A high level of neuroaxial block may produce profound bradycardia and hypotension, possibly as a result of an imbalance between sympathetic and parasympathetic control of heart rate.
Our results indicate that cervical, but not lumbar, epidural anesthesia depresses phasic and tonic dynamic modulation of the cardiac cycle by the vagal nerve in conscious humans.
IMPLICATIONS: Cervical epidural anesthesia with lidocaine produces depressed heart rate variability and baroreflex control of heart rate, whereas lumbar epidural anesthesia exerts minimal effects on autonomic nervous system activity in conscious humans.
Anesth Analg 2004;99:924-929
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000131966.61686.66
REGIONAL ANESTHESIA
The Effects of Cervical and Lumbar Epidural Anesthesia on Heart Rate Variability and Spontaneous Sequence Baroreflex Sensitivity
Makoto Tanaka, MD, Toru Goyagi, MD, Tetsu Kimura, MD, and Toshiaki Nishikawa, MD
Thursday, May 1, 2008
Influence of sympathectomy in humans on the rhythmicity of 6-sulphatoxymelatonin urinary excretion
The amount of 6-sulphatoxymelatonin, the chief metabolite of melatonin, in the urine was measured in nine patients, who were subjected to bilateral sympathectomy at the second thoracic ganglionic level for treatment of hyperhidrosis of the palms. All patients showed before surgery a normal 6-sulphatoxymelatonin excretion with a peak in the excretion during the night time. After the sympathectomy, the high night time excretion was clearly abolished in five patients but remained high in four patients. This indicates that the segmental locations of the preganglionic sympathetic perikarya in the spinal cord, stimulating the melatonin secretion in the pineal gland in humans, vary between individuals. An increase in daytime melatonin excretion was observed in the patients responding to the sympathectomy with an abolished 6-sulphatoxymelatonin rhythm. This increase could indicate that the final sympathetic neurons innervating the pineal gland might have a both stimulatory and inhibitory function.
Morten Møllera, Corresponding Author Contact Information, E-mail The Corresponding Author, Ole Osgaardb and Michael Grønbech-Jensenc
aInst. Med. Anatomy, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200 Copenhagen, Denmark
bDepartment Neurosurgery, Rigshospitalet, Copenhagen, Denmark
cNeurological Specialist Clinic Copenhagen, Christianshavns Torv 2, Copenhagen, Denmark
Morten Møllera, Corresponding Author Contact Information, E-mail The Corresponding Author, Ole Osgaardb and Michael Grønbech-Jensenc
aInst. Med. Anatomy, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200 Copenhagen, Denmark
bDepartment Neurosurgery, Rigshospitalet, Copenhagen, Denmark
cNeurological Specialist Clinic Copenhagen, Christianshavns Torv 2, Copenhagen, Denmark
Does the pineal gland have a role in the psychological mechanisms involved in the progression of cancer?
Department of Anatomical Sciences, University of Adelaide, Adelaide, Australia
Received 9 November 2001;
accepted 13 February 2002.
Available online 28 August 2002.
Psychological factors, e.g., depression and psychological stress have been implicated in the progress of cancer. Similarly, the pineal gland and its principal secretion, melatonin, are known to influence the initiation and progress of cancer. Furthermore, changes in melatonin secretion have been linked with psychological stress and depression, and both the pineal gland and the cerebral cortex act via the limbic system in producing their effects. Both psychological stress and melatonin affect the immune system, as does the hypothalamus and the autonomic nervous system. The pineal gland has both a direct effect on cancer, and via the immune system. Psychological treatment and melatonin treatment have both been found to alleviate the course of cancer clinically. It is thus hypothesized that the pineal gland, and melatonin, are involved in the mechanism of psychological effects in the promotion of the progress of cancer.
Received 9 November 2001;
accepted 13 February 2002.
Available online 28 August 2002.
