Risk of bradycardia after endoscopic electrocautery of the upper thoracic sympathetic ganglia
We evaluated risk of bradycardia after endoscopic electrocautery of the upper thoracic sympathetic ganglia (ETS). Enrolled in this study were 24 patients. Bradycardia, defined as heart rate below 50 beats per min continuing for more than 5 min, was found in 12 patients (50%). All patients were divided into two groups; bradycardia group and non-bradycardia group. Age, sex, region of electrocautery, fentanyl dosage, and operation time were not different between the two groups. Power spectral analysis of heart rate variability revealed that sympathetic activity decreased after ETS. Multivariate analysis indicates that postoperative-minimal heart rate depends upon preoperative heart rate at rest. We conclude that careful monitoring after ETS is necessary in a patient with heart rate below 60 bpm preoperatively.
http://www.ncbi.nlm.nih.gov/pubmed/10885235
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the most pronounced feature is a mental change
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.
Acta Oto-laryngologica
1952, Vol. 42, No. 1-2, Pages 133-151
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82.9% Were Disturbed Because CS Was More Than Expected
However, compensatory sweating (CS) developed in 97.1% of the patients, and 82.9% answered that they were disturbed because it was more than they had expected. This result makes us realize further the importance of preoperative informed consent for CS. The problem of palmar hyperhidrosis is very serious for patients, and hence it is important to give treatment with a thorough understanding of the effectiveness and problems of ETS for palmar hyperhidrosis according to the analytical results of this questionnaire.
http://ci.nii.ac.jp/naid/110006980508/en
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Ultrastructural Changes in the Nerves Innervating the Cerebral Artery after Sympathectomy
TAKASHI IWAYAMA
Z. Zellforsch. 109, 465--480 (1970) 9 by Springer-Verlag 1970
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An Ultrastructural Study - effects of Preganglionic Sympathectomy
The ultrastructure of satellite cells of the rat superior cervical ganglion was studied following preganglionic sympathectomy. Several distinct morphological alterations were observed: (a) enlargement of the intercellular space between the ganglion cells and the satellite cells, (b) dilation of the granular endoplasmic reticulum and loss of attached ribosomes, and (c) swelling of the mitochondria with disorganization of the cristae mitochondriales. The presence of degenerating nerve fibers and synaptic boutons was also noted.
Journal of Neural Transmission 38, 43--57 (1976)
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Results of elective procedure can be "devastating"
Surgery ofthe sympathetic system is performed for a variety ofindications,hyperhidrosis being a major one. Despite excellent results, sympathectomy for hyperhidrosis bears a number of sequels, some of which may be devastating.
Clin Auton Res (2003) 13 [Suppl 1]:I/83–I/88
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lesser (sic!) imbalance of the autonomic nervous system
Ramicotomy is a surgical procedure, with less adverse effects than conventional sympathectomy, however, it was abandoned due to the high recurrence rate.
With the purpose of using a less aggressive surgical approach and lesser imbalance of the autonomic nervous system, the ramicotomy was proposed.
Ramicotomy allows complete section of all rami communicantes of the sympathetic ganglia. The histological regeneration might be greater than the recurrence rates of clinical symptoms seen in a human being due to non-functional regenerations.
Interact CardioVasc Thorac Surg 2009;9:411-415.
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increased blood supply is associated with decreased vascular permeability
The influence of the sympathetic nervous system on capillary permeability was studied in cats. The dye penetration from the blood through the synovial membrane was tested by perfusing the two knee joints, one of which was deprived of its sympathetic nerve supply by unilateral lumbosacral
sympathectomy.
In confirmation of previous experiments, it was found in a great majority of experiments that, in spite of marked vasodilatation, the dye excretion was considerably reduced on the sympathectomised side.
A permeability factor under the influence of the sympathetic nervous system has been postulated; its character and mechanism is still unknown.
Further unpublished experiments seem to support the view that increased blood supply is associated with decreased vascular permeability.
Res Exp Med (Berl) 173, 1--8 (1978)
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lead to hyperfunction of the serotoninergic system and pathology
We studied the balance of activity of sympathetic, parasympathetic, and serotoninergic divisions of the autonomic nervous system in the regulation of the heart function in rabbits. High activities of the sympathetic and parasympathetic system are associated with antagonistic interactions between them. Moderation of activity of these systems could be accompanied by activation of the serotoninergic system. Physiological sympathectomy and parasympathectomy lead to hyperfunction of the serotoninergic system and pathology.
Bulletin of Experimental Biology and Medicine, Vol. 140, No. 5, 2005 PHYSIOLOGY
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In all cases wrinkling was abolished after interruption of the hand sympathetic innervation
In the study, the effect ofcervical sympathectomy on water immersion wrinkling was examined in 12 patients treated for palmar hyperhidrosis.
