ETS for palmar HH results in systemic (non-localized) changes of the ANS function

ETS for palmar HH results in systemic (non-localized) changes of the ANS function

In contrast to compensatory sweating in other parts of the body after T2-3 sympathetomy, improvement in plantar sweating was shown in 72% and worsened symptoms in 6% of patients. The intraoperative plantar skin temperature change and perioperative SSR demonstrated a correlation between these changes.
Associated change in plantar temperature and sweating after transthoracic endoscopic T2-3 sympathectomy for palmar hyperhidrosis.

Chen HJ, Liang CL, Lu K.

Department of Neurosurgery, Chang Gung University and Medical Center at

Kaohsiung, Taiwan. chenmd@ms8.hinet.net
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

Thoracoscopic sympathectomy for palmar hyperhidrosis: effects on pulmonary function.

Tseng MY, Tseng JH.

tmy59100@ms4.hinet.net

Palmar hyperhidrosis, probably caused by an over-reactivity of sympathetic nerves passing through the second and the third thoracic sympathetic ganglia (T2 & T3 ganglia), can only be cured by sympathectomy. Such sympathetic denervation may also alter pulmonary function. In order to investigate the effect of sympathectomy, pulmonary function was compared before and four weeks after operation in 20 patients. Forced vital capacity (FVC) (-2.3%), forced expiratory volume in one second (FEV1) (-6.1%), and FEV1/FVC (-4.6%) were all slightly but significantly decreased four weeks after thoracoscopic sympathectomy. Also the instantaneous forced expiratory flow at 75%, 50% and 25% of the FVC (Vmax25, Vmax50, Vmax75) in flow-volume curves were decreased (-1.6%, -8.4%, and -20% respectively).

PMID: 11787462 [PubMed - indexed for MEDLINE]

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

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

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}

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

Lexin Wang, MD PhD

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

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.

	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

Stefan Duschek and Rainer Schandry
Stefan 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

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

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

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

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

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.

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

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

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

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

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

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

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

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

sympathectomy might suppress immune functions

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

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

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

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

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

Circulation Research. 1996;79:317-323

sympathectomy results in an increased collagen content in the vascular wall

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

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

adverse effects and complications are not systematically reported

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

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

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

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

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

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

A Systematic Literature Review of Late Complications

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

(PhysMed) and Marios Papagapioua Msc

unable to establish the etiology of redistribution

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

migration of adventitial fibroblasts and loss of medial smooth muscle cells

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

elevated susceptibility to ventricular fibrillation after sympathectomy

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

Side effect of elective surgery - disastrous proportions

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

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

High incidence of nausea and vomiting after sympathectomy

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

European Journal of Anaesthesiology 2009, Vol 26 No 4

SNS regulates cerebral blood flow

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

sympathetic denervation-hypersensitivity and migraine

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

Headache: The Journal of Head and Face Pain

Volume 20 Issue 6, Pages 321 - 335

Published Online: 22 Jun 2005

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

Complications of endoscopic sympathectomy

Alan E. P. Cameron

Abstract

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

European Journal of Surgery

See Also:

• British Journal of Surgery

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.