Psychological factors, e.g., depression and psychological stress have been implicated in the progress of cancer. Similarly, the pineal gland and its principal secretion, melatonin, are known to influence the initiation and progress of cancer. Furthermore, changes in melatonin secretion have been linked with psychological stress and depression, and both the pineal gland and the cerebral cortex act via the limbic system in producing their effects. Both psychological stress and melatonin affect the immune system, as does the hypothalamus and the autonomic nervous system. The pineal gland has both a direct effect on cancer, and via the immune system. Psychological treatment and melatonin treatment have both been found to alleviate the course of cancer clinically. It is thus hypothesized that the pineal gland, and melatonin, are involved in the mechanism of psychological effects in the promotion of the progress of cancer.
Two cases of symptomatic cluster-like headache suggest the importance of sympathetic/parasympathetic balance
Despite several reports on symptomatic cluster-like headache, there is no clear explanation of how different lesions thought to be causative are related to cluster-like headache. On the basis of two additional cases of symptomatic cluster headache, we discuss the possibility that an acute imbalance of the autonomic nervous system, namely a net overactivity of the parasympathetic system, may be able to trigger these headache attacks in patients who probably have an additional individual predisposition to react with a cluster-like headache. Such an imbalance can be due to an increase in parasympathetic tone (e.g. stimulation of parasympathetic fibres) or to a reduction of the sympathetic tone (e.g. a lesion of the sympathetic fibres).
Two cases of symptomatic cluster-like headache suggest the importance of sympathetic/parasympathetic balance
* A Straube,
* T Freilinger,
* T Rüther &
* C Padovan
*
Department of Neurology, Klinikum Großhadern, Ludwig-Maximilians-University Munich, Germany
----------------------------------
A chronobiological study of melatonin, cortisol growth hormone and prolactin secretion in cluster headache
Results from this study suggest a neuroendocrine dysregulation in cluster headache in the endogenous clock which controls the pineal rhythmicity.
* Guy Chazot11Unite Neurométabolique, Hôpital Neurologique. 59 boulevard Pinel, 69003 Lyon, France; ,
* Bruno Claustrat22Service de Radiopharmacie et Radioanalvse. Centre de Médecine Nucléaire, 59 boulevard Pinel, 69003 Lyon, France; ,
* Jocelyne Brun22Service de Radiopharmacie et Radioanalvse. Centre de Médecine Nucléaire, 59 boulevard Pinel, 69003 Lyon, France; ,
* Daniel Jordan33Laboratoire de Médecine Expérimentale, INSERM U. 197-UER, Médecine Alexis Carrel, rue Guillaume Paradin. 69008 Lyon, France; ,
* Geneviève Sassolas44Unite de Soins, Centre de Médecine Nucléaire, 59 boulevard Pinel, 69003 Lyon, France,
* Bernard Schott
Cephalalgia
Volume 4 Issue 4 Page 213-220, December 1984
Although migraineurs appear in general to be hypersensitive to external stimuli, they maybe also have increased daytime sleepiness and complain of fatigue. Neurophisiological studies between attacks have shown that for a number of different sensory modalities the migrainous brain is characterised by a lack of habituation of evoked responses. Whether this is due to increased cortical hyperexcitability, possibly due to decreased inhibition, or to an abnormal responsivity of the cortex due a decreased preactivation level remains disputed. Studies using transcranial magnetic stimulation in particular have yielded contradictory results. We will review here the available data on cortical excitability obtained with different methodological approaches in patients over the migraine cycle. We will show that these data congruently indicate that the sensory cortices of migraineurs react excessively to repetitive, but not to single, stimuli and that the controversy above hyper- versus hypo-excitability is merely a semantic misunderstanding. Describing the migrainous brain as ‘hyperresponsive’ would fit most of the available data. Deciphering the precise cellular and molecular underpinnings of this hyperresponsivity remains a challenge for future research. We propose, as a working hypothesis, that a thalamo-cortical dysrhythmia might be the culprit.