In all cases wrinkling was abolished after interruption of the hand sympathetic innervation. A separate study in patients with diabetic neuropathy noted that reduced or absent water immersion wrinkling was linked to autonomic dysfunction as indicated by diarrhea and orthostatic hypotension [3]. Two clinical studies on patients with leprosy further strengthened deficient water immersion wrinkling as an indicator ofperipheral sympathetic nerve damage [14,18]. Interestingly, central nervous system sympathetic dysfunction has also been shown to affect finger wrinkling.In a study of patients with unilateral Parkinsonism, wrinkling was significantly reduced on the side not affected by motor signs.
Clin Auton Res (2004) 14:125–131
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Autonomic neuropathy simulating the effects of sympathectomy
Autonomic neuropathy simulating the effects of sympathectomy as a complication of diabetes mellitus. Diabetes 1955;4:92-97. 112.
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Sympathectomy = autonomic neuropathy
A number of papers have been published which
stressed [22-24] the high failure rate of sympathecto-
my operations in diabetics. We believe that the failure
of the operation is due to the fact that diabetic auto-
nomic neuropathy has already sympathectomized the
patient. The results of the present study are compati-
ble with this idea. It is also of interest that the histolog-
ical abnormalities found in the present study are simi-
lar to those described in the bladder [15], in the corpo-
ra cavernosa [16] and in the myocardium [17], all of
which are typical sites of diabetic autonomic neuro-
pathy. Thus, autonomic neuropathy is a very com-
mon feature in diabetes and an important back-
ground to the development of other complications.
For example, although the chronic dryness of the skin
is rarely troublesome for the patient, it may lead to
skin shrinkage and cracking which may, in turn, pre-
dispose to infection.
Diabetologia, Volume 22, Number 2 / February, 1982
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severe compensatory sweating was experienced in 90% of patients
Postsurgery, severe compensatory sweating was experienced in 90% of patients (P < p="0.005)." n="4)" n="5)." n =" 9)," n =" 6)" command="N&absnum=" dir="S190" dopt="Abstract" dopt="Abstract" cv =" 100" cv =" 11%)." rid="173908&DT=" n="22)." n="11)" p="0.025)." p="0.366)." p =" 0.911)." p =" 0.035)," p =" 0.030)."> 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
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collateral effects of thoracic sympathectomy not disclosed to patients
Several reports also demonstrate significantly lower heart rate increases during exercise in subjects who have undergone bilateral ISS [9–12] compared to pre-surgical levels. In spite of this high occurrence, recent reviews on the usual collateral effects of thoracic sympathectomy still do not include these possible cardiac consequences [6].
Eur J Cardiothorac Surg 2001;20:1095-1100
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Compensatory sweating occurred in 87% of the patients - serious in 36% and incapacitating in 6%
Ann Thorac Surg. 2004 Nov;78(5):1801-7.
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The rates of compensatory sweating and gustatory sweating were 93.5% and 49.4%, respectively
Surgical Endoscopy
Volume 23, Number 7 / July, 2009
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Patients decide in what form the surgery should be performed!
The 25 patients with palmar hyperhidrosis who insisted on receiving ETS of T4 experienced no compensatory hyperhidrosis. Of the 54 patients with facial blushing who received ESB of T2, 23 experienced compensatory hyperhidrosis.
http://www.springerlink.com/content/j6k17332rhqjv663/
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90 % of patients experienced severe compensatory sweating
Postsurgery, severe compensatory sweating was experienced in 90% of patients (P < 0.0001). The sites of
compensatory sweating were the back (75%), abdomen (51%), feet (23%), groin and thigh (13%), chest (13%), andaxillae (8%). Transient whole-body sweating for no apparent reason was experienced in 30% of patients.
Thirty-seven patients (11%) regretted having undergone the surgical procedure.
Main outcome measures included the incidence of dry hands, compensatory sweating, chest pain, upper-limb muscle weakness, shortness of breath, and gustatory phenomena;
Surg Laparosc Endosc Percutan Tech. 2000 Aug;10(4):226-9.
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Gustatory sweating 56 %, recurrence rate 38% after Sympathectomy
Gustatory sweating in the neck was reported by nine patients (56%), which usually occurred in response to
hot or spicey foods.
The symptoms are not troublesome for most patients, but in severe cases furhter surgery might be required.
Six patients (38%/) also had mild recurrent sweating of the hands, especially in response to either extreme heat,
anxiety or food.
A return of sweating in the hands is common occurrence in patients followed up for sufficient length of time.
Annals of the Royal College of Surgeons of England (1989) vol. 7.1
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Results support our hypothesis that blockade of the sympathetic nervous system substantially degrades ligament
Journal of Applied Physiology
2004, vol. 96, no2, pp. 711-718 [8 page(s) (article)] (44 ref.)
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Supersensitivity to noradrenaline and chronic neuropathic pain conditions
Supersensitivity to noradrenaline contributes to certain vascular disorders (e.g., hypertension) and chronic neuropathic pain conditions (e.g., complex regional pain syndrome). We aimed to develop a procedure for inducing adrenergic supersensitivity that could be used to investigate the role of catecholamines in these clinical conditions.
