
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
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
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.
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
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;79:317-323sympathectomy 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
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
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.
The weighted mean incidence of gustatory
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
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
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
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,
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
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
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.
Am J Physiol. 1980 Apr;238(4):H594-8.
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.
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 |
European Journal of Surgery
See Also:
Volume 164 Issue S1, Pages 33 - 35
Published Online: 2 Dec 2003
Catastrophic complications - tension pneumothorax
Catastrophic complications such as delayed recognition of tension
pneumothorax from left sided CO2 insufflation, leading to fatal and
disabling consequences was reported.
Doolabh N, Horswell S, Williams M, Huber L, Syma Prince S, Meyer
DM, and Mack MJ. Thoracoscopic Sympathectomy for Hyperhi-
drosis: Indications and Results. Ann Thorac Surg 2004; 77: 410 – 414.
pneumothorax from left sided CO2 insufflation, leading to fatal and
disabling consequences was reported.
Doolabh N, Horswell S, Williams M, Huber L, Syma Prince S, Meyer
DM, and Mack MJ. Thoracoscopic Sympathectomy for Hyperhi-
drosis: Indications and Results. Ann Thorac Surg 2004; 77: 410 – 414.
medical sects and cults that propagate the Absurd
“...when irrational beliefs are shared with a surrounding community of sympathetic thinkers, errors become institutionalized. Thus are generated medical sects and cults that propagate the Absurd....
The guardians that usually keep the institution of medicine from reeling off into irrationality are social contracts built into medical science and ethical behavior. The academic community guards the contractual borders of science, while laws and regulations encode our ethical system. For the Absurd to have advanced, there must have been some breakdown of these social guardians.”
Propagation of the Absurd: demarcation of the Absurd revisited
Wallace Sampson, MD Editor and Clinical Professor of Medicine, Stanford University
Kimball Atwood IV, MD, Anaesthesiologist; and Assistant Clinical Professor, Tufts University School of Medicine Medical Journal of Australia Dec. 2005
The guardians that usually keep the institution of medicine from reeling off into irrationality are social contracts built into medical science and ethical behavior. The academic community guards the contractual borders of science, while laws and regulations encode our ethical system. For the Absurd to have advanced, there must have been some breakdown of these social guardians.”
Propagation of the Absurd: demarcation of the Absurd revisited
Wallace Sampson, MD Editor and Clinical Professor of Medicine, Stanford University
Kimball Atwood IV, MD, Anaesthesiologist; and Assistant Clinical Professor, Tufts University School of Medicine Medical Journal of Australia Dec. 2005
Arthritis exacerbated following sympathectomy
"...capsaicin-eenhanced DRRs are blocked by sympathecotmy. In contrast, arthritis even be exacerbated following sympathectomy. Surgical sympathectomy does exert profound effects on immune system stimulation in the early stages of adjuvant arthritis and may therefore affect disease progression through this action."
Furthermore, the sympathetic nervous system may play a regulatory role in secondary lymphoid organs as it has been shown that selective sympathectomy in secondary lympoid organs exacerbates experimental arthritis.
Morphological and functional studies revealed a complex system of primary sensory neurons which parallels the autonomic nervous system not only in its extent, but probably also in its significance. Neuropeptides released from activated nociceptive afferent nerves play a pivotal role in inflammatory reactions and pain, significantly modulate cardiac, vascular, respiratory, gastrointestinal and immune functions and influence the protective, restorative and trophic functions of somatic and visceral tissues.
Furthermore, the sympathetic nervous system may play a regulatory role in secondary lymphoid organs as it has been shown that selective sympathectomy in secondary lympoid organs exacerbates experimental arthritis.
Morphological and functional studies revealed a complex system of primary sensory neurons which parallels the autonomic nervous system not only in its extent, but probably also in its significance. Neuropeptides released from activated nociceptive afferent nerves play a pivotal role in inflammatory reactions and pain, significantly modulate cardiac, vascular, respiratory, gastrointestinal and immune functions and influence the protective, restorative and trophic functions of somatic and visceral tissues.
Publication Date: 2009-01-01
Publisher: Elsevier Science & Technol
Central Nervous System Activation following Peripheral Chemical Sympathectomy: Implications for Neural–Immune Interactions
Many studies have demonstrated that ablation of the sympathetic nervous system (SNS) alters subsequent immune responses. Researchers have presumed that the altered immune responses are predominantly the result of the peripheral phenomenon of denervation. We, however, hypothesized that chemical sympathectomy will signal and activate the central nervous system (CNS). Activation of the CNS was determined by immunocytochemical visualization of Fos protein in brains from male C57BL/6 mice at 8, 24, and 48 h following denervation. A dramatic induction of Fos protein was found in the paraventricular nucleus (PVN) of the hypothalamus and other specific brain regions at 8 and 24 h compared to vehicle control mice. Dual-antigen labeling demonstrates that corticotrophin releasing factor (CRF)-containing neurons in the PVN are activated by chemical sympathectomy; however, neurons containing neurotransmitters which may modulate CRF neurons, such as vasopressin, tyrosine hydroxylase, and adrenocorticotropin, do not coexpress Fos. Our findings suggest an involvement of the CNS in sympathectomy-induced alterations of immunity.
Brain, Behavior, and Immunity
Volume 12, Issue 3, September 1998, Pages 230-241
Brain, Behavior, and Immunity
Volume 12, Issue 3, September 1998, Pages 230-241
International Society for Sympathetic Surgery founded
Here are the basics of our new classifications:
ESB2 (clamp upper end of T2 only): 2.5%, (in Europe 15%)
Facial blushing, Craniofacial sweating, Some psychic disorders, Rosacea, Vibration disorder (?), Parkinsonism (?)...
ESB3: 2.5%, (in Europe 50%)
Hyperhidrosis Palmaris with Craniofacial sweating, blushing, or any other craniofacial sympathetic disorders
ESB4: 95%, (in Europe 20%)
Hyperhidrosis Palmaris with or without axillary hyperhidrosis (Bromidrosis)
Unilateral ESB: (in Europe 15%)
Social phobia, schizophrenia, sleep disorders, addiction, cardiac arrhythmias
http://www.hyperhidrosis.com/symposium.htm
ESB2 (clamp upper end of T2 only): 2.5%, (in Europe 15%)
Facial blushing, Craniofacial sweating, Some psychic disorders, Rosacea, Vibration disorder (?), Parkinsonism (?)...