Is the cerebral cortex hyperexcitable or hyperresponsive in migraine?
* G Coppola11G.B. Bietti Eye Foundation-IRCCS, Department of Neurophysiology of Vision and Neurophthalmology, ,
* F Pierelli2,32University of Rome ‘La Sapienza’ Polo Pontino—I.C.O.T., Rome and 3IRCCCS-Neuromed, Pozzilli (IS), Italy, &
* J Schoenen4,5
Two cases of symptomatic cluster-like headache suggest the importance of sympathetic/parasympathetic balance
* A Straube,
* T Freilinger,
* T Rüther &
* C Padovan
*
Department of Neurology, Klinikum Großhadern, Ludwig-Maximilians-University Munich, Germany
----------------------------------
A chronobiological study of melatonin, cortisol growth hormone and prolactin secretion in cluster headache
Results from this study suggest a neuroendocrine dysregulation in cluster headache in the endogenous clock which controls the pineal rhythmicity.
* Guy Chazot11Unite Neurométabolique, Hôpital Neurologique. 59 boulevard Pinel, 69003 Lyon, France; ,
* Bruno Claustrat22Service de Radiopharmacie et Radioanalvse. Centre de Médecine Nucléaire, 59 boulevard Pinel, 69003 Lyon, France; ,
* Jocelyne Brun22Service de Radiopharmacie et Radioanalvse. Centre de Médecine Nucléaire, 59 boulevard Pinel, 69003 Lyon, France; ,
* Daniel Jordan33Laboratoire de Médecine Expérimentale, INSERM U. 197-UER, Médecine Alexis Carrel, rue Guillaume Paradin. 69008 Lyon, France; ,
* Geneviève Sassolas44Unite de Soins, Centre de Médecine Nucléaire, 59 boulevard Pinel, 69003 Lyon, France,
* Bernard Schott
Cephalalgia
Volume 4 Issue 4 Page 213-220, December 1984
Although migraineurs appear in general to be hypersensitive to external stimuli, they maybe also have increased daytime sleepiness and complain of fatigue. Neurophisiological studies between attacks have shown that for a number of different sensory modalities the migrainous brain is characterised by a lack of habituation of evoked responses. Whether this is due to increased cortical hyperexcitability, possibly due to decreased inhibition, or to an abnormal responsivity of the cortex due a decreased preactivation level remains disputed. Studies using transcranial magnetic stimulation in particular have yielded contradictory results. We will review here the available data on cortical excitability obtained with different methodological approaches in patients over the migraine cycle. We will show that these data congruently indicate that the sensory cortices of migraineurs react excessively to repetitive, but not to single, stimuli and that the controversy above hyper- versus hypo-excitability is merely a semantic misunderstanding. Describing the migrainous brain as ‘hyperresponsive’ would fit most of the available data. Deciphering the precise cellular and molecular underpinnings of this hyperresponsivity remains a challenge for future research. We propose, as a working hypothesis, that a thalamo-cortical dysrhythmia might be the culprit.
Is the cerebral cortex hyperexcitable or hyperresponsive in migraine?
* G Coppola11G.B. Bietti Eye Foundation-IRCCS, Department of Neurophysiology of Vision and Neurophthalmology, ,
* F Pierelli2,32University of Rome ‘La Sapienza’ Polo Pontino—I.C.O.T., Rome and 3IRCCCS-Neuromed, Pozzilli (IS), Italy, &
* J Schoenen4,5
Comparison of the Emotional Effects of a Beta-Adrenergic Blocking Agent and a Tranquilizer
This study investigated the emotional effects of the beta-adrenergic blocking agent oxprenolol (40 mg, p.o.) and the tranquilizing agent diazepam (5 mg, p.o.) in healthy subjects under three situational conditions:an emotionally neutral control situation and two situations designed to arouse different levels of anxiety. Both oxprenolol and diazepam induced positive emotional changes only in the more strongly anxiety-arousing situation. Significant differences between oxprenolol and diazepam in inducing emotional stabilization were not demonstrable.