These observations indicate that prolonged depletion of adrenergic stores by guanethidine induces adrenergic supersensitivity in cutaneous vessels, and that adrenergic supersensitivity enhances thermal hyperalgesia in the presence of noradrenaline.
Autonomic Neuroscience
Volume 88, Issues 1-2, 12 April 2001, Pages 86-93
Darren M. Lipnicki and Peter D. DrummondCorresponding Author Contact Information, E-mail The Corresponding Author
School of Psychology, Murdoch University, Murdoch, Western Australia 6150, Australia
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increased blood flow after sympathectomy is due to increased nonnutritive AVA flow
In the acute canine model, increased blood flow after sympathectomy is due to increased nonnutritive arteriovenous anastomoses (AVA) flow, with no change in total hindlimb capillary flow, both at rest and during reactive hyperemia.
Surgery. 1977 Jul;82(1):82-9.
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sympathectomy on cerebral blood flow
CBF increased significantly after the elevation of systemic blood pressure compared with that in the control group, and cerebral autoregulation was impaired. After a 1-hour study, the specific gravity of the cerebral tissue in the treated group significantly decreased; electron microscopic studies at that time revealed brain edema. It is suggested that depletion of brain noradrenaline levels causes a disturbance in cerebral microvascular tone and renders the cerebral blood vessels more vulnerable to hypertension.
J Neurosurg. 1991 Dec;75(6):906-10.
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sympathectomy leading to an extracranial steal phenomenon.
The incidence and extension of brain infarcts was increased in animals with additional ipsilateral cervical preganglionic sympathectomy. Sympathectomy did not affect markedly the respiration and systemic circulation. The effect of sympathectomy was attributed to a cutaneous vasodilation, leading to an extracranial steal phenomenon.
J Neurol Neurosurg Psychiatry. 1983 August; 46(8): 768–773.
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ventilation technique may prevent hypoxemia during endoscopic sympathectomy
The near-sitting position, a single-lumen tube, and a continuous two-lung ventilation technique is simple and may prevent hypoxemia during endoscopic transthoracic sympathectomy.
Journal of Cardiothoracic and Vascular Anesthesia
Volume 10, Issue 2, February 1996, Pages 210-212
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chronic sympathectomy on muscle fibre composition
It is concluded that sympathectomy induces several biochemical changes in skeletal muscle which constitute a change and increase in fast myosin light chain synthesis and a corresponding fibre type transformation.
Received 24 August 1987; accepted 26 October 1987
Clinical Physiology and Functional Imaging
"We have previously reported functional and histological studies in five beagle dogs with unilateral lumbar sympathectomy. Three months later, fatiguability in the gracilis muscles was increased on the denervated sides, and this was associated with an increase in the relative distribution of FT fibres. Biochemical studies now show that these changes were associated with an increase in cytosolic protein without change in DNA content; this is consistent with an increase in cell size. There was a reduction in the proportion of slow myosin light chain isoforms from 50 +/- 7 to 34 +/- 6%. Noradrenaline levels were increased on the denervated sides but this may reflect greater vascularity. Calcium content did not correlate with fibre type but there was a positive relation with both noradrenaline content (r = 0.73; P less than 0.05) and DNA content (r = 0.84; P less than 0.05). It is concluded that sympathectomy induces several biochemical changes in skeletal muscle which constitute a change and increase in fast myosin light chain synthesis and a corresponding fibre type transformation."
Journal: Clinical physiology (Oxford, England) (Clin Physiol), published in ENGLAND.
Reference: 1988-Apr; vol 8 (issue 2) : pp 181-91
Dates: Created 1988/06/08; Completed 1988/06/08; Revised 2004/11/17;
PMID: 3359751, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )
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Sympathectomy--how much side-effects are acceptable?
Lakartidningen 2001 Oct 10;98(41):4494-5
[Article in Swedish]
Berglund F, Berglund E.
Publication Types:
Letter
PMID: 11699265 [PubMed - indexed for MEDLINE]
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Cardiac Arrest during Endoscopic Thoracic Sympathicotomy with One Lung Ventilation
Korean J Anesthesiol. 2007 Apr;52(4):479-483.
Published online 2007 April 30. doi: 10.4097/kjae.2007.52.4.479.
Cardiac Arrest during Endoscopic Thoracic Sympathicotomy with One Lung Ventilation under General Anesthesia - Two cases report -
Sang Woo Jung, M.D., Sung Wook Park, M.D.,* and Moo Il Kwon, M.D.*
Department of Anesthesiology and Pain Medicine, Seoul Sacred Heart Hospital, Seoul, Korea.
*Department of Anesthesiology and Pain Medicine, College of Medicine, Kyung Hee University, Seoul, Korea.
Corresponding author (Email: kwonmooil@yahoo.co.kr )
