Introduction Essential hyperhidrosis (EH) is often considered to be related to an increased activity of sympathetic nervous system (SNS). However, there is a lack of studies comparing autonomic nervous system (ANS) activity in controls and in EH patients. The aim of the present study was to simultaneously investigate in patients with severe EH, blood pressure, heart rate variability and plasma catecholamine levels in comparison with controls.
Methods 19 EH patients and 20 controls with normal ANS function assessed by clinical testing were included. Blood pressure (BP) and heart rate (HR) were measured using a Finapres beat-to-beat monitor. BP and HR variabilities (Fast Fourier transformation) and plasma catecholamine levels (HPLC) were obtained at rest and during a 15 min 70° head-up tilt test.
Results At rest, a significantly higher relative energy of low frequency band (LF) of systolic BP was observed in EH in comparison with controls contrasting with the lack of difference in BP, HR, plasma catecholamine levels and in other spectral parameters. During tilt, all changes were comparable in EH and in control subjects excepting relative energy of LF of SBP which remained unchanged when compared to the resting condition in EH group.
Conclusions In EH, SNS is not overreactive even if resting overactivity cannot be excluded.
http://www.springerlink.com/content/xe7g2w72617phl0e/
Volume 13, Number 4 / August, 2003
http://www.springerlink.com/content/xe7g2w72617phl0e/
Volume 13, Number 4 / August, 2003
Clinical conditions that cervico-thoracic sympathetic blockade may benefit
...Miscellaneous conditions in head region: stroke, Meniere disease, tinnitus
Amblyopia due to quinine poisining (also causes retinal artery spasm and thrombosis)
Wolters Kluwer Health
Edition: 4 - 2008
Amblyopia due to quinine poisining (also causes retinal artery spasm and thrombosis)
Cousins and Bridenbaugh's Neural Blockade in Clinical Anesthesia and Pain Medicine by Michael J Cousins, Phillip O Bridenbaugh, Daniel B Carr, and Terese T Horlocker
Edition: 4 - 2008
Acquired cardiovascular disease following Sympathectomy
Effects of endoscopic thoracic sympathectomy for primary hyperhidrosis on cardiac autonomic nervous activity
We found statistically significant differences (P < .05) in both time and frequency domains. Parameters that evaluate global cardiac autonomic activity (total power, SD of normal R-R intervals, SD of average normal R-R intervals) and vagal activity (rhythm corresponding to percentage of normal R-R intervals with cycle greater than 50 ms relative to previous interval, square root of mean squared differences of successive normal R-R intervals, high-frequency power, high-frequency power in normalized units) were statistically significantly increased after sympathectomy. Low-frequency power in normalized units, reflecting sympathetic activity, was statistically significantly decreased after sympathectomy. Low-/high-frequency power ratio also showed a significant decrease, indicating relative decrease in sympathetic activity and increase in vagal activity.
The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 3, March 2009, Pages 664-669
We found statistically significant differences (P < .05) in both time and frequency domains. Parameters that evaluate global cardiac autonomic activity (total power, SD of normal R-R intervals, SD of average normal R-R intervals) and vagal activity (rhythm corresponding to percentage of normal R-R intervals with cycle greater than 50 ms relative to previous interval, square root of mean squared differences of successive normal R-R intervals, high-frequency power, high-frequency power in normalized units) were statistically significantly increased after sympathectomy. Low-frequency power in normalized units, reflecting sympathetic activity, was statistically significantly decreased after sympathectomy. Low-/high-frequency power ratio also showed a significant decrease, indicating relative decrease in sympathetic activity and increase in vagal activity.
The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 3, March 2009, Pages 664-669
sympathectomy leads to peripheral vasodilation, reduced preload, and subsequently decreased cardiac output
Despite a duration of only 2 week, repeated IVRS (intravenous regional sympathetic block) efferent blocks are an attractive alternative to the higher-risk techniques of thoracic sympathetic block and thoracic surgical or thoracoscopic sympathectomy. (p. 848)
Table 42-1
Classification of percutaneous neural destructive procedures:
Anatomy
1. Peripheral neurotomy (such as destruction of intercostal, ilioinguinal nerves)
2. Rhizotomy (spinal dorsal root rhizotomy, trigeminal rhizotomy)
3. Destruction of sensory pathways in the spinal cord (midline punctuate myelotomy, cordotomy)
4. destruction of brain sensory centers (hypophysectomy)
5. Sympathectomy
(p.992)
The authors found that the incidence of hypotension was a function of the level of sympathetic denervation, occurring in 60% of patients with a T7 sympathectomy, and in 100% of patient with a T4 or higher level of sympathectomy.
(p 226)
After thoracoscopic sympathectomy for hyperhidrosis, very severe discomfort and hyperhidrosis in the neighboring non-sympathectomized regions occurred with alarming frequency and intensity.
