Cervical sympathectomy causes alveolar bone loss
Both superior cervical ganglionectomy and oral challenge with P. gingivalis resulted in accelerated alveolar bone loss. Gingival tissues in the superior cervical ganglionectomy group showed increased expression of the cytokines interleukin-1alfa, tumor necrosis factor-alfa and interleukin-6. The density of neuropeptide Y-immunoreactive fibers was decreased following superior cervical ganglionectomy. Osteoclasts were observed in the superior cervical ganglionectomy and P. gingivalis-challenged groups. Conclusion: Both superior cervical ganglionectomy and oral challenge with P. gingivalis induced alveolar bone loss.
http://www.ingentaconnect.com/content/mksg/per/2009/00000044/00000006/art00002
http://www.ingentaconnect.com/content/mksg/per/2009/00000044/00000006/art00002
73% of patients suffered form 'gustatory sweating' and variety of phenomena
In a series of 100 bilateral upper dorsal sympathectomies performed for palmar hyperhidrosis,
gustatory sweating and other gustatory phenomena were reported by 68 of 93 patients (73%),
followed up for an average of 11/2 years. These gustatory phenomena were quite different from
physiologic gustatory sweating: a wide range of gustatory stimuli caused a variety of phenomena in
varied locations. There was a negative correlation between the incidence of these phenomena and the
occurrence of Horner's syndrome after sympathectomy. Analysis of our observations, and of clinical
and experimental work of others, leads to the conclusion that gustatory phenomena after upper
dorsal sympathectomy are the result of preganglionic sympathetic regeneration or collateral sprouting
with aberrant synapses in the superior cervical ganglion.
•
Arch Neurol. 1977;34(10):619-623.
gustatory sweating and other gustatory phenomena were reported by 68 of 93 patients (73%),
followed up for an average of 11/2 years. These gustatory phenomena were quite different from
physiologic gustatory sweating: a wide range of gustatory stimuli caused a variety of phenomena in
varied locations. There was a negative correlation between the incidence of these phenomena and the
occurrence of Horner's syndrome after sympathectomy. Analysis of our observations, and of clinical
and experimental work of others, leads to the conclusion that gustatory phenomena after upper
dorsal sympathectomy are the result of preganglionic sympathetic regeneration or collateral sprouting
with aberrant synapses in the superior cervical ganglion.
•
Arch Neurol. 1977;34(10):619-623.
36% intense 'compensatory sweating'
The results and complication rates have not necessarily been similar in reports worldwide. This can be explained in part due to the lack of clear-cut definitions for the indications, success, complications, side effects, and short- and long-term follow-up data of the procedures. It is well known that sympathectomy is often complicated by CH; the reported incidence rates vary greatly from 30% to 84% [15]. In our series it has been noted in 62.5% of the patients (26.5% moderate and 36% intense).
Although VATS sympathectomy is a simple and quick procedure, unusual complications such as chylothorax may occur [16]. However, lethal or potentially serious complications have also been reported [8, 17, 18], such as subclavian artery injury, damage to brachial plexus, large hemothorax, cerebral edema, neurologic sequelae, sinus bradycardia, and cardiac arrest.
Ann Thorac Surg 2003;76:886-891
Although VATS sympathectomy is a simple and quick procedure, unusual complications such as chylothorax may occur [16]. However, lethal or potentially serious complications have also been reported [8, 17, 18], such as subclavian artery injury, damage to brachial plexus, large hemothorax, cerebral edema, neurologic sequelae, sinus bradycardia, and cardiac arrest.
Ann Thorac Surg 2003;76:886-891
significant decrease of MAP, cardiac arrythmia, cardiac arrest and hypoxemia - complications of ETS surgery
Both MAP 1 and MAP2were reduced after sympahtectomy (P < 0.05). Heart rate was reduced transiently after the sympahtectomy and returned to the baseline value. PaO2 was reduced in 10 min after each right lung ventilation (P < 0.05) and left lung ventilation (P < 0.05).
Since thoracoscopic sympathectomy can rarely cause a significant decrease of MAP, cardiac arrythmia, cardiac arrest and hypoxemia, we concluded that invasive BP monitoring should be used for early detection of those complications and immediate arterial sampling.