ESB3: 2.5%, (in Europe 50%)
Hyperhidrosis Palmaris with Craniofacial sweating, blushing, or any other craniofacial sympathetic disorders
ESB4: 95%, (in Europe 20%)
Hyperhidrosis Palmaris with or without axillary hyperhidrosis (Bromidrosis)
Unilateral ESB: (in Europe 15%)
Social phobia, schizophrenia, sleep disorders, addiction, cardiac arrhythmias
http://www.hyperhidrosis.com/symposium.htm
The 4th International Symposium on Sympathetic Surgery was held in Finland in June 2001, and was attended by the world’s most renowned ETS surgeons, including its Chairman, Dr. Timo Telaranta. Louis Stein of Surgical Team was there to listen to the experts.
· International Society for Sympathetic Surgery founded
International Society for Sympathetic Surgery was founded during the Symposium. It has a council of five members:
- Dr. Christer Drott from Sweden - The Society’s first Chairman
- Dr. Christoph Schick from Germany
- Dr. Timo Telaranta from Finland
- Dr. Chien-Chih Lin from Taiwan
- Dr. Moshe Hashmonai from Israel
Dr. Alan Cameron from England joined as an English language expert, especially for the revision of the by-laws.
Significant reductions in maximal heart rate (HR) and oxygen and carbon dioxide uptakes were observed
Ten patients had positive bronchial challenge test results that remained positive 3 months after surgery, and 2 patients whose challenge test results were negative before surgery became positive after sympathectomy. Significant reductions in maximal heart rate (HR) and oxygen and carbon dioxide uptakes were observed during the maximal exercise test.
CHEST October 2005 vol. 128 no. 4 2702-2705
CHEST October 2005 vol. 128 no. 4 2702-2705
Role of sympathoadrenergic mechanisms in arrhythmogenesis
The NA content in the heart was not measured but it is likely to be small at least at the 10-day period. It is known that three days after chemical sympathectomy NA content is only 7% of normal value [6]. Second, the development of adrenoceptor supersensitivity in the transplanted heart was demonstrated clearly with enhanced heart rate responses to NA or propranolol (at Day 10) [1]. As dennervation sensitization increases the arrhythmia susceptibility [6], it is thus possible that, in the presence of receptor supersensitivity, adrenergic activation occurs by either increase in circulating catecholamines and possibly local release of residual NA, which might still have been sufficient to contribute to arrhythmia development.
Role of sympathoadrenergic mechanisms in arrhythmogenesis
Xiao-Jun Du* and Anthony M. Dart
Baker Medical Research Institute, Melbourne, Victoria, Australia
Cardiovascular Research 1999 43(4):832-834;
Role of sympathoadrenergic mechanisms in arrhythmogenesis
Xiao-Jun Du* and Anthony M. Dart
Baker Medical Research Institute, Melbourne, Victoria, Australia
Cardiovascular Research 1999 43(4):832-834;
Surgeons should be aware of adverse effects such as bradycardia
The heart rate and systolic blood pressure de-
creased significantly after T2-T3ganglionectomy.
A prolonged QT interval was also recorded (p<> 0.05). The decrease was signifi-
cant in the sympathectomy group.
Our study also, it was revealed that
sympathectomy significantly prolonged the QT in-
terval.
Surgeons should be aware of adverse effects such as bradycardia during thoracic
sympathectomy. This study suggested that careful monitoring was required during thoracic sym-
pathectomy and early postoperative period.
Orhan YÜCEL, MD
GATA, Department of
Thoracic Surgery, Ankara,
TÜRKİYE/TURKEY
creased significantly after T2-T3ganglionectomy.
A prolonged QT interval was also recorded (p<> 0.05). The decrease was signifi-
cant in the sympathectomy group.
Our study also, it was revealed that
sympathectomy significantly prolonged the QT in-
terval.
Surgeons should be aware of adverse effects such as bradycardia during thoracic
sympathectomy. This study suggested that careful monitoring was required during thoracic sym-
pathectomy and early postoperative period.
Orhan YÜCEL, MD
GATA, Department of
Thoracic Surgery, Ankara,
TÜRKİYE/TURKEY
Sympathetic nervous system regulation of immunity
"suppressor T cells through an immune-privileged site requires an intact sympathetic nervous system."
Journal of Neuroimmunology
Volume 147, Issues 1-2, February 2004, Pages 87-90
Journal of Neuroimmunology
Volume 147, Issues 1-2, February 2004, Pages 87-90
Sympathectomy-induced alterations in immunity
These experiments indicate that an inflammatory response is not likely to be responsible for sympathectomy-induced immune alterations, eliminating a potential confounding factor in interpreting sympathectomy studies.
Brain, behavior and immunity ISSN 0889-1591
2002, vol. 16, no1, pp. 33-45 [13
CALLAHAN Tracy A. ; MOYNIHAN Jan A. ;
Brain, behavior and immunity ISSN 0889-1591
2002, vol. 16, no1, pp. 33-45 [13
CALLAHAN Tracy A. ; MOYNIHAN Jan A. ;
Reduced Heart Rate Variability associated with incresed mortality
These results support an association between CAN (cardiovascular autonomic neuropathy) and increased risk of mortality. The stronger association observed in studies defining CAN by the presence of two or more abnormalities may be due to more severe autonomic dysfunction in these subjects or a higher frequency of other comorbid complications that contributed to their higher mortality risk. Future studies should evaluate whether early identification of subjects with CAN can lead to a reduction in mortality.
- Raelene E. Maser, PHD1,
- Braxton D. Mitchell, PHD2,
- Aaron I. Vinik, MD, PHD3 and
- Roy Freeman, MD4
Sympathectomy also results in reduced heart rate variability
"Cardiovascular autonomic neuropathy (CAN) is the most prominent focus because of the life-threatening consequences and the availability of direct tests of cardiovascular autonomic function.. .CAN results from damage due to the autonomic nerve fibers that innervate the heart and blood vessels and results in abnormalities in heart rate control and vascular dynamics. Reduced heart variation is the earliest indicator of CAN."
"CAN is the most studied and clinically important form of DAN. Meta-analyses of published data demonstrate that reduced cardiovascular autonomic function as measured by heart rate variability (HRV) is strongly associated with an increased risk of silent myocardial ischemia and mortality. The determination of the presence of CAN is usually based on a battery of autonomic function tests..."
"CAN is the most studied and clinically important form of DAN. Meta-analyses of published data demonstrate that reduced cardiovascular autonomic function as measured by heart rate variability (HRV) is strongly associated with an increased risk of silent myocardial ischemia and mortality. The determination of the presence of CAN is usually based on a battery of autonomic function tests..."