(p.879)
Cardiovascular effects of epidural blockade
"Central" Sympathetic block (T1-T4) - Blockade of
Cardiac sympathetic outflow from vasomotor center
Cardiac sympathetic reflexes at segmental level
Vasoconstrictor fibers to head, neck, and arms
Effect:
HR ↓ CO ↓
Vasodilation in upper limbs
"Inappropriate bradycardia"; "sudden bradycardia"; vagal arrest (p. 247)
↓↓Venous return may result in sudden parasympathetic tone ("faint response")
↓ ↓ HR → cardiac arrest
"Inappropriate" bradycardia (i.e. "normal" HR in face of ↓MAP with sensory level T3-T4)
Peripheral vasodilation should evoke an ↑ HR. But ↓ venous return → ↑vagal tone, so HR remains at preblock rate but is "inappropriately" slow.
↓HR with visceral traction in presence of blockade to T1.
Total sympathetic block
Unopposed vagus
Changes in vagal tone → profound changes in HR; may → transient asystole (p. 248)
Thermoregulation and Shivering
Hypothermia (a decrease in core temperature) is common in patients undergoing surgery with epidural anesthesia and is thought to result from heat loss to the cold environment due to sympathectomy-induced vasodilation. The normal process by which thermoregulation usually minimizes intraoperative core temperature is prevented, since epidural anesthesia directly inhibits vasoconstriction in the analgesic dermatomes. (p.253)
Central neuraxial anesthesia-induced sympathectomy leads to peripheral vasodilation, reduced preload, and subsequently decreased cardiac output. The incidence and extent of hypotension depends on the height of the block, the patient's position, and whether appropriate measures were instituted prophylactically to minimize hypotension.
Wolters Kluwer Health
Edition: 4 - 2008
Table 42-1
Classification of percutaneous neural destructive procedures:
Anatomy
1. Peripheral neurotomy (such as destruction of intercostal, ilioinguinal nerves)
2. Rhizotomy (spinal dorsal root rhizotomy, trigeminal rhizotomy)
3. Destruction of sensory pathways in the spinal cord (midline punctuate myelotomy, cordotomy)
4. destruction of brain sensory centers (hypophysectomy)
5. Sympathectomy
(p.992)
The authors found that the incidence of hypotension was a function of the level of sympathetic denervation, occurring in 60% of patients with a T7 sympathectomy, and in 100% of patient with a T4 or higher level of sympathectomy.
(p 226)
After thoracoscopic sympathectomy for hyperhidrosis, very severe discomfort and hyperhidrosis in the neighboring non-sympathectomized regions occurred with alarming frequency and intensity.
(p.879)
Cardiovascular effects of epidural blockade
"Central" Sympathetic block (T1-T4) - Blockade of
Cardiac sympathetic outflow from vasomotor center
Cardiac sympathetic reflexes at segmental level
Vasoconstrictor fibers to head, neck, and arms
Effect:
HR ↓ CO ↓
Vasodilation in upper limbs
"Inappropriate bradycardia"; "sudden bradycardia"; vagal arrest (p. 247)
↓↓Venous return may result in sudden parasympathetic tone ("faint response")
↓ ↓ HR → cardiac arrest
"Inappropriate" bradycardia (i.e. "normal" HR in face of ↓MAP with sensory level T3-T4)
Peripheral vasodilation should evoke an ↑ HR. But ↓ venous return → ↑vagal tone, so HR remains at preblock rate but is "inappropriately" slow.
↓HR with visceral traction in presence of blockade to T1.
Total sympathetic block
Unopposed vagus
Changes in vagal tone → profound changes in HR; may → transient asystole (p. 248)
Thermoregulation and Shivering
Hypothermia (a decrease in core temperature) is common in patients undergoing surgery with epidural anesthesia and is thought to result from heat loss to the cold environment due to sympathectomy-induced vasodilation. The normal process by which thermoregulation usually minimizes intraoperative core temperature is prevented, since epidural anesthesia directly inhibits vasoconstriction in the analgesic dermatomes. (p.253)
Central neuraxial anesthesia-induced sympathectomy leads to peripheral vasodilation, reduced preload, and subsequently decreased cardiac output. The incidence and extent of hypotension depends on the height of the block, the patient's position, and whether appropriate measures were instituted prophylactically to minimize hypotension.
Cousins and Bridenbaugh's Neural Blockade in Clinical Anesthesia and Pain Medicine by Michael J Cousins, Phillip O Bridenbaugh, Daniel B Carr, and Terese T Horlocker
Edition: 4 - 2008
Perioperative risks are low, but complications can be devastating
- Endoscopic thoracic sympathectomy (ETS) involves division of the thoracic sympathetic chain between T2 and T4.
- The main indication for ETS is the treatment of palmar hyperhidrosis.
- The most common method of anaesthesia for ETS uses intermittent positive pressure ventilation via a standard tracheal tube.
- Perioperative risks are low, but complications can be devastating.
- Postoperative compensatory sweating occurs in almost 50% of patients.
hypoxic pulmonary vasoconstriction may be impaired after Sympathectomy
It is well known that hypoxic pulmonary vasoconstriction(HPV) plays an important role to protect hypoxemia during the atelectasis induced by one-lung ventilation. Thoracic sympathectomy may have effects on pulmonary vasculature(HPV) and hemodynamics during one-lung anesthesia.
