Cardiovascular collapse developing during thoracoscopic thoracic sympathectomy

Cardiovascular collapse developing during thoracoscopic thoracic sympathectomy in a patient with essential palmar hyperhidrosis: A case report.  
Park SJ, Jee DL.

Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Korea. djee@medical.yeungnam.ac.kr

Thoracoscopic thoracic sympathectomy (TTS) is usually a safe and uncomplicated procedure for treating essential palmar hyperhidrosis. However, we report a case of cardiovascular collapse that developed in a healthy patient undergoing TTS. The surgeon performed the left sympathectomy without incident. However, scarcely had an incision been made in the skin of the right chest when the patient developed sinus bradycardia and sudden, severe hypotension. Pulseless ventricular tachycardia occurred immediately thereafter, which rapidly progressed to ventricular fibrillation and cardiovascular collapse. The patient required resuscitation with 200 J of direct current shock defibrillation along with an intravenous injection of epinephrine 1 mg. She recovered without sequelae. We believe the Bezold-Jarisch reflex was triggered by pooling of venous blood and surgical stimuli, and the patient developed cardiovascular collapse as a result.

cervical sympathectomy for sexual dysfunction?

Use of stellate ganglion block for the treatment of sexual dysfunction

If the claims of the hundreds of ETS/ESB surgeons is true, than cervical or thoracic sympathectomy affects a well controlled, and limited area of the upper extremity (the hands only) to 'eliminate the overactive nerves that supply the sweat glands', - then this 'invention' registered by Lipov should be dismissed. 


Lipov here claims to prove systemic effect of the cervical procedure that will influence sexual function. Is he finally asserting what so many patients are saying and so many surgeons keep denying, that:
a: interference with the upper sympathetic chain elicited systemic changes of the nervous system
b: interference with the upper thoracic chain affected (also) sexual function - which was not beneficial to the patient. Indeed, retrograde ejaculation can be found in studies describing adverse effects of sympathectomy.
http://www.freepatentsonline.com/y2006/0286132.html

'Sweating surgery' controversy

There is tremendous controversy surrounding ETS. While prestigious medical boards such as the Society of Thoracic Surgeons fully support it, the National Institutes of Health considers ETS to be a "nerurocardiologic disorder", and NIH studies ETS patients as part of their protocol for autonomic failure. There is much disagreement among ETS surgeons about the best surgical method, opitimal location for nerve destruction, and as to the nature and extent of the consequent side effects. The internet now features many websites run by surgeons extolling the benefits of ETS backed by happy patient testimonials. However, there are also many websites run by disabled ETS victims who complain of severe complications and lack of adequate informed consent. Several online discussion forums are dedicated to the subject of ETS surgery, where both positive and negative patient testimonials abound.
http://www.wordiq.com/definition/Sympathectomy

FACTORS CONTRIBUTING TO SYMPATHECTOMY FAILURE

1. Sympathectomy is analogous to the act of killing the messenger. The sympathetic nervous system has the critical job of properly controlling and preserving the circulation in different parts of the body, especially in the extremities. By paralyzing the system, the extremity will be more apt to have disturbance of circulation and is left unprotected from fluctuation in circulation.

Sympathectomy is similar to permanently removing the central heat and air-conditioning system and never replacing it because of malfunction.

Sympathectomy permanently damages the temperature regulatory system. The reason sympathectomy does not cause side effects other than ineffective control of pain as well as impotence and orthostatic hypotension is because it is invariably partial and incomplete.

2. Even after "complete" removal of the sympathetic plexus for the upper or lower extremities, the sympathetic nerves in the wall of the blood vessels are left intact.

3. As shown in Table 6, the most common form (over 80%) of RSD is disuse RSD. In this situation, the sympathetic system is temporarily hyperactive. Proper conservative treatment would prevent any unnecessary invasive surgery (such as sympathectomy) in such patients.

4. Usually the patients that end up needing sympathectomy are the ones who suffer from ephaptic dystrophy. Sympathectomy in such cases cause a classic Cannon phenomenon. This physiological phenomenon refers to the fact that the end organ that is controlled by sympathetic nerve fibers  will become uninhibited in its chemical dysfunction. As a result, even though the sympathetic fibers are not contributing to acetylcholine or become uninhibited with resultant increase of pain input.

In diabetic neuropathy RSD, sympathectomy dramatically relieves the pain for the first 1 to 3 years. Then deafferentation can Cannon phenomenon set in. As a result, invariably by the second to fifth year the patient ends up with a lot more pain. Sympathetic blocks repeated every 6 to 12 months yield similar results.

In patients who have had sympathectomy, thermography shows an increase of temperature  in the focus of ephaptic nerve damage (Cannon phenomenon) with secondary increase of pain and discomfort.

H. Hooshmand, M.D., Neurological Associates