TECHNICAL REVIEW: Standard of Care - Diabetic Autonomic Neuropathy
Aaron I. Vinik, MD, PHD; Braxton D. Mitchell, PHD
Raelene E. Maser, PHD; Roy Freeman, MD
Skin denervation
Epidermal nerve fiber densities were significantly reduced in the skin of all patients, consistent with concomitant small-fiber neuropathies. Perivascular infiltration by T cells and macrophages was demonstrated by immunohistochemistry. All patients experienced neurologic improvement in muscle strength and alleviation of sensory symptoms after immunotherapy with corticosteroids, plasma exchange, or cyclophosphamide. Conclusions: Small-diameter sensory nerves are affected in vasculitis in addition to the well-known effect of vasculitis on large-diameter nerves. Significant inflammatory vasculopathy is present in the skin despite the absence of clinically active vasculitic lesions.
Archives of neurology ISSN 0003-9942 CODEN ARNEAS
2005, vol. 62, no10, pp. 1570-1573 [4 page(s) (article)] (24 ref.)
Archives of neurology ISSN 0003-9942 CODEN ARNEAS
2005, vol. 62, no10, pp. 1570-1573 [4 page(s) (article)] (24 ref.)
sympathetic vascular innervation in sympathectomized patients
We measured arterial and venous plasma catecholamines and used laser-Doppler flowmetry to measure cutaneous microcirculatory flow in the sympathectomized and in the intact limbs of 3 patients who had undergone regional sympathectomies. Venous concentrations of norepinephrine, the sympathetic neurotransmitter, exceeded arterial concentrations in the intact limbs--a normal finding--but invariably were less than arterial in the sympathectomized limbs of the same patients, both during baseline conditions and during sympathetic stimulation using tilt, standing and the cold pressor test (mean arteriovenous decrement about 40%). Arterial epinephrine levels exceeded venous levels with or without sympathectomy. Skin microvascular flow rapidly decreased during the cold pressor test and the Valsalva maneuver in the intact but not in the sympathectomized limbs, and spontaneous flow oscillations occurred in the sympathectomized limbs. The results suggest that an arteriovenous increment in plasma norepinephrine reflects local release of norepinephrine from sympathetic nerve endings, whereas removal of circulating catecholamines can occur with or without sympathetic neural impulses. Laser-Doppler flowmetry can measure reflexive sympathetically mediated responses of skin microvascular flow and so can detect sympathetic denervation.
PMID: 3517118 [PubMed - indexed for MEDLINE
PMID: 3517118 [PubMed - indexed for MEDLINE
Impaired skin vasomotor reflexes
Not surprisingly, diminished vasoconstrictor responses, similar to the current findings, have been found
in patients with sympathetic dystrophies [26], dysautomias [27], post-regional sympathectomy [28] and
diabetic neuropathies [11].
Additionally, there have been a few reports of EM patients benefitting from sympathectomy or neurolitic
irreversible blocks of the lumbar sympathetic ganglia [22,23], while others have found the symptoms of EM to
be aggravated by such treatment [24,25], possibly as a result of denervation supersensitivity.
Clinical Science (1999) 96, 507ñ512 (Printed in Great Britain)
Roberta C. LITTLEFORD, Faisel KHAN and Jill J. F. BELCH
University Department of Medicine, Section of Vascular Medicine and Biology, Ninewells Hospital and Medical School,
Dundee DD1 9SY, Scotland, U.K.
in patients with sympathetic dystrophies [26], dysautomias [27], post-regional sympathectomy [28] and
diabetic neuropathies [11].
Additionally, there have been a few reports of EM patients benefitting from sympathectomy or neurolitic
irreversible blocks of the lumbar sympathetic ganglia [22,23], while others have found the symptoms of EM to
be aggravated by such treatment [24,25], possibly as a result of denervation supersensitivity.
Clinical Science (1999) 96, 507ñ512 (Printed in Great Britain)
Roberta C. LITTLEFORD, Faisel KHAN and Jill J. F. BELCH
University Department of Medicine, Section of Vascular Medicine and Biology, Ninewells Hospital and Medical School,
Dundee DD1 9SY, Scotland, U.K.
Peripheral Nervous System Disease
Combined with loss of active vasodilation, anhidrosis places tetraplegic patients at risk for hyperthermia.
Peripheral Nervous System Disease
With normal aging, thermoregulatory sweat output declines due to peripheral neural and eccrine glandular factors, which vary in degree depending on genetic predisposition and level of physical conditioning.[75] Extensive anhidrosis may also accompany disease of the peripheral nervous system. When exposed to an elevated ambient temperature or physical exercise, these individuals may present with symptoms of heat intolerance, dizziness, weakness, flushing, dyspnea, or palpitations and may be at risk for heat exhaustion and hyperthermia.
Peripheral Neuropathy
Distal anhidrosis, although often subclinical, is detectable by clinical sudomotor testing in many patients with peripheral neuropathy.[76,77] Diabetes mellitus, the most common cause of autonomic neuropathy in the developed world, typically impairs thermoregulatory sweating in a stocking and glove distribution.[78] As the neuropathy progresses, asymmetric truncal anhidrosis or global anhidrosis may develop.[76]
Some immune-mediated neuropathies selectively target the autonomic neuron. Autoimmune autonomic neuropathy typically presents with sicca complex, anhidrosis, gastrointestinal hypomotility, orthostatic hypotension, abnormal pupillary light reflexes, and neurogenic bladder that may be subacute or insidious in onset. Autoantibodies to the ganglionic acetylcholine receptor have been demonstrated in these patients.[29,79,80] Subacute autonomic neuropathy may signal an occult malignancy, most commonly small cell lung carcinoma. The dysautonomia in paraneoplastic autonomic neuropathy can be manifested mainly by cholinergic failure presenting as gastrointestinal dysfunction and anhidrosis.
Hypohidrosis commonly occurs in the autonomic neuropathy associated with Sjögren's syndrome.[83,84] Hypohidrosis also accompanies neuropathies due to amyloidosis, alcoholism, Tangier disease, vasculitis, and Fabry's disease.[85] Focal areas of hypohidrosis may be found in patients with leprosy.[86]
Anhidrosis is a prominent feature of hereditary sensory and autonomic neuropathies type IV and V (congenital insensitivity to pain with anhidrosis), in which absent skin innervation is associated with mutations of the NTRK1 gene encoding the neurotrophic tyrosine kinase receptor type 1.[30]
Link between skin innervation and neuropathic pain
Nerve conduction studies for large-diameter motor and sensory nerves were normal. This report documents a pure small-fibre sensory neuropathy after prolonged use of linezolid, and the relationship between skin innervation and corresponding neuropathic pain.