Mean arterial blood pressure was decreased from 81.9+/-2.89 to 73.2+/-2.49 mmHg after thoracic sympathectomy and heart rate was decreased from 104.4+/-3.12 to 88.2+/-2.31beats/min. Arterial oxygen tension was decressed from 570.5+/-17.9 to 521.4+/-23.2mmHg after position change, and decreased to 271.1+/-28.1 mmHg under one-lung ventilation, and finally decreased to 217.0+/-18.3 mmHg after thoracic sympathectomy. With the above results, we can conclude that patients for TES should be carefully observed during and after the procedure, and hypoxic pulmonary vasoconstriction may be impaired after TES.
Korean J Anesthesiol. 1993 Aug;26(4):695-699.
Mean arterial blood pressure was decreased from 81.9+/-2.89 to 73.2+/-2.49 mmHg after thoracic sympathectomy and heart rate was decreased from 104.4+/-3.12 to 88.2+/-2.31beats/min. Arterial oxygen tension was decressed from 570.5+/-17.9 to 521.4+/-23.2mmHg after position change, and decreased to 271.1+/-28.1 mmHg under one-lung ventilation, and finally decreased to 217.0+/-18.3 mmHg after thoracic sympathectomy. With the above results, we can conclude that patients for TES should be carefully observed during and after the procedure, and hypoxic pulmonary vasoconstriction may be impaired after TES.
Korean J Anesthesiol. 1993 Aug;26(4):695-699.
profound decrease of arterial oxygen partial pressure during sympathectomy
Left-lung ventilation and right-chest operation caused profound decrease of arterial oxygen partial pressure (PaO2), compared with two-lung ventilation before surgery (70.7%, P > 0.0003) and compared with PaO2 at two-lung ventilation during and after surgery (decrease of 80.1% and 75.3%, respectively; P > 0.001 and < 0.005, respectively). Right-lung ventilation and left-chest operation did not cause hypoxemia.
Pulse oximetry and repeated blood gas measurements are needed during endoscopic transthoracic sympathectomy in order to detect and treat hypoxemic events, which may jeopardize the patient's life.
Journal of Cardiothoracic and Vascular Anesthesia
Volume 10, Issue 2, February 1996, Pages 207-209
Pulse oximetry and repeated blood gas measurements are needed during endoscopic transthoracic sympathectomy in order to detect and treat hypoxemic events, which may jeopardize the patient's life.
Journal of Cardiothoracic and Vascular Anesthesia
Volume 10, Issue 2, February 1996, Pages 207-209
Spinal cord infarction occurring during thoraco-lumbar sympathectomy
Spinal cord infarction, because of interference with an important radicular tributary, is a rare complication of thoraco-lumbar sympathectomy.
In a brief survey of the literature we found only 12 previously recorded cases in which this complication
was presumed to have occurred.
J. Neurol. Neurosurg. Psychiat., 1963, 26, 418
In a brief survey of the literature we found only 12 previously recorded cases in which this complication
was presumed to have occurred.
J. Neurol. Neurosurg. Psychiat., 1963, 26, 418
Acute Postoperative Shingles After Thoracic Sympathectomy for Hyperhidrosis
Shingles secondary to reactivation of a previous varicella-zoster virus infection has been reported to develop within surgical wounds and after trauma. We report the case of a 17-year-old girl with history of chicken pox in childhood who had acute postoperative shingles develop along the T3-T4 dermatomes after thoracic sympathectomy for hyperhidrosis.
Other possible explanations for the development of shingles in this patient include (1) the reactivation of the old varicella-zoster virus in the dorsal root ganglia by manipulation of the sympathetic chain through preoperative and postoperative ganglionic axonal connections between the denervated sympathetic ganglia and the T3 and T4 dorsal root ganglia, or (2) reactivation of the virus by direct pressure of the thoracoscopic instruments on the third and fourth intercostal nerve bundles.
http://ats.ctsnetjournals.org/cgi/content/full/78/6/2159
Other possible explanations for the development of shingles in this patient include (1) the reactivation of the old varicella-zoster virus in the dorsal root ganglia by manipulation of the sympathetic chain through preoperative and postoperative ganglionic axonal connections between the denervated sympathetic ganglia and the T3 and T4 dorsal root ganglia, or (2) reactivation of the virus by direct pressure of the thoracoscopic instruments on the third and fourth intercostal nerve bundles.
http://ats.ctsnetjournals.org/cgi/content/full/78/6/2159
Severe 'Compensatory Sweating' in 28%
Compensatory sweating is a common symptom following thoracic sympathectomy; however, the reported incidence of this complication varies greatly, and its severity has not been quantified. METHODS: In this study changes in the distribution of sweating following bilateral T2-3 thoracoscopic sympathectomy for hyperhidrosis were assessed in 42 patients. Sweat production in the palms, axillae, face, trunk and feet was assessed using a linear analogue scale. RESULTS: The operation was most successful in reducing sweat production in the palms, axillae and face (in descending order). The operation also reduced pedal sweat production in 12 of the 29 patients who suffered concomitant pedal hyperhidrosis. Compensatory truncal sweating occurred in 36 of the 42 patients; it was severe in ten, (28%) moderate in 16 and minimal in ten. CONCLUSION: Patients should be warned about compensatory sweating before thoracic sympathectomy.
http://www.ncbi.nlm.nih.gov/pubmed/9448619?dopt=Abstract
Br J Surg. 1997 Dec;84(12):1702-4.
http://www.ncbi.nlm.nih.gov/pubmed/9448619?dopt=Abstract
Br J Surg. 1997 Dec;84(12):1702-4.
