Smithwick, R. H.: An Evaluation of the Surgical
Treatment of Hypertension. Bull. New York Acad. 1949.
The author discusses the effect upon hypertension of unilateral nephrectomy and removal of adrenal tumors but, principally, he considers his experience with operations on the sympathetic nervous system. The two principal known actions of sympathectomy are modification of blood pressure levels and modifications of the reflex regulation resulting from the inactivation of important components of the vasoconstrictor mechanism. Presumed effects of sympathectomy are abolition of reflex secretion of
adrenaline and stabilization of 1l)ood flow through the denervated vascular bed.
Wednesday, May 28, 2008
diminution of the myocardial concentration of epinephrine
It is known that sympathectomy is followed by a marked diminution of the myocardial concentration of epinephrine-like catechols.
Raab, W., and Lepeschkin, E.: Biochemical Versus
Hemodynamic Factors in the Origin of Hyperten-
sive Heart Disease. Acta med. Scandinav. 138:
81 (June), 1950.
Raab, W., and Lepeschkin, E.: Biochemical Versus
Hemodynamic Factors in the Origin of Hyperten-
sive Heart Disease. Acta med. Scandinav. 138:
81 (June), 1950.
Definiton of sympathectomy: interruption of the efferent motor innervation of the heart
the increased effort tolerance after sympathectomy is primarily
a result of interruption of the efferent motor in-
nervation of the heart rather than division of sen-
sory pathways.
CORONARY ARTERY DISEASE
Apthorp, G. H., Chamberlain, D. A., and Hay-
ward, G. W.: The Effects of Sympathec-
tomy on the Electrocardiogram and Effort
Tolerance in Angina Pectoris. Brit. Heart
J. 26:218 (March), 1964.
a result of interruption of the efferent motor in-
nervation of the heart rather than division of sen-
sory pathways.
CORONARY ARTERY DISEASE
Apthorp, G. H., Chamberlain, D. A., and Hay-
ward, G. W.: The Effects of Sympathec-
tomy on the Electrocardiogram and Effort
Tolerance in Angina Pectoris. Brit. Heart
J. 26:218 (March), 1964.
ETS attenuates autonomic circulatory response
Takashi Suzuki1, Yutaka Masuda1, Makoto Nonaka2, Mitsutaka Kadokura2 and Akiyoshi Hosoyamada1
(1) Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan, JP
(2) First Department of Surgery, Showa University School of Medicine, Tokyo, Japan, JP
Abstract
Purpose. Our purpose was to examine perioperative alterations in hemodynamic changes with head-up tilt (HUT) in patients undergoing endoscopic thoracic sympathectomy (ETS).
Methods. The subjects were 11 patients with essential hyperhidrosis scheduled to undergo ETS (ETS group) and 9 age-matched volunteers undergoing minor surgery (control group). HUT was performed (40°; 5 min) before and after the surgery, under nitrous oxide anesthesia. Orthostatic hypertension and hypotension in response to HUT were defined as changes of 10% or greater in systolic blood pressure.
Results. The increase in heart rate in response to HUT was significantly reduced after surgery in the ETS group (from 34 ± 18 to 14 ± 11 beats·min−1; P < 0.001), but not in the control group (from 23 ± 18 to 22 ± 12 beats·min−1; P = 0.911). Orthostatic hypertension disappeared completely after ETS (from 5 of 11 to none of 11 patients; P = 0.035), whereas the prevalence of orthostatic hypotension increased significantly after ETS (from 3 of 11 to 9 of 11 patients; P = 0.030). In the control group, the prevalence of neither orthostatic hypertension nor orthostatic hypotension changed after surgery.
Conclusions. ETS attenuates autonomic circulatory response under nitrous oxide anesthesia.
SpringerLink Date Friday, February 01, 2002
(1) Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan, JP
(2) First Department of Surgery, Showa University School of Medicine, Tokyo, Japan, JP
Abstract
Purpose. Our purpose was to examine perioperative alterations in hemodynamic changes with head-up tilt (HUT) in patients undergoing endoscopic thoracic sympathectomy (ETS).
Methods. The subjects were 11 patients with essential hyperhidrosis scheduled to undergo ETS (ETS group) and 9 age-matched volunteers undergoing minor surgery (control group). HUT was performed (40°; 5 min) before and after the surgery, under nitrous oxide anesthesia. Orthostatic hypertension and hypotension in response to HUT were defined as changes of 10% or greater in systolic blood pressure.
Results. The increase in heart rate in response to HUT was significantly reduced after surgery in the ETS group (from 34 ± 18 to 14 ± 11 beats·min−1; P < 0.001), but not in the control group (from 23 ± 18 to 22 ± 12 beats·min−1; P = 0.911). Orthostatic hypertension disappeared completely after ETS (from 5 of 11 to none of 11 patients; P = 0.035), whereas the prevalence of orthostatic hypotension increased significantly after ETS (from 3 of 11 to 9 of 11 patients; P = 0.030). In the control group, the prevalence of neither orthostatic hypertension nor orthostatic hypotension changed after surgery.
Conclusions. ETS attenuates autonomic circulatory response under nitrous oxide anesthesia.
SpringerLink Date Friday, February 01, 2002
Ventricular Ectopic Rhythms and Ventricular Fibrillation following Sympathectomy
Harris, A. S., Estandia, A., and Tillotson, R. F.:
Ventricular Ectopic Rhythms and Ventricular
Fibrillation following Cardiac Sympathectomy and
Coronary Occlusion. Am. J. Physiol. 165: 505
(June), 1951.