Journal of Neurology, Neurosurgery, and Psychiatry 2008;79:97-99
Journal of Neurology, Neurosurgery, and Psychiatry 2008;79:97-99
Some patients demonstrate unexpected responses
The indications for neurolytic or surgical sympathectomy are uncertain. There is no clear correlation between the degree or duration of pain relief and the actual period of sympathetic blockade and the same patient may show variable responses on different occasionsv (Loh et al 1980). Some patients demonstrate unexpected responses such as contralateral or delayed blocks and some are made worse (Purcell-Jones &Justins 1988, Evans et al 1980, Kleiman 1954)
Neurological Rehabilitation
by R. Greenwood
"All neurological diseases can cause short- and long-term disability..."
Neurological Rehabilitation
by R. Greenwood"All neurological diseases can cause short- and long-term disability..."
- Publisher: Psychology Press; New edition edition (February 1, 1997)
- Language: English
- ISBN-10: 0863774849
Nerve 'injury' and consequences well observed in animals
Ligation injury of the L5/L6 nerve roots in rats produces behavioral signs representative of clinical conditions of neuropathic pain, including tactile allodynia and thermal and mechanical hyperalgesia.
Anesthesiology:
January 1997 - Volume 86 - Issue 1 - pp 196-204
Laboratory Investigation the ablated segment becomes hypersensitive to acetylcholine
The injured tissue distal to the ablated segment becomes hypersensitive to acetylcholine. This can explain why CH may appear very early after sympathectomy.
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.
by MC Kao - 1998
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.
CONCLUSION: Transthoracic endoscopic sympathectomy is an effective and simple modality to treat palmar hyperhidrosis. However, all patients need to be warned of the common complications, particularly compensatory hyperhidrosis, before surgery.
by MC Kao - 1998
Neurosurgery:
July 1997 - Volume 41 - Issue 1 - pp 110-115
sympathectomy abolished the Psychogalvanic Reflex
Some P.G.R. studies in a female subject who had bilateral cervical sympathectomy were described. It was found that sympathectomy abolished P.G.R. and that intra-arterial infusion of acetylcholine evoked marked P.G.R. changes in the sympathectomized limb. These findings support the theory that the P.G.R. is mediated through the cholinergic fibres of the sympathetic nervous system.
Submitted on May 22, 1967The British Journal of Psychiatry (1968) 114: 639-642. doi: 10.1192/bjp.114.510.639
© 1968 The Royal College of Psychiatrists
Sympathetic Innervation of Cerebral Arteries: Prejunctional Supersensitivity to Norepinephrine After Sympathectomy
© 1975 American Heart Association, Inc.
augmented cholinergic preponderance in cardiac dynamics
In the majority of 16 non-cardiac and in two angina pectoris patients, unilateral
or bilateral endoscopic transthoracic sympathectomy (method of Kux) was followed
by signs of augmented cholinergic preponderance in cardiac dynamics (especially
prolongation of the Isometric period of the left ventricle).
The findings obtained in 16 non-cardiac patients concerning the length
of the isometric or tension period (TP), heart rate and pulse pressure
are represented in Table 1.
In response to transthoracic sympathectomy, all three parameters
varied from person to person in wide ranges in both directions. However,
when the tests were repeated in the same patients at different time inter-
vals after the operation (with or without a second contralateral syrn-
pathectomy inbetween), their qualitative pattern of response (either
upward or downward) remained the same in nearly all instances, as
far as the TP and pulse pressure were concerned. The responses of the
heart rate, on the other hand, were less striking percentage-wise and
varied in quite an irregular fashion in identical individuals.
No significant relationship existed between the magnitude of the pre-
operative average values and the type (positive or negative) or degree
of the postoperative deviations in either one of the three recorded pa-
rameters.
DOI 10.1378/chest.38.4.423
1960;38;423-428
Dis Chest
W. RAAB, E. KUX and H. MARCHET
Effect of Transthoracic Endoscopic Sympathectomy
on the Cardiac Neurovegetative Equilibrium
and on Angina Pectoris
or bilateral endoscopic transthoracic sympathectomy (method of Kux) was followed
by signs of augmented cholinergic preponderance in cardiac dynamics (especially
prolongation of the Isometric period of the left ventricle).
The findings obtained in 16 non-cardiac patients concerning the length
of the isometric or tension period (TP), heart rate and pulse pressure
are represented in Table 1.
In response to transthoracic sympathectomy, all three parameters
varied from person to person in wide ranges in both directions. However,
when the tests were repeated in the same patients at different time inter-
vals after the operation (with or without a second contralateral syrn-
pathectomy inbetween), their qualitative pattern of response (either
upward or downward) remained the same in nearly all instances, as
far as the TP and pulse pressure were concerned. The responses of the
heart rate, on the other hand, were less striking percentage-wise and
varied in quite an irregular fashion in identical individuals.
No significant relationship existed between the magnitude of the pre-
operative average values and the type (positive or negative) or degree
of the postoperative deviations in either one of the three recorded pa-
rameters.
DOI 10.1378/chest.38.4.423
1960;38;423-428
Dis Chest
W. RAAB, E. KUX and H. MARCHET
Effect of Transthoracic Endoscopic Sympathectomy
on the Cardiac Neurovegetative Equilibrium
and on Angina Pectoris
not found any improvement in ulcer healing with sympathectomy
We have not found any improvement in ulcer healing with sympathectomy as compared with local wound care and have not performed upper extremity sympathectomy for upper extremity ischemia in over a decade.
Noninvasive Vascular Diagnosis:
2nd ed., 2007
ISBN: 978-1-84628-446-5
Noninvasive Vascular Diagnosis:
A Practical Guide to Therapy
By Ali F. AbuRahma, John J. Bergan2nd ed., 2007
ISBN: 978-1-84628-446-5
sympathectomy severs both vasomotor and sensory fibres
CUTANEOUS INNERVATION IN MAN BEFORE AND AFTER LUMBAR SYMPATHECTOMY: EVIDENCE FOR INTERRUPTION OF BOTH SENSORY AND VASOMOTOR NERVE FIBRES.
ANZ Journal of Surgery. 73(1-2):14-18, January 2003.
COVENTRY, BRENDON J. BM BS, PhD, FRACS *; WALSH, JOHN A. MD, FRACS +
ANZ Journal of Surgery. 73(1-2):14-18, January 2003.