Effect of adrenalectomy or sympathectomy on spinal cord blood flow
After sympathectomy, RSCBF (regional spinal cord blood flow) was unchanged during hypothermia. In the cauda equina, flow fell in all hypothermic rats. The hypothermia-associated increases in RSCBF were not related to changes in mean arterial blood pressure. We conclude that adrenalectomy near-totally ablates the hypothermia-associated increase in RSCBF measured in intact rats and that abdominal sympathectomy totally ablates it. This evidence complements morphological evidence for adrenergic innervation of the spinal cord vasculature.
Am J Physiol. 1991 Mar;260(3 Pt 2):H827-31.
Am J Physiol. 1991 Mar;260(3 Pt 2):H827-31.
burning causes nerve scaring, which may behave like epilepsy
ETS is a very effective way to treat hyperhidrosis and FB in the vast majority of the cases, but a small group of patients have devastating effects. Unfortunately, we do not know who these patients are before we operate.
Extensive surgery or burning causes nerve scaring, which may behave like epilepsy of the autonomous nervous system and cause the well known devastating side effects.
http://www.sympathectomy.info/
Extensive surgery or burning causes nerve scaring, which may behave like epilepsy of the autonomous nervous system and cause the well known devastating side effects.
http://www.sympathectomy.info/
sympathectomy may retard aversive conditioning
"Researchers have examined the role of autonomic feedback in emotional experience using the heartbeat paradigm. Katkin at al. (1982) found that some normal subjects can accurately detect their heartbeats, and it was those individuals who had a stronger emotional response to negative slides as determined by self-report (Hantas et al., 1982). Further support for the importance of autonomic feedback comes from observations. Experiments in animals demonstrate that sympathectomy may retard aversive conditioning (DiGusto and King, 1972), most likely because sympathectomy reduces fear.
In order for a feedback to occur, there must be a means for the viscera and autonomic nervous system to become activated.
Oxford University Press
In order for a feedback to occur, there must be a means for the viscera and autonomic nervous system to become activated.
Clinical neuropsychology
By Kenneth M. Heilman, Edward ValensteinOxford University Press
pain states associated with the loss of sympathetic fibres
Postsympathectomy limb pain, postsympathectomy parotid pain, and Raeder's
paratrigeminal syndrome are pain states associated with the loss of sympathetic fibres
and in particular with postganglionic sympathetic lesions. There is a characteristic interval
of about 10 days between surgical sympathectomy and onset of pain. It is proposed that
this pain in man is correlated with the delayed rise in sensory neuropeptides seen in
rodents after sympathectomy. These chemical changes probably reflect the sprouting of
sensory fibres and may result from the greater availability of nerve growth factor after
sympathectomy. The balance between the sensory and sympathetic innervations of a
peripheral organ may be determined by competition for a limited supply of nerve growth
factor.
Lancet. 1985 Nov 23;2(8465):1158-60.
paratrigeminal syndrome are pain states associated with the loss of sympathetic fibres
and in particular with postganglionic sympathetic lesions. There is a characteristic interval
of about 10 days between surgical sympathectomy and onset of pain. It is proposed that
this pain in man is correlated with the delayed rise in sensory neuropeptides seen in
rodents after sympathectomy. These chemical changes probably reflect the sprouting of
sensory fibres and may result from the greater availability of nerve growth factor after
sympathectomy. The balance between the sensory and sympathetic innervations of a
peripheral organ may be determined by competition for a limited supply of nerve growth
factor.
Lancet. 1985 Nov 23;2(8465):1158-60.
Abnormal autonomic functions, however, markedly affect the individual's ability to respond to changing conditions
Normal function of all components of the ANS is not required to maintain life, as long as
environmental conditions are a constant and optimum. Abnormal autonomic functions, however,
markedly affect the individual's ability to respond to changing conditions. This can be demonstrated
by sympathectomy, the removal of sympathetic ganglia. An animal becomes highly sensitive to heat,
cold, or other forms of stress following sympathectomy. In a hot environment the animal's ability to
lose heat by increasing blood flow to the skin and by sweating is decreased. When exposed to the
cold, the animal is less able to reduce blood flow to the skin and conserve heat. Sympathectomy also
results in low blood pressure caused by dilation of peripheral blood vessels and results in the
inability to increase blood pressure during periods of physical activity.
http://www.mhhe.com/biosci/ap/seeleyap/nervous/reading3.mhtml
environmental conditions are a constant and optimum. Abnormal autonomic functions, however,
markedly affect the individual's ability to respond to changing conditions. This can be demonstrated
by sympathectomy, the removal of sympathetic ganglia. An animal becomes highly sensitive to heat,
cold, or other forms of stress following sympathectomy. In a hot environment the animal's ability to
lose heat by increasing blood flow to the skin and by sweating is decreased. When exposed to the
cold, the animal is less able to reduce blood flow to the skin and conserve heat. Sympathectomy also
results in low blood pressure caused by dilation of peripheral blood vessels and results in the
inability to increase blood pressure during periods of physical activity.
http://www.mhhe.com/biosci/ap/seeleyap/nervous/reading3.mhtml
Degeneration patterns of postganglionic fibers following sympathectomy
In the reg signs of degeneration can already be recognized in the myelinated as well as in the unmyelinated axons 48h after sympathectomy.
