The amount of compensatory sweating depends on the patient, the damage that the white rami communicans incurs, and the amount of cell body reorganization in the spinal cord after surgery.
Other potential complications include inadequate resection of the ganglia, gustatory sweating, pneumothorax, cardiac dysfunction, post-operative pain, and finally Horner’s syndrome secondary to resection of the stellate ganglion.
www.ubcmj.com/pdf/ubcmj_2_1_2010_24-29.pdf

After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration
After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within a year.

http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract

Tuesday, January 6, 2009

Chronotropic incompetence is one of the consequences on sympathectomy

Chronotropic incompetence, an attenuated heart rate response to exercise, is a predictor of all-cause mortality in healthy populations. This association may be independent of exercise-induced myocardial perfusion defects.
Impaired Chronotropic Response to Exercise Stress Testing as a Predictor of Mortality
Michael S. Lauer, MD; Gary S. Francis, MD; Peter M. Okin, MD; Fredric J. Pashkow, MD; Claire E. Snader, MS; Thomas H. Marwick, MD
JAMA. 1999;281:524-529.

Chronotropic incompetence was defined as the failure to achieve 85% of the age-predicted maximal HR (APMHR), <80%>chronotropic response index (CRI).
Chronotropic incompetence, an attenuated heart rate (HR) response to exercise, is an independent predictor of cardiovascular mortality, but it is not known whether chronotropic incompetence is related to carotid atherosclerosis. The association between chronotropic incompetence and carotid atherosclerosis in 8567 (age 47.6±8.8 years) healthy men was examined.
http://eurheartj.oxfordjournals.org/cgi/content/abstract/27/8/954

Long-term efficiency of endoscopic thoracic sympathicotomy: survey 10 years after surgery

We detected 8 patients (53%) complaining about a decent to moderate recurrence of hand sweating and compensatory and gustatory sweating were observed in 9 (60%) and 5 (33%) patients, respectively. Reported side effects related to surgery were paresthesias of the upper limb and the thoracic wall in 8 patients (53%) and recurrent pain in the axillary region in 1. At an average 12 years after surgery 47% of patients were satisfied with the treatment results, 40% were disappointed. Six patients (40%) affirmed they would ask for the operation if it were to be redone. Our findings indicate that results of ETS deteriorate and compensatory sweating does not improve with time. It is mandatory to inform patients of the potential long-term adverse effects before surgery.
Interact Cardiovasc Thorac Surg. 2008 Sep 30.

Autonomic paresthesia

Autonomic and Peripheral Nerve Laboratory, Dept. of Neurology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA 02215, USA.

OBJECTIVE: To describe the biology of phantom sweating, a novel autonomic neuropathy symptom, based on a description of a patient with a small fiber and autonomic neuropathy. METHODS: Clinical and laboratory assessments. RESULTS: Evidence of a generalized small fiber and autonomic neuropathy. INTERPRETATION: Phantom sweating occurs frequently after sympathectomy but has not been reported previously in patients with a somatosensory or autonomic neuropathy. We suggest that this symptom is an autonomic paresthesia.

Clinical Autonomic Research

Volume 18, Number 6 / December, 2008

Cardiac arrest - a major complication of bilateral sympathectomy

Thoracic sympathectomy has usually minimal consequences if unilateral, especially on the right side. For
bilateral procedures, a mean reduction of the heart rate of 12% was reported. Around 50% of patients have bradycardia in the following minutes of abilateral surgery and mean and diastolic blood pressures significantly reduced.
Since the sympathectomy will block the chronotropic response, a significant increase of the ejection volume is observed when the patient moves in the erect position from dorsal decubitus.

We present a case of a patient who suffered from a 43 s asystolic cardiac arrest the night following a second contralateral thoracoscopic T2-T3 sympathectomy for severe axillary and truncal hyperhidrosis. The cardiovascular effects of cervico-dorsal sympathectomy will be reviewed. Evaluation required to prevent such a serious cardiac complication will also be discussed.
Interact Cardiovasc Thorac Surg. 2008 Nov 27.