Gisela Erdmann, Wilhelm Janke, Sigrid Köchers, Brunhild Terschlüsen
Institut fur Psychologie, Technische Universität Berlin; Lehrstuhl fur Psychologie I, Universität Würzburg, BRD
Neuropsychobiology 1984;12:143-151 (DOI: 10.1159/000118129)
Gisela Erdmann, Wilhelm Janke, Sigrid Köchers, Brunhild Terschlüsen
Institut fur Psychologie, Technische Universität Berlin; Lehrstuhl fur Psychologie I, Universität Würzburg, BRD
Neuropsychobiology 1984;12:143-151 (DOI: 10.1159/000118129)
when sympathectomy results in excessive hypotension, vasoconstrictor drugs may be needed
High spinal anaesthesia may block the
nociceptive and haemodynamic responses to common
surgical events such as sternotomy. The extensive sym-
pathectomy provided by high spinal anaesthesia has po-
tential benefits and risks. If cardiac sympathectomy is achieved, there may be improvements in coronary per-
fusion. Stress response may be diminished. However,
when sympathectomy results in excessive hypotension, va-
soconstrictor drugs may be needed. These agents may
have detrimental effects on the coronary circulation, by-
pass grafts, and other organs.30"32
11 Parsonnet V, Dean D, Bernstein AD. A method of uni-
form stratification of risk for evaluating the results of
surgery in acquired adult heart disease. Circulation 1989;
79 (Suppl I): 13-112.
12 Robbins GR, Wynands JE, Whalley DG, et al.
nociceptive and haemodynamic responses to common
surgical events such as sternotomy. The extensive sym-
pathectomy provided by high spinal anaesthesia has po-
tential benefits and risks. If cardiac sympathectomy is achieved, there may be improvements in coronary per-
fusion. Stress response may be diminished. However,
when sympathectomy results in excessive hypotension, va-
soconstrictor drugs may be needed. These agents may
have detrimental effects on the coronary circulation, by-
pass grafts, and other organs.30"32
11 Parsonnet V, Dean D, Bernstein AD. A method of uni-
form stratification of risk for evaluating the results of
surgery in acquired adult heart disease. Circulation 1989;
79 (Suppl I): 13-112.
12 Robbins GR, Wynands JE, Whalley DG, et al.
Heart rate, heart rate variability and skin conductance as indicators of arousal
Arousal is a physiological and psychological state of being awake. It involves the activation of the reticular activating system in the brain stem, the autonomic nervous system and the endocrine system, leading to increased heart rate and blood pressure and a condition of sensory alertness, mobility and readiness to respond.
There are many different neural systems involved in what is collectively known as the arousal system. Four major systems originating in the brainstem, with connections extending throughout the cortex, are based on the brain's neurotransmitters, acetylcholine, norepinephrine, dopamine, and serotonin. When these systems are in action, the receiving neural areas become sensitive and responsive to incoming signals.
Importance
Arousal is important in regulating consciousness, attention, and information processing. It is crucial for motivating certain behaviours, such as mobility, the pursuit of nutrition, the fight or flight response and sexual activity (see Masters and Johnson's human sexual response cycle, where it is known as the arousal phase). It is also very important in emotion, and has been included as a part of many influential theories such as the James-Lange theory of emotion. According to Hans Eysenck, differences in baseline arousal level lead people to be either extraverts or introverts.
There are many different neural systems involved in what is collectively known as the arousal system. Four major systems originating in the brainstem, with connections extending throughout the cortex, are based on the brain's neurotransmitters, acetylcholine, norepinephrine, dopamine, and serotonin. When these systems are in action, the receiving neural areas become sensitive and responsive to incoming signals.