In the muscle nerves the first signs of an axonal degeneration of the sympathetic fibers can be recognized 4 days after surgery. The signs of axonal degeneration are most striking about 8 days p.o. They have more or less disappeared another week later. The reactions of the Schwann cells also start on the fourth day but outlast the degenerative processes by some 8 days. Thus the degenerative and reactive processes in the reg precede those in the muscle nerves by 2 days early after surgery and by 6 days 3 weeks later. Seven weeks after surgery, fragments of folded basement lamella and Remak bundles with condensed cytoplasm and numerous flat processes are persisting signs of the degeneration.
http://www.springerlink.com/content/m21m2612n2147011/
In the muscle nerves the first signs of an axonal degeneration of the sympathetic fibers can be recognized 4 days after surgery. The signs of axonal degeneration are most striking about 8 days p.o. They have more or less disappeared another week later. The reactions of the Schwann cells also start on the fourth day but outlast the degenerative processes by some 8 days. Thus the degenerative and reactive processes in the reg precede those in the muscle nerves by 2 days early after surgery and by 6 days 3 weeks later. Seven weeks after surgery, fragments of folded basement lamella and Remak bundles with condensed cytoplasm and numerous flat processes are persisting signs of the degeneration.
http://www.springerlink.com/content/m21m2612n2147011/
Effect of sympathetic blockade on cerebral perfusion
- J Neurol. 2002 Jan;249(1):108-9.
-
Effect of sympathetic blockade on cerebral perfusion demonstrated on Tc-99m HMPAO SPECT.
- http://www.ncbi.nlm.nih.gov/pubmed/11954858
Sympathetic nerves protect against blood-brain barrier disruption
Sympathetic nerves protect against blood-brain barrier disruption in the spontaneously hypertensive rat.
http://www.ncbi.nlm.nih.gov/pubmed/7064183?holding=ukpmcUltrastructural changes in the nerves innervating the cerebral artery after sympathectomy
Iwayama T. Ultrastructural changes in the nerves innervating the cerebral artery after sympathectomy. Z Zellforsch Mikrosk Anat. 1970;109(4):465–480.
http://www.ncbi.nlm.nih.gov/pubmed/5498231?holding=ukpmc
http://www.ncbi.nlm.nih.gov/pubmed/5498231?holding=ukpmc
Alteration in 'fight-or-flight response following sympathectomy
Mental arithmetic produces a psychophysiological arousal similar to the so-called defence-alarm reaction elicited by stimulation ofthe hypothalamic defence area in experimental animals (Folkow, 1982). This reaction pattern is characterized by increased heart rate, cardiac output and blood pressure, whereas total peripheral resistance is unchanged or decreased (Brod, 1970).
The increase of platelet concentration during psychological arousal is also in accordance with what has been observed in response to other stressors, i.e. physical exercise and adrenaline infusion (Sarajas et al, 1961; Gjerloff Schmidt & Waever Rasmussen, 1984; Dawson & Ogston, 1969; Vilen et al, 1980).
The emotional leucocytosis observed in dogs has been claimed to be neurogenic in origin, since sympathectomy abolished the rise in leucocyte count (Garrey & Bryan, 193 5).
Both alpha- and beta-receptors seem to be of importance in the mobilization of lymphocytes (Gader & Cash, 1975).
British Journal of Haematology. 1989. 71, 153-1 56
The increase of platelet concentration during psychological arousal is also in accordance with what has been observed in response to other stressors, i.e. physical exercise and adrenaline infusion (Sarajas et al, 1961; Gjerloff Schmidt & Waever Rasmussen, 1984; Dawson & Ogston, 1969; Vilen et al, 1980).
The emotional leucocytosis observed in dogs has been claimed to be neurogenic in origin, since sympathectomy abolished the rise in leucocyte count (Garrey & Bryan, 193 5).
Both alpha- and beta-receptors seem to be of importance in the mobilization of lymphocytes (Gader & Cash, 1975).
British Journal of Haematology. 1989. 71, 153-1 56
normal forearm vasodilator response to mental stress was absent months or years after surgical sympathectomy
Additional indirect evidence on this topic in humans comes from a study conducted in the 1950s (3). In this study, the normal forearm vasodilator response to mental stress was absent months or years after surgical sympathectomy.
J Appl Physiol
Vol. 92, Issue 5, 2019-2025, May 2002
J Appl Physiol
Vol. 92, Issue 5, 2019-2025, May 2002
Sympathectomy as a way to achive tranquility for the patient
In every case of bilateral cervical or upper dorsal sympathectomy that I have performed the most pronounced feature is a mental change in the patient from one of worry and apprehension to that of tranquillity and a sense of well-being.