COVENTRY, BRENDON J. BM BS, PhD, FRACS *; WALSH, JOHN A. MD, FRACS +
INFLUENCES OF SHORT-TERM SYMPATHECTOMY ON THE COMPOSITION OF PROTEINS
The protein constituents in parasympathetically evoked saliva from normal and short-term sympathectomized parotid glands were compared. There was a reduction in all proline-rich proteins (PRP) in the saliva following sympathectomy. The decrease was quantified for acidic PRP by high-performance ion-exchange chromatography, which showed an increase in the ratio of amylase to other proteins. These results suggest that sympathetic impulses influence the synthesis of PRP and amylase in opposite directions.
http://ep.physoc.org/content/73/1/139.abstract
http://ep.physoc.org/content/73/1/139.abstract
Enhanced vascular reactivity
In conclusion, we showed that sympathectomy produces complex alterations of vascular reactivity both in vivo and in isolated vessels, which shift the balance of the sensitivity of the vessel between vasoconstrictor and vasodilating agents towards an increased constriction. These results are unlikely to simply reflect denervation supersensitivity; their underlying receptor, post-receptor and/or contractile mechanisms are yet to be identified.
Journal of Hypertension:
August 2000 - Volume 18 - Issue 8 - p 1041-1049
An adrenergic sensitivity in nociceptive afferents might contribute to pain and hyperalgesia
Normal inhibitory influences on pain during sympathetic arousal are compromised in the majority of patients with CRPS. The augmented vasoconstrictor response in the symptomatic limb during sympathetic arousal is consistent with adrenergic supersensitivity. An adrenergic sensitivity in nociceptive afferents might contribute to pain and hyperalgesia during sympathetic arousal in certain patients with CRPS.
Drummond PD, Finch PM, Skipworth S, Blockey P.
PMID: 11591852 [PubMed - indexed for MEDLINE
Drummond PD, Finch PM, Skipworth S, Blockey P.
School of Psychology, Murdoch University, Perth, Western Australia. drummond@central.murdoch.edu.au
PMID: 11591852 [PubMed - indexed for MEDLINE
Persistence of pain induced by startle and forehead cooling after sympathetic blockade
J Neurol Neurosurg Psychiatry. 2004 Jan;75(1):98-102.
These findings suggest that stimuli arousing sympathetic activity act by a central process to exacerbate pain in some patients, independent of the peripheral sympathetic nervous system. This may account for the lack of effect of peripheral sympathetic blockade on pain in some CRPS patients.Drummond PD, Finch PM. School of Psychology, Murdoch University, Perth, Western Australia,
PMID: 14707316 [PubMed - indexed for MEDLINE
enhanced hyperalgesic response following sympathectomy
We report on the ability of a delayed sympathectomy after a prolonged hyperalgesia to result in a subsequent enhanced hyperalgesic response. Sympathectomy was performed one day after injection of prostaglandin E2 plus rolipram, which induces a prolonged sympathetically-maintained hyperalgesia [Aley K. O. and Levine J. D. (1995) Eur. J. Pharmac. 273, 107-112].
http://cat.inist.fr/?aModele=afficheN&cpsidt=3017786
http://cat.inist.fr/?aModele=afficheN&cpsidt=3017786
Sympathectomy mimicks SART stress-induced hyperalgesia
Frontiers in Bioscience 11, 2179-2192, September 1, 2006
Joint inflammation is reduced by dorsal rhizotomy and not by sympathectomy
Joint inflammation is reduced by dorsal rhizotomy and not by sympathectomy or spinal cord transection.
Annals of the Rheumatic Diseases 1994;53:309-314http://ard.bmj.com/cgi/content/abstract/53/5/309
Sympathectomy alters bone architecture
Journal of Cellular Biochemistry
Volume 104 Issue 6, Pages 2155 - 2164
Allostasis - a state of imbalance responsible for Autoimmune disorders
In general, enhancing the sympathetic tone decreases both T0-cell and NK cell functions but not the proliferation of splenic B cells (Dowdell and Whitacre, 2000). In contrast, chemical sympathectomy, although having varying results, does seem to increase the severity of autoimmune disorders (Dowdell and Whitacre, 2000)
As far as metabolism, catecholamines promote mobilization of fuel stores at time of stress and act synergistically with glucocorticoids to increased glycogenolysis, gluconeogenesis, and lipolysis but exert opposing effects of protein catabolism, as noted earlier. One important aspect is regulation of body temperature (Goldsttein and Eisenhofer, 2000) Epinephrine levels are also positively related to serum levels of HDL cholesterol and negatively related to triglycerines. However, perturbing the balance of activity of various mediators or metabolism and body weight regulation can lead to well-known metabolic disorders such as type 2 diabetes and obesity.
At the same time, increased sympathetic activitation and nerephinephrine release is elevated in hypertensive individuals and also higher levels of insulin, and there are indications that insulin further increases sympathetic activity in a vicious cycle (Arauz-Pacheco et al.,1996)
As a result of either local production, cytokines often enter the the circultion and can be detected in plasma samples. Sleep deprivation and psychological stress, such as public speaking, are reported to elevate inflammatory cytokine level in blood (Altemus et al., 2001) Circulting levels of a number of inflammatory cytokines are elevated in relation to viral and other infections and contirbute to the feeling of being sick, as well as sleepiness, wiht both direct and indirect effects on the central nervous system (Arkins et al., 2000; Obal and Kueger, 2000)
Inflammatory autoimmune diseases, such as multiple sclerosis, rheumatoid arthritis, and type 1 diabetes, reflect an allostatic state that consists of at least three principal causes: genetic risk factors, (...) factors that contribute to the development of tolerance of self-antigens (...) and the hormonal mikieu that regulates adaptive immunes responses (Dowdell and Whitacre, 2000)
Cambridge University Press, 2004
As far as metabolism, catecholamines promote mobilization of fuel stores at time of stress and act synergistically with glucocorticoids to increased glycogenolysis, gluconeogenesis, and lipolysis but exert opposing effects of protein catabolism, as noted earlier. One important aspect is regulation of body temperature (Goldsttein and Eisenhofer, 2000) Epinephrine levels are also positively related to serum levels of HDL cholesterol and negatively related to triglycerines. However, perturbing the balance of activity of various mediators or metabolism and body weight regulation can lead to well-known metabolic disorders such as type 2 diabetes and obesity.