Importance
Arousal is important in regulating consciousness, attention, and information processing. It is crucial for motivating certain behaviours, such as mobility, the pursuit of nutrition, the fight or flight response and sexual activity (see Masters and Johnson's human sexual response cycle, where it is known as the arousal phase). It is also very important in emotion, and has been included as a part of many influential theories such as the James-Lange theory of emotion. According to Hans Eysenck, differences in baseline arousal level lead people to be either extraverts or introverts.
Adrenaline or peripheral noradrenaline depletion and passive avoidance in the rat
Physiol Behav. 1972 Jun;8(6):1059-62.
Adrenaline or peripheral noradrenaline depletion and passive avoidance in the rat.
Di Giusto EL.
J Comp Physiol Psychol. 1972 Dec;81(3):491-500.Links
Chemical sympathectomy and avoidance learning in the rat.
Di Giusto EL, King MG.
Adrenaline or peripheral noradrenaline depletion and passive avoidance in the rat.
Di Giusto EL.
J Comp Physiol Psychol. 1972 Dec;81(3):491-500.Links
Chemical sympathectomy and avoidance learning in the rat.
Di Giusto EL, King MG.
Heart rate and blood pressure responses to signaled and unsignaled shocks: effects of cardiac sympathectomy
J Comp Physiol Psychol. 1969 Jun;68(2):163-74.Links
Heart rate and blood pressure responses to signaled and unsignaled shocks: effects of cardiac sympathectomy.
Katcher AH, Solomon RL, Turner LH, LoLordo V, Overmier JB, Rescorla RA.
Heart rate and blood pressure responses to signaled and unsignaled shocks: effects of cardiac sympathectomy.
Katcher AH, Solomon RL, Turner LH, LoLordo V, Overmier JB, Rescorla RA.
adrenergic nerve degeneration after sympathectomy of the pineal gland
Electron microscopic evidence that bretylium and pargyline delay adrenergic nerve degeneration after sympathectomy of the pineal gland
Journal Naunyn-Schmiedeberg's Archives of Pharmacology
Publisher Springer Berlin / Heidelberg
ISSN 0028-1298 (Print) 1432-1912 (Online)
Issue Volume 319, Number 2 / May, 1982
Journal Naunyn-Schmiedeberg's Archives of Pharmacology
Publisher Springer Berlin / Heidelberg
ISSN 0028-1298 (Print) 1432-1912 (Online)
Issue Volume 319, Number 2 / May, 1982
Effects of thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis on bronchial responsiveness
Respirology. 1996 Sep;1(3):195-9.Links
Effects of thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis on bronchial responsiveness to histamine: implications on the autonomic imbalance theory of asthma.
Noppen MM, Vincken WG.
Respiratory Division, Academic Hospital AZ-VUB, Free University of Brussels, Belgium.
Three of the 26 patients (12%) without pre-operative bronchial hyperresponsiveness became hyperresponsive after TS, whereas 1 of the 9 patients with pre-operative BHR lost hyperresponsiveness. Upper dorsal thoracoscopic D2-D3 sympathicolysis performed for the treatment of EH has no significant effects on mean PD20 His and individual loss (11%) or development (12%) of BHR occurs only in 12% of patients.
Effects of thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis on bronchial responsiveness to histamine: implications on the autonomic imbalance theory of asthma.
Noppen MM, Vincken WG.
Respiratory Division, Academic Hospital AZ-VUB, Free University of Brussels, Belgium.
Three of the 26 patients (12%) without pre-operative bronchial hyperresponsiveness became hyperresponsive after TS, whereas 1 of the 9 patients with pre-operative BHR lost hyperresponsiveness. Upper dorsal thoracoscopic D2-D3 sympathicolysis performed for the treatment of EH has no significant effects on mean PD20 His and individual loss (11%) or development (12%) of BHR occurs only in 12% of patients.
beta 1-adrenoreceptor-mediated change in pulmonary capillary membrane permeability
Respir Med. 1997 Oct;91(9):537-45.Click here to read Links
Partial pulmonary sympathetic denervation by thoracoscopic D2-D3 sympathicolysis for essential hyperhidrosis: effect on the pulmonary diffusion capacity.