Sympathectomy in Relation to Meniere's Disease, Nerve Deafness
and Tinnitus. A Report on 110 Cases
By E. R. GARNETT PASSE, F.R.C.S., F.A.C.S.
Sympathectomy in Relation to Meniere's Disease, Nerve Deafness
and Tinnitus. A Report on 110 Cases
By E. R. GARNETT PASSE, F.R.C.S., F.A.C.S.
1952, Vol. 42, No. 1-2, Pages 133-151
Bilateral Cervical Sympathectomy for the Relief of Epilepsy
Bilateral Cervical Sympathectomy for the Relief of Epilepsy, With Report of Three Cases; Notes on the Physiologic Effects of Cutting the Sympathetic, and on the Histologic Changes Found in the Cases in Question
Spratling, William P. M.D.; Park, Roswell M.D.
The Journal of Nervous and Mental Disease:
April 1905 - Volume 32 - Issue 4 - ppg 217-232
Haematological changes during stress abolished by sympathectomy
To study haematological effects of emotional stress, blood samples were obtained from 29 healthy, normotensive, non-smoking males aged 20–34 years before, during and after 10 min of mental arithmetic. There were significant increases in pheripheral blood cell count, haemoglobin concentration, and haematocrit in response to mental stress. Parallel to these changes significant increases in heart rate, and systolic and diastolic blood pressure were observed. The relative increments of leucocyte (8%) and platelet (3·5%) count were significantly higher than the increase in haemoglobin concentration (2%). There was a significant positive correlation between the blood pressure increase and the mobilization of leucocytes, whereas the increase in erythrocyte count, haemoglobin concentration, and haematocrit showed significant positive correlations with heart rate reactivity. It is concluded that mental stress causes an increase in leucocyte and platelet count that could not solely be accounted for by the concurrent haemoconcentration.
The emotional leucocytosis observed in dogs has been claimed to be neurogenic in origin, since sympathectomy abolished the rise in leucocyte count (Garrey & Bryan, 19 3 5).http://www3.interscience.wiley.com/journal/120731423/abstract
the pineal capability of producing antigonadal substance is suppressed by cervical ganglionectomy
Pineal glands of male hamsters 8 weeks after removal of both eyes or both superior cervical ganglia and those of untreated animals were studied by electron microscopy. In the blinded hamsters the reproductive organs were remarkably involuted, whereas the pinealocytes enlarged and were characterized by a tremendous hypertrophy of the smoothsurfaced endoplasmic reticulum, in the mesh of which some dense cored vesicles were distributed. In contrast the pinealocytes of ganglionectomized hamsters atrophied and were noted by a large number of lysosomes and sparsity of the agranular reticulum, the testes being significantly larger than the controls. The findings were interpreted to be compatible with the view that the pineal capability of producing antigonadal substance is augmented by blinding and is suppressed by cervical ganglionectomy due to the impairment of normal functioning of the pineal by denervation.
Volume 158, Number 3 / May, 1975
Fine structural changes in the hamster pineal gland after blinding and superior cervical ganglionectomy
Cell and Tissue ResearchVolume 158, Number 3 / May, 1975
Cervical sympathectomy, the method to create (experimental) vasomotor rhinitis
Unilateral and bilateral experimental vasomotor rhinitis was produced in 4 dogs with cervical sympathectomy unilaterally and bilaterally. We studied this problem from several points of view in order to explain the mechanism of vasomotor rhinitis and the relationship between upper and lower respiratory tract.
1972, Vol. 73, No. 2-6, Pages 212-217
One patient with documented transection of the cord above T5 behaved like subjects after surgical sympathectomy
Increase in blood flow is generally followed by a rise in skin temperature but decrease in blood flow in response to the Gibbon-Landis procedure after sympathectomy is not necessarily accompanied by a fall in surface temperature. This poor correlation between skin temperature and blood flow confirms the previous report of Hoobler and co-workers and helps define the limits of usefulness of measurements
of skin temperature as an index of blood flow to the extremity.
The vasomotor responses to the Gibbon-Landis procedure (reflex response to warming) were studied in hemiplegic patients, subjects with "high transection" of the cord, and in sympathectomized patients.
One patient with documented transection of the cord above T5 behaved like subjects after surgical sympathectomy.
Of 11 sympathectomized limbs tested for vasodilatation in response to the Gibbon-Landis procedure, 4
showed no response, while 7 responded with decrease in blood flow (vasoconstriction).
Vasomotor Responses in the Extremities of Subjects with Various Neurologic Lesions
I. Reflex Responses to Warming
By WALTER REDISCH, M.D., FRANCISCO T. TANGCO, M.D., LOTHAR WERTHEIMER, M.D.,
ARTHUR J. LEWIS, M.D., J. MURRAY STEELE, M.D.
1957;15;518-524 Circulation
of skin temperature as an index of blood flow to the extremity.
The vasomotor responses to the Gibbon-Landis procedure (reflex response to warming) were studied in hemiplegic patients, subjects with "high transection" of the cord, and in sympathectomized patients.
One patient with documented transection of the cord above T5 behaved like subjects after surgical sympathectomy.
Of 11 sympathectomized limbs tested for vasodilatation in response to the Gibbon-Landis procedure, 4
showed no response, while 7 responded with decrease in blood flow (vasoconstriction).