At the same time, increased sympathetic activitation and nerephinephrine release is elevated in hypertensive individuals and also higher levels of insulin, and there are indications that insulin further increases sympathetic activity in a vicious cycle (Arauz-Pacheco et al.,1996)
As a result of either local production, cytokines often enter the the circultion and can be detected in plasma samples. Sleep deprivation and psychological stress, such as public speaking, are reported to elevate inflammatory cytokine level in blood (Altemus et al., 2001) Circulting levels of a number of inflammatory cytokines are elevated in relation to viral and other infections and contirbute to the feeling of being sick, as well as sleepiness, wiht both direct and indirect effects on the central nervous system (Arkins et al., 2000; Obal and Kueger, 2000)
Inflammatory autoimmune diseases, such as multiple sclerosis, rheumatoid arthritis, and type 1 diabetes, reflect an allostatic state that consists of at least three principal causes: genetic risk factors, (...) factors that contribute to the development of tolerance of self-antigens (...) and the hormonal mikieu that regulates adaptive immunes responses (Dowdell and Whitacre, 2000)
Allostasis, homeostasis and the costs of physiological adaptation
By Jay SchulkinCambridge University Press, 2004
Allostasis is the process of achieving stability, or homeostasis, through physiological or behavioral change. This can be carried out by means of alteration in HPA axis hormones, the autonomic nervous system, cytokines, or a number of other systems, and is generally adaptive in the short term [1]
contributing to the elevated susceptibility to ventricular fibrillation
Sympathetic denervation is frequently observed in heart disease. To investigate the linkage of sympathetic denervation and cardiac arrhythmia, we developed a rat model of chemical sympathectomy by subcutaneous injections of 6-hydroxydopamine (6-OHDA).
We observed that sympathectomy (i) decreased cardiac sympathetic nerve density and norepinephrine level, (ii) reduced the protein expression of Kv4.2, Kv1.4, and Kv channel-interacting protein 2 (KChIP2), (iii) decreased current densities and delayed activation of Ito channels, (iv) reduced the phosphorylation of extracellular signal-regulated kinase 1 and 2 (ERK1/2) and cAMP response element-binding protein (CREB), and (v) increased the severity of ventricular fibrillation induced by rapid pacing.
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.
Can. J. Physiol. Pharmacol. 86(10): 700–709 (2008)
We observed that sympathectomy (i) decreased cardiac sympathetic nerve density and norepinephrine level, (ii) reduced the protein expression of Kv4.2, Kv1.4, and Kv channel-interacting protein 2 (KChIP2), (iii) decreased current densities and delayed activation of Ito channels, (iv) reduced the phosphorylation of extracellular signal-regulated kinase 1 and 2 (ERK1/2) and cAMP response element-binding protein (CREB), and (v) increased the severity of ventricular fibrillation induced by rapid pacing.
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.
Can. J. Physiol. Pharmacol. 86(10): 700–709 (2008)
Sterility following lumbar sympathectomy
Bacq (1931) found that bilateral lumbar sympathectomy in rabbits resulted in sterility with prolonged copulation and absence of orgasm.
J. Reprod. Fertil. (1964) 7, 113-122
J. Reprod. Fertil. (1964) 7, 113-122
Altered Cerebral Blood Flow following Sympathectomy
The subject has recently been studied by James, Millar&Purves who measured the cerebral vascular response to hypoxia with all nerves intact and following division or stimulation of the vagus and cervical sympathetic nerves. The effect of sympathectomy (...) is seen to consist of an elevation of both grey and white matter blood flow 40-50 per cent above control over the range of PaO2 tested, 35 to 440 mmHg. When the cervical sympathetic nerve as stimulated at constant frequency and intensity, cortical flow was reduced to control levels.
The Physiology of the Cerebral Circulation (Monographs of the Physiological Society) by M. J. Purves (Hardcover - May 31, 1972)
The Physiology of the Cerebral Circulation (Monographs of the Physiological Society) by M. J. Purves (Hardcover - May 31, 1972)
decrease in resting pulmonary resistance that follows thoracic thoracic sympathectomy
Diminished sympathetic constrictor discharge to pulmonary arterioles probably contributes to the lowering of resistance. No direct evidence for such an action has been presented, but the decrease in resting pulmonary resistance that follows thoracic thoracic sympathectomy shows that the potential for such a response exists. Whatever the mechanism, the net result is that pulmonary blood flow can be increased greatly without raising intravascular pressures to a degree that would encourage capillary transudation of fluid.
Cardiovascular physiology
By William R. Milnor| New York : Oxford University Press, 1990. |
Sympathetic nervous system control of anti-influenza CD8+ T cell responses
Adoptive transfer experiments indicate that enhanced CD8+ responses do not result from permanent alterations in CD8+ T cell function in sympathectomized mice. Rather, additional findings suggest that the sympathetic nervous system tempers the capacity of antigen-presenting cells to activate naïve CD8+ T cells. We also show that antiviral CD8+ T cell responses are enhanced by administration of a β2 (but not β1 or α) adrenergic antagonist. These findings demonstrate a critical role for the sympathetic nervous system in limiting CD8+ T cell responses and indicate that CD8+ T cell responses may be altered in patients using β-blockers, one of the most widely prescribed classes of drugs.
PNAS March 31, 2009 vol. 106 no. 13
PNAS March 31, 2009 vol. 106 no. 13
Following sympathectomy the basal t-PA activity in plasma was 70% less than controls
Following sympathectomy: (i) the basal t-PA activity in plasma was 70% less than controls (2.92 ± 1.96 versus 9.33 ± 1.72 IU/ml;P ≤ 0.001); (ii) the acute release from isolated vessels induced by bradykinin or phenylephrine was comparably reduced; and (iii) the greatest reductions occurred in densely innervated small vessel explants. The results provide new support for an autonomic regulation of neural t-PA release into the vessel wall matrix and blood of densely innervated thin-walled microvessels.
Blood Coagulation & Fibrinolysis:
September 2002 - Volume 13 - Issue 6 - pp 471-481
In another work on dogs, sympathectomy caused a state similar to atrophic rhinitis in man
Relationship Between the Vegetative Innervation and the Sensibility of the Nasal Mucosa
Z. Krajina; Z. Poljak
Acta Oto-Laryngologica, 1651-2251, Volume 79, Issue 3, 1975, Pages 172 – 175
Z. Krajina; Z. Poljak
Acta Oto-Laryngologica, 1651-2251, Volume 79, Issue 3, 1975, Pages 172 – 175
Structural changes associated with parotid "degeneration secretion" after post-ganglionic sympathectomy
This loss of granules is considered to be due to sympathetic "degeneration secretion" caused by the release of noradrenaline from the degenerating adrenergic nerves between 12 and 24 hours after ganglionectomy. This is thought to be the first example of morphological change resulting from "degeneration activation" to be recorded microscopically.
Cell Tissue Res. 1975 Sep 16;162(1):1-12.
Cell Tissue Res. 1975 Sep 16;162(1):1-12.