Department of Anesthesiology and Pain Medicine, College of medicine, Kyung Hee University, Seoul, Korea
2004; 8: 147-153
Since thoracoscopic sympathectomy can rarely cause a significant decrease of MAP, cardiac arrythmia, cardiac arrest and hypoxemia, we concluded that invasive BP monitoring should be used for early detection of those complications and immediate arterial sampling.
Department of Anesthesiology and Pain Medicine, College of medicine, Kyung Hee University, Seoul, Korea
2004; 8: 147-153
perioperative alterations in hemodynamic changes
Our purpose was to examine perioperative alterations in hemodynamic changes with head-up tilt (HUT) in patients undergoing endoscopic thoracic sympathectomy (ETS).
Methods. The subjects were 11 patients with essential hyperhidrosis scheduled to undergo ETS (ETS group) and 9 age-matched volunteers undergoing minor surgery (control group). HUT was performed (40°; 5 min) before and after the surgery, under nitrous oxide anesthesia. Orthostatic hypertension and hypotension in response to HUT were defined as changes of 10% or greater in systolic blood pressure.
Results. The increase in heart rate in response to HUT was significantly reduced after surgery in the ETS group (from 34 ± 18 to 14 ± 11 beats·min−1; P < 0.001), but not in the control group (from 23 ± 18 to 22 ± 12 beats·min−1; P = 0.911). Orthostatic hypertension disappeared completely after ETS (from 5 of 11 to none of 11 patients; P = 0.035), whereas the prevalence of orthostatic hypotension increased significantly after ETS (from 3 of 11 to 9 of 11 patients; P = 0.030). In the control group, the prevalence of neither orthostatic hypertension nor orthostatic hypotension changed after surgery.
Methods. The subjects were 11 patients with essential hyperhidrosis scheduled to undergo ETS (ETS group) and 9 age-matched volunteers undergoing minor surgery (control group). HUT was performed (40°; 5 min) before and after the surgery, under nitrous oxide anesthesia. Orthostatic hypertension and hypotension in response to HUT were defined as changes of 10% or greater in systolic blood pressure.
Results. The increase in heart rate in response to HUT was significantly reduced after surgery in the ETS group (from 34 ± 18 to 14 ± 11 beats·min−1; P < 0.001), but not in the control group (from 23 ± 18 to 22 ± 12 beats·min−1; P = 0.911). Orthostatic hypertension disappeared completely after ETS (from 5 of 11 to none of 11 patients; P = 0.035), whereas the prevalence of orthostatic hypotension increased significantly after ETS (from 3 of 11 to 9 of 11 patients; P = 0.030). In the control group, the prevalence of neither orthostatic hypertension nor orthostatic hypotension changed after surgery.
| Journal of Anesthesia | |
| ISSN | 0913-8668 (Print) 1438-8359 (Online) |
| Issue | Volume 16, Number 1 / February, 2002 |
controversial subject
The treatment of facial blushing and or facial sweating is a controversial subject. The uncontrolled and embarrassing situation of facial sweating and blushing was thought to be easily treated with ETS. This came about when ETS was done for patients with sweaty hands. Among those patients who also suffered from facial blushing and/or facial sweating the results were also successful at reducing facial blushing and/or sweating. However over the years two observations were made when this operation was applied only for patients with facial blushing and or facial sweating. Percentage wise these patients developed a higher rate of severe compensatory sweating. Also these patients experienced a higher degree of dissatisfaction due to the side effects. Side effects such as facial flushed feelings, loss of stamina, facial skin sensitivity, increased amount of fatigue and others led Dr. Reisfeld to the decision not to perform ETS when only facial blushing or facial sweating were involved. The clinical experience that was accumulated over the last several years is what has allowed Dr. Reisfeld to reach this assessment. More time is needed to reach a definite conclusion with regard to the most appropriate procedure for patients who suffer from only facial blushing and/or facial sweating.
http://www.sweaty-palms.com/blushing.html
http://www.sweaty-palms.com/blushing.html
haemodynamic instability during surgery
Rapid and excessive carbon dioxide insufflation into the closed chest cavity may create a tension pneumopthorax, 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 common with other surgical procedures, routine monitoring during thorascopic sympathectomy should include ECG, pulse oximetry and capnography. However, during thorascopic surgery, SpO2 and end-tidal carbon dioxide have the additional function of monitoring the surgical technique.
BJA 1997;79: 113-119