Noppen MM, Vincken WG.
Respiratory Division, Academic Hospital, University of Brussels, Belgium.
In patients with essential hyperhidrosis (EH), a pathological condition characterized by increased activity of the upper dorsal sympathetic ganglia D2-D3, anatomical interruption at the D2-D3 level by thoracoscopic sympathicolysis (TS) is a safe and effective treatment. The D2 and D3 ganglia, however, are also in the pathway of sympathetic lung innervation, which may influence the pulmonary diffusion capacity for carbon monoxide (expressed as transfer factor for CO:TLCO, and as transfer coefficient for CO:KCO). We therefore studied the effect of TS on TLCO and KCO in 50 EH patients: compared with pre-operative values, both TLCO (-6.7%, P < 0.001) and KCO (-4.2%, P = 0.002) were significantly decreased at 6 weeks after bilateral TS, an effect which was independent of the smoking status of the patients. In order to explain this phenomenon, the following pharmacological interventions were studied: (1) oral beta 1 + 2-adrenoreceptor blockade with propranolol caused a comparable decrease of TLCO (-6.3%) and KCO (-7.5%) in matched normal subjects, but had no effect on TLCO and KCO in EH patients prior to TS; and (2) subsequent inhalation of the beta 2-adrenoreceptor agonist salbutamol in a dosage suspected to cause alveolar beta-receptor stimulation had no effect on TLCO and KCO, neither in the normal subjects, nor in EH patients (before and after TS). Although the exact mechanism of the TS-induced decrease in TLCO and KCO remains speculative, these findings suggest that they may be related to a beta 1-adrenoreceptor-mediated change in pulmonary capillary membrane permeability, although TS-induced changes in pulmonary blood flow or an interplay of both mechanisms cannot be excluded.
Partial pulmonary sympathetic denervation by thoracoscopic D2-D3 sympathicolysis for essential hyperhidrosis: effect on the pulmonary diffusion capacity.
Noppen MM, Vincken WG.
Respiratory Division, Academic Hospital, University of Brussels, Belgium.
In patients with essential hyperhidrosis (EH), a pathological condition characterized by increased activity of the upper dorsal sympathetic ganglia D2-D3, anatomical interruption at the D2-D3 level by thoracoscopic sympathicolysis (TS) is a safe and effective treatment. The D2 and D3 ganglia, however, are also in the pathway of sympathetic lung innervation, which may influence the pulmonary diffusion capacity for carbon monoxide (expressed as transfer factor for CO:TLCO, and as transfer coefficient for CO:KCO). We therefore studied the effect of TS on TLCO and KCO in 50 EH patients: compared with pre-operative values, both TLCO (-6.7%, P < 0.001) and KCO (-4.2%, P = 0.002) were significantly decreased at 6 weeks after bilateral TS, an effect which was independent of the smoking status of the patients. In order to explain this phenomenon, the following pharmacological interventions were studied: (1) oral beta 1 + 2-adrenoreceptor blockade with propranolol caused a comparable decrease of TLCO (-6.3%) and KCO (-7.5%) in matched normal subjects, but had no effect on TLCO and KCO in EH patients prior to TS; and (2) subsequent inhalation of the beta 2-adrenoreceptor agonist salbutamol in a dosage suspected to cause alveolar beta-receptor stimulation had no effect on TLCO and KCO, neither in the normal subjects, nor in EH patients (before and after TS). Although the exact mechanism of the TS-induced decrease in TLCO and KCO remains speculative, these findings suggest that they may be related to a beta 1-adrenoreceptor-mediated change in pulmonary capillary membrane permeability, although TS-induced changes in pulmonary blood flow or an interplay of both mechanisms cannot be excluded.
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