PMID: 1175216 [PubMed - indexed for MEDLINE]
acinar degranulation following sympathectomy
Chronic bilateral postganglionic sympathectomy (4-6 weeks duration) caused a drastic reduction in the capacity of the gland to secrete saliva in response to parasympathetic stimulation, reaching only one-third of that from normal animals. The initial output of amylase was greater than in normal animals but the total output was similar. The control unstimulated sympathectomized glands appeared similar morphologically to normal resting glands. However, on the parasympathetically stimulated side, besides the usual amount of acinar degranulation, there was also a conspicuous development of acinar vacuolation, not seen in the other groups of animals.
J. Physiol. November 15, 2008 586:5537-5547
J. Physiol. November 15, 2008 586:5537-5547
Cervical sympathectomy inhibits axonal transport of gonadotropin-releasing hormone
To examine the effects of cervical sympathectomy on the transport of gonadotropin-releasing hormone (GnRH) between the hypothalamic neurons and the median eminence, 16 male rats were assigned into four groups: control (C), light (L), light-sympathectomy (LS), and light-colchicine (LC).
Considering the action of colchicine, which inhibits axonal transport, it is suggested that cervical sympathectomy also inhibits axonal transports of GnRH between the GnRH neurons and the median eminence during continuous exposure to light.
Journal of Anesthesia
Volume 10, Number 3 / September, 1996
Considering the action of colchicine, which inhibits axonal transport, it is suggested that cervical sympathectomy also inhibits axonal transports of GnRH between the GnRH neurons and the median eminence during continuous exposure to light.
Journal of Anesthesia
Volume 10, Number 3 / September, 1996
Calcitonin gene-related peptide and substance P contribute to reduced blood pressure in sympathectomized rats
Am J Physiol Heart Circ Physiol 289: H1169-H1175, 2005.
Sympathectomized rats displayed reductions in blood pressure (BP) and atria norepinephrine levels, whereas NGF levels in the DRG, spleen, and ventricles were increased. Sympathectomy also enhanced CGRP and SP mRNA and peptide content in DRG. Administration of CGRP and SP receptor antagonists increased the BP in sympathectomized rats but not in the controls. Thus sympathectomy enhances sensory neuron CGRP and SP expression that contributes to the BP reduction.
Sympathectomized rats displayed reductions in blood pressure (BP) and atria norepinephrine levels, whereas NGF levels in the DRG, spleen, and ventricles were increased. Sympathectomy also enhanced CGRP and SP mRNA and peptide content in DRG. Administration of CGRP and SP receptor antagonists increased the BP in sympathectomized rats but not in the controls. Thus sympathectomy enhances sensory neuron CGRP and SP expression that contributes to the BP reduction.
Neurogenic and non-neurogenic inflammation in the rat paw following chemical sympathectomy
http://www.ncbi.nlm.nih.gov/pubmed/1723182?dopt=Abstract
Neuroscience. 1991;45(3):761-5.
Neonatal guanethidine sympathectomy caused an 86% depletion of noradrenaline in the paw skin and neurogenic plasma protein extravasation upon antidromic nerve stimulation was impaired. Sensory neuropeptides were unchanged in the skin after neonatal guanethidine and only calcitonin gene-related peptide content was increased in the spinal cord and sciatic nerves. The other observations (i.e. the sensitivity towards heat stimuli, the neurogenic mustard oil inflammation and the non-neurogenic carrageenan oedema) were similar to those observed after neonatal 6-hydroxydopamine treatment.
Neuroscience. 1991;45(3):761-5.
Neonatal guanethidine sympathectomy caused an 86% depletion of noradrenaline in the paw skin and neurogenic plasma protein extravasation upon antidromic nerve stimulation was impaired. Sensory neuropeptides were unchanged in the skin after neonatal guanethidine and only calcitonin gene-related peptide content was increased in the spinal cord and sciatic nerves. The other observations (i.e. the sensitivity towards heat stimuli, the neurogenic mustard oil inflammation and the non-neurogenic carrageenan oedema) were similar to those observed after neonatal 6-hydroxydopamine treatment.
Sympathectomy exaggerates antihypertensive effect of vasopressin withdrawal
The results are consistent with the hypothesis that withdrawal of sympathetic activity is a contributing factor or a prerequisite condition for development of a WAP.(withdrawal-induced antihypertensive phenomenon)
AJP - Heart and Circulatory Physiology, Vol 268, Issue 1 1-H6, Copyright © 1995 by American Physiological Society
AJP - Heart and Circulatory Physiology, Vol 268, Issue 1 1-H6, Copyright © 1995 by American Physiological Society
plasma levels of natriuretic peptides in response to sympathectomy
The occurrence of receptor binding sites for natriuretic peptides was examined by in vitro receptor autoradiography. In contrast to the marked occurrence of natriuretic peptide receptor binding sites seen in the ventricular endocardium of control rats, the sympathectomized rats exhibited a decreased number of binding sites for natriuretic peptides in the endocardium of both the right and left chambers. Interestingly, this was found in parallel with a significant decrease of systolic and diastolic blood pressure and increased plasma levels of pro-atrial natriuretic peptide in the treated group of rats. These findings, together with those in previous studies, give support to an idea that one part of the blood pressure-decreasing effects, seen in patients treated with β-adrenergic blockade, might be through a reduction of the natriuretic clearance receptor C, then giving rise to increased levels of atrial natriuretic peptide.
http://cat.inist.fr/?aModele=afficheN&cpsidt=17030448
http://cat.inist.fr/?aModele=afficheN&cpsidt=17030448
Abolition of sympathetic skin responses following endoscopic thoracic sympathectomy
The recording of sympathetic skin responses (SSRs) is a simple, electrophysiological method to assess sympathetic nerve function. Within the last 10 years, SSRs have mainly been applied to delineate peripheral and central nervous system diseases, although the sympathetic nature of these responses was not fully documented, e.g., by a study of sympathectomy. We therefore recorded SSRs before and after 30 cases of endoscopic thoracic sympathectomy. The main indication was palmar hyperhidrosis, in which we found two types of SSR abnormalities. Most patients exhibited normal SSR waveforms but with increased amplitudes. The other patients exhibited abnormal SSRs which did not occur as single responses but as several consecutive waves.
Muscle & Nerve
Volume 19 Issue 5, Pages 581 - 586
Published Online: 7 Dec 1998
cervical sympathectomy resulted in a rapid degeneration in some of the cells in the sinuatrial and atrioventricular nodes
This study describes the ultrastructural changes in the sinuatrial and atrioventricular nodes of the heart of the monkey (Macaca fascicularis) after right cervical sympathectomy. Obvious changes in the nodal cells were seen one day after operation. Numerous glycogen particles grouped together to form electron-dense patches containing vacuoles in the cytoplasm. At three days after operation, intracellular organelles exhibited fragmentation and dissolution. By five and seven days after operation, the affected cells were vacuolated and some were swollen and appeared to have degenerated. Simultaneously, there was massive infiltration of macrophages were present nodal tissues. Axon profiles and terminals showing various degrees of degeneration were present in the vicinity of the nodal cells throughout the period of study.