Vasomotor Responses in the Extremities of Subjects with Various Neurologic Lesions
I. Reflex Responses to Warming
By WALTER REDISCH, M.D., FRANCISCO T. TANGCO, M.D., LOTHAR WERTHEIMER, M.D.,
ARTHUR J. LEWIS, M.D., J. MURRAY STEELE, M.D.
1957;15;518-524 Circulation
increased sensitivity to adrenaline is produced by sympathectomy alone
"The increased sensitivity to adrenaline is produced by sympathectomy alone. I think sensory denervation makes no difference."
Vascular Reactivity Following Sympathectomy
Chapter Author: R. T. Grant
Ciba Foundation Symposium - Peripheral Circulation in Man
Book Series: Novartis Foundation Symposia
Published Online: 27 May 2008
Editor(s): G. E. W. Wolstenholme, Jessie S. Freeman
Print ISBN: 9780470714706 Online ISBN: 9780470715185
there are no reports of phantom sweating without a prior sympathectomy
Phantom sweating - a novel autonomic paresthesia
L. L. Lair, C. Gibbons, R. Freeman
Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
Objective: To report a novel autonomic paresthesia in a patient with an idiopathic sensory and autonomic neuropathy.
Phantom sweating is the sensation of sweating in the absence of actual sweating. This symptom is reported in 40% of patients after sympathectomy. To our knowledge there are no reports of phantom sweating without a prior sympathectomy.
Quantitative sudomotor axon reflex testing revealed absent sudomotor activity in the dorsal foot with preserved activity in the distal thigh. Skin biopsy showed a loss of epidermal nerve fibers, nerve fiber swellings, and denervation of sweat glands.
Conclusions: We report a patient with symptoms of phantom sweating in the setting of a sensory and post-ganglionic autonomic neuropathy. The pathophysiologic mechanisms underlying this autonomic paresthesia are not known. Possible mechanisms include aberrant reinnervation, ephaptic communication between nerve fibers, ectopic discharges from injured nerve fibers, and a central
response to autonomic deafferentation.
Clin Auton Res (2007) 17:264–327
L. L. Lair, C. Gibbons, R. Freeman
Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
Objective: To report a novel autonomic paresthesia in a patient with an idiopathic sensory and autonomic neuropathy.
Phantom sweating is the sensation of sweating in the absence of actual sweating. This symptom is reported in 40% of patients after sympathectomy. To our knowledge there are no reports of phantom sweating without a prior sympathectomy.
Quantitative sudomotor axon reflex testing revealed absent sudomotor activity in the dorsal foot with preserved activity in the distal thigh. Skin biopsy showed a loss of epidermal nerve fibers, nerve fiber swellings, and denervation of sweat glands.
Conclusions: We report a patient with symptoms of phantom sweating in the setting of a sensory and post-ganglionic autonomic neuropathy. The pathophysiologic mechanisms underlying this autonomic paresthesia are not known. Possible mechanisms include aberrant reinnervation, ephaptic communication between nerve fibers, ectopic discharges from injured nerve fibers, and a central
response to autonomic deafferentation.
Clin Auton Res (2007) 17:264–327
hypotension-related poorer mental ability is also reflected in diminished cortical activity
EEG studies have demonstrated that the hypotension-related poorer mental ability is also reflected in
diminished cortical activity. Contrary to convention, more recent research has suggested a deficient regulation of cerebral blood flow in persons with low blood pressure. In addition to reduced tonic brain perfusion, studies demonstrated insufficient adjustment of blood flow to cognitive requirements.
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.
Clin Auton Res. 2007 April; 17(2): 69–76.
diminished cortical activity. Contrary to convention, more recent research has suggested a deficient regulation of cerebral blood flow in persons with low blood pressure. In addition to reduced tonic brain perfusion, studies demonstrated insufficient adjustment of blood flow to cognitive requirements.
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.
Clin Auton Res. 2007 April; 17(2): 69–76.
Nitric Oxide synthesis contributes to the regulation of vasomotor tone
These findings indicate that NO is involved in the central regulation of sympathetic outflow in humans and suggest that both neuronal and endothelial NO synthesis may contribute to the regulation of vasomotor tone.
Circulation. 1997 Dec 2;96(11):3897-903.
Circulation. 1997 Dec 2;96(11):3897-903.
hypoxaemia, a potentially serious complication of Sympathectomy
Consecutive series of patients (n = 210), suffering from upper limb hyperhidrosis, anaesthetised for TES.
SpO2 decreased below 98% in 58 patients. Sudden hypotension and bradycardia in two patients.
The mean PaO2 was significantly (p = 0.03) decreased during two-lung ventilation (TLV), after reinflation of the right lung, compared with TLV after endobronchial intubation. There was no significant difference in mean PaO2 during one-lung ventilation of both lungs. Lowest PaO2 observed during one-lung ventilation was less than 13.3 kPa in three sympathectomies. Postoperative pain, severe on awakening and mainly retrosternal, was relieved with i.v. opiates. CONCLUSION: Controlled ventilation with 100% inspired O2, SpO2 monitoring and one to two gentle manual ventilations when it decreases is the cornerstone of the management of hypoxaemia, a potentially serious complication of TES.