Abrupt coronary artery occlusion in dogs with
open chest is followed by a 10 minute period (phase
I) of ectopic discharges of increasing frequency which
either pass through a maximum and then decrease
or end in fibrillation. A two stage occlusion avoids
the danger of fibrillation in this phase. During the
next four and one-half to eight hours the ectopic
frequency is no more than 5 per minute (phase II)
in those animals which survive. Following this there
is a rapid increase in ectopic frequency (phase III)
which reaches a maximum in 10 to 20 hrs. after the
artery has been tied. This ectopic activity usually
lasts two to four days. Experiments were devised to
obtain evidence concerning the effects of upper
thoracic sympathectomy upon the occurrence of
ectopic ventricular complexes during each of these
three phases. The authors, as a result of their ex-
periments, came to the point of view that "multiple
excitatory factors contribute to the production of
ectopic impulses following coronary occlusion during
all three phases and that sympathetic nerve excitation is one of these factors.
Ventricular Ectopic Rhythms and Ventricular
Fibrillation following Cardiac Sympathectomy and
Coronary Occlusion. Am. J. Physiol. 165: 505
(June), 1951.
Abrupt coronary artery occlusion in dogs with
open chest is followed by a 10 minute period (phase
I) of ectopic discharges of increasing frequency which
either pass through a maximum and then decrease
or end in fibrillation. A two stage occlusion avoids
the danger of fibrillation in this phase. During the
next four and one-half to eight hours the ectopic
frequency is no more than 5 per minute (phase II)
in those animals which survive. Following this there
is a rapid increase in ectopic frequency (phase III)
which reaches a maximum in 10 to 20 hrs. after the
artery has been tied. This ectopic activity usually
lasts two to four days. Experiments were devised to
obtain evidence concerning the effects of upper
thoracic sympathectomy upon the occurrence of
ectopic ventricular complexes during each of these
three phases. The authors, as a result of their ex-
periments, came to the point of view that "multiple
excitatory factors contribute to the production of
ectopic impulses following coronary occlusion during
all three phases and that sympathetic nerve excitation is one of these factors.
disabilities or inconveniences
The symptoms referable to hypertension were
definitely reduced or eliminated by sympathectomy.
The eyeground findings were also markedly changed
in the direction of normalcy. However, there were
very few electrocardiographic alterations postopera-
tively.
The authors conclude that the extensive sympa-
thectomy performed by them retards and in some
instances arrests the progression of the hypertensive
disease process. However, they emphasize the fact
that this type of operation is associated with certain
disabilities or inconveniences, such as pain, which
may be intense, postural lowering of blood pressure,
producing dizziness and other symptoms, excessive
sweating in areas of regeneration or in areas not de-
nervated, and obstruction of nasal airways caused by
swelling of the mucous membranes.
Grimson, K. S., Orgain, E. S., Anderson, B., Broome,
R. A., Jr., and Longino, F. H.: Results of Treat-
ment of Patients with Hypertension by Total
Thoracic and Partial to Total Lumbar Sympathec-
tomy, Splanchnicectomy and Celiac Ganglionec-
tomy. Ann. Surg. 129: 850 (June), 1949.
definitely reduced or eliminated by sympathectomy.
The eyeground findings were also markedly changed
in the direction of normalcy. However, there were
very few electrocardiographic alterations postopera-
tively.
The authors conclude that the extensive sympa-
thectomy performed by them retards and in some
instances arrests the progression of the hypertensive
disease process. However, they emphasize the fact
that this type of operation is associated with certain
disabilities or inconveniences, such as pain, which
may be intense, postural lowering of blood pressure,
producing dizziness and other symptoms, excessive
sweating in areas of regeneration or in areas not de-
nervated, and obstruction of nasal airways caused by
swelling of the mucous membranes.
Grimson, K. S., Orgain, E. S., Anderson, B., Broome,
R. A., Jr., and Longino, F. H.: Results of Treat-
ment of Patients with Hypertension by Total
Thoracic and Partial to Total Lumbar Sympathec-
tomy, Splanchnicectomy and Celiac Ganglionec-
tomy. Ann. Surg. 129: 850 (June), 1949.
marked athropy of the extremity, etc
Contraindications to the use of sympathectomy
are marked atrophy of the extremity with loss of
subcutaneous tissues and consequent diminution in
the available vascular bed, constant intractable pain
uninfluenced by sympathetic block, the rapid onset
of symptoms and a rapidly progressive vascular lesion.
BLOOD VESSELS AND VASCULAR
DISEASE
Blain, A., III, and Campbell, K. N.: Lumbar Sympa-
thectomy for Arteriosclerosis Obliterans. Surgery
25: 950 (June), 1949.
are marked atrophy of the extremity with loss of
subcutaneous tissues and consequent diminution in
the available vascular bed, constant intractable pain
uninfluenced by sympathetic block, the rapid onset
of symptoms and a rapidly progressive vascular lesion.
BLOOD VESSELS AND VASCULAR
DISEASE
Blain, A., III, and Campbell, K. N.: Lumbar Sympa-
thectomy for Arteriosclerosis Obliterans. Surgery
25: 950 (June), 1949.
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