Electrophysiology - effect on the heart
Chemical sympathectomy was obtained following intravenous injection of 50 mg·kg–1 of 6-hydroxydopamine. Sympathectomised dogs presented significant increases in: basic sinus period, sino-atrial conduction time (SACT), AH and HV intervals of the His bundle electrogram, atrial functional (AFRP) and effective (AERP) refractory periods, atrio-ventricular node functional (AVNFRP) and effective (AVNERP) refractory periods, ventricular functional (VFRP) and effective (EVRP) refractory periods and atrial (AMAP) and ventricular (VMAP) monophasic action potential durations. Corrected sinus recovery time (CSRT) was not affected by chemical sympathectomy. Neither was the atrial ERP/MAP duration ratio. This new form of sympathectomy affects all the levels of the cardiac conduction system. Such results are in accordance with those obtained with surgical sympathectomy or the use of beta-blocking agents.
Cardiovascular Research 1982 16(9):524-529; doi:10.1093/cvr/16.9.524
Cardiovascular Research 1982 16(9):524-529; doi:10.1093/cvr/16.9.524
Infra-stellate upper thoracic sympathectomy results in a relative bradycardia during exercise, irrespective of the operated side
Patients should be informed of the exercise bradycardia resulting from ISS.
Eur J Cardiothorac Surg 2001;20:1095-1100
Eur J Cardiothorac Surg 2001;20:1095-1100
Sympathectomy induces adrenergic excitability of cutaneous C-fiber nociceptors
Journal of Neurophysiology, Vol 75, Issue 1 514-517, Copyright © 1996 by APS
The induction of adrenergic excitability in CPMs by sympathectomy is suggested to be a counterpart to postsympathectomy neuralgia in human beings and a possible part of the mechanism leading to sympathetically related pain states.
The induction of adrenergic excitability in CPMs by sympathectomy is suggested to be a counterpart to postsympathectomy neuralgia in human beings and a possible part of the mechanism leading to sympathetically related pain states.
The results provide new evidence about the change in atrial natriuretic peptide levels that occurs when sympathetic innervation is altered.
Neuroma following nerve injury/surgery
When a nerve is cut, the piece of nerve that is beyond the cut point eventually dies, however, its Schwann cells, the cells that encircle the nerve fibers remain for a much longer time. These Schwann cells secrete a chemical messenger known as nerve growth factor that tells the cut end of nerve where to grow back. So the cut end of nerve will send out multiple sprouts in the direction of the nerve growth factor, however, these sprouts do not go out in an orderly manner, instead they grow out in all directions and eventually cluster and form a knot of nerve fibers. This eventually leads to the formation of a TRUE neuroma or a END BULB or STUMP neuroma.
www.tarsaltunnelcenter.com/assets/recurrent.shtml
www.tarsaltunnelcenter.com/
Risks during Thoracic Sympathectomy - Surgery not as safe as reported
Even epidural blockade limited only to the thoracic dermatomes is liable to cause complete sympathectomy, including cardiac sympathetic denervation. The ensuing vasodilation and bradycardia lead to hypotension, poor tolerance of mechanical interference with the heart, and inability to respond to acute changes in intravascular volume or body position. This symptom complex is especially troublesome to manage during intrathoracic operations when avoidance of hypervolemia is emphasized.
Thoracic sympathectomy has two other potenital consequences: effect on bronchomotor tone and effect on oxygenation.
During intrathoracic procedures using one-lung ventilation, a right-to-left intrapulmonary shunt is intentionally created (in the form of the nonventilated lung). The ensuing arterial oxygen tension (PaO2) is determined by a complex interaction involving cardiac output, mixed venous oxygen tension, the status of the ventilated lung, size of the shunt, and most significantly, hypoxic pulmonary vasoconstriction (HPV).
HPV diverts pulmonary blood flow away from the shunt by vavsoconstriction in the nonventilated lung, and is the principal adaptive defense mechanism against arterial hypoxemia during one-lung ventilation. The cellular mechanism and regulation of HPV, and the possible role of the autonomic nervous system are not completely understood.
The effect of thoracic sympathectomy of HPV is even less well understood. Since potent vasodilators such as nitroprusside antagonize HPV-induced vasoconstriction and lower the arterial oxygen tension, it is reasonable to assume that HPVwill become less effective with thoracic sympathectomy.
Clinical studies have produced conflicting conclusions, most probably because direct measurement of HPV is not possible in human studies, and the surrogate endpoing examined PaO2 is determined not only by HPV, but also by a host of interacting factors, some of which may be affected by the sympathectomy and can not be held constant.
Risk Factor for Neuraxial Anesthesia-Associated Bradycardia:
Block height higher than T5
Younger age
Thoracic sympathectomy has two other potenital consequences: effect on bronchomotor tone and effect on oxygenation.
During intrathoracic procedures using one-lung ventilation, a right-to-left intrapulmonary shunt is intentionally created (in the form of the nonventilated lung). The ensuing arterial oxygen tension (PaO2) is determined by a complex interaction involving cardiac output, mixed venous oxygen tension, the status of the ventilated lung, size of the shunt, and most significantly, hypoxic pulmonary vasoconstriction (HPV).
HPV diverts pulmonary blood flow away from the shunt by vavsoconstriction in the nonventilated lung, and is the principal adaptive defense mechanism against arterial hypoxemia during one-lung ventilation. The cellular mechanism and regulation of HPV, and the possible role of the autonomic nervous system are not completely understood.
The effect of thoracic sympathectomy of HPV is even less well understood. Since potent vasodilators such as nitroprusside antagonize HPV-induced vasoconstriction and lower the arterial oxygen tension, it is reasonable to assume that HPVwill become less effective with thoracic sympathectomy.
Clinical studies have produced conflicting conclusions, most probably because direct measurement of HPV is not possible in human studies, and the surrogate endpoing examined PaO2 is determined not only by HPV, but also by a host of interacting factors, some of which may be affected by the sympathectomy and can not be held constant.
Risk Factor for Neuraxial Anesthesia-Associated Bradycardia:
Block height higher than T5
Younger age
Spinal and Epidural AnesthesiaBy Cynthia Wong |
Publication Date: 2007-01-01 Publisher: MCGRAW-HILL EDUCATION - EUROPE Country of origin: UNITED STATES
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