Eur J Surg Suppl. 1994;(572):23-5.
SpO2 decreased below 98% in 58 patients. Sudden hypotension and bradycardia in two patients.
The mean PaO2 was significantly (p = 0.03) decreased during two-lung ventilation (TLV), after reinflation of the right lung, compared with TLV after endobronchial intubation. There was no significant difference in mean PaO2 during one-lung ventilation of both lungs. Lowest PaO2 observed during one-lung ventilation was less than 13.3 kPa in three sympathectomies. Postoperative pain, severe on awakening and mainly retrosternal, was relieved with i.v. opiates. CONCLUSION: Controlled ventilation with 100% inspired O2, SpO2 monitoring and one to two gentle manual ventilations when it decreases is the cornerstone of the management of hypoxaemia, a potentially serious complication of TES.
Eur J Surg Suppl. 1994;(572):23-5.
Haemodynamic changes following denervation of the heart
Bilateral cardiac sympathectomy significantly decreased the heart rate and the systemic arterial blood pressure from 191 + 8 to 124 + 6 beats min-' and from 121 + 10 to 88 + 9 mmHg, respectively. These variables increased to 129 + 7 beats min-' and to 103 + 10 mmHg, respectively, following bilateral vagotomy.
Journal of Physiology (1996), 490.3, pp.793-803
Journal of Physiology (1996), 490.3, pp.793-803
inhibition of sympathetic activity and a possible impairment of endothelial function
Alterations in skin microcirculation induced by brachial plexus block can be evaluated by wavelet transform of the laser Doppler flowmetry signal. Brachial plexus block reduces the oscillatory components within the 0.0095- to 0.021- and 0.021- to 0.052-Hz intervals of the perfusion signal. These alterations are related to inhibition of sympathetic activity and a possible impairment of endothelial function.
Endothelial dysfunction, or the loss of proper endothelial function, is a hallmark for vascular diseases, and often leads to atherosclerosis.
http://en.wikipedia.org/wiki/Endothelium
Anesthesiology:
September 2006 - Volume 105 - Issue 3 - pp 478-484
Clinical Investigations
Endothelial dysfunction, or the loss of proper endothelial function, is a hallmark for vascular diseases, and often leads to atherosclerosis.
http://en.wikipedia.org/wiki/Endothelium
Surgical sympathectomy listed as neurologic disorder (surgically induced)
Other neurologic disorders
- Idiopathic orthostatic hypotension
- Multiple sclerosis
- Parkinsonism
- Posterior fossa tumor
- Shy-Drager syndrome
- Spinal cord injury with paraplegia
- Surgical sympathectomy
- Syringomyelia
- Syringobulbia
- Tabes dorsales (syphillis)
- Wernicke's encephalopathy
Dizziness: Classification and Pathophysiology
The Journal of Manual and Manipulative Therapy, Vol. 12, No 4 (2004)
- Idiopathic orthostatic hypotension
- Multiple sclerosis
- Parkinsonism
- Posterior fossa tumor
- Shy-Drager syndrome
- Spinal cord injury with paraplegia
- Surgical sympathectomy
- Syringomyelia
- Syringobulbia
- Tabes dorsales (syphillis)
- Wernicke's encephalopathy
Dizziness: Classification and Pathophysiology
The Journal of Manual and Manipulative Therapy, Vol. 12, No 4 (2004)
Sympathectomy: "suppression of the neuroendocrine stress response"
p.254Neuraxial blocks typically produce variable decrease in blood pressure that might be accompanied by a decrease in heart rate and cardiac contractility. These effects are generally proportional to the degree (level) of the sympathectomy. Vasomotor tone is primarily determined by sympathetic fibres arising from T5 to L1, innervating arterial and venous smooth muscle. Blocking these nerves causes vasodilation of the venous capacitance vessels, pooling of blood, and decreased vvenous terurn to the heart; in some instances, arterial vasodilation may also decrease systemic vascular resistance. The effects of arterial vasodilation may be minimized by compensatory vasoconstriction above the level of the block. A high sympathetic block not only prevents compensatory vasoconstriction but also blocks the sympathetic cardiac accelerator fibres that arise at T1-T4.
Profound hypotension may result from vasodilation combined with bradycardia and decreased contractility. These effects are further exaggerated if venous return is further compromised by a head-up position or from the weight of a gravid uterus. Unopposed vagal tone in some persons may explain cardiac arrest with spinal anesthesia.
p.261
The sympathetic system normally maintains some tonic vasoconstriction on the vascular tree. Loss off this tone following induction of anesthesia or sympathectomy frequently contributes to perioperative hypotension.
p.375
AV conduction abnormalities are usually manifested by abnormal ventricular depolarization (bundle-branch block) prolongation of the P-R interval (first degree AV block) failure of some atrial impulses to depolarize the ventricles (second degree AV block) or AV dissociation (third degree AV block or complete heart block).
p.428
Clinical anesthesiology By G. Edward Morgan, Maged S. Mikhail, Michael J. Murray
McGraw-Hill, Edition: 3 - 2002
