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

Monday, February 23, 2009

Risk of road traffic accidents associated with the prescription of drugs

Engeland A, Skurtveit S, Mørland J.

Norwegian Institute of Public Health, University of Bergen, Norway. anders.engeland@isf.uib.no

The risk was markedly increased in users of natural opium alkaloids (2.0; 1.7-2.4), benzodiazepine tranquillizers (2.9; 2.5-3.5), and benzodiazepine hypnotics (3.3; 2.1-4.7). Somewhat increased or unchanged SIRs were found for nonsteroidal antiiflammatory drugs (1.5; 1.3-1.9), selective beta-2-adrenoreceptor agonists (i.e., antiasthmatics, 1.5; 1.0-2.1), calcium receptor antagonists (0.9; 0.5-1.5), and penicillin (1.1; 0.8-1.5). CONCLUSIONS: The increased risk of being involved in a road accident as driver while receiving prescribed opiates and benzodiazepines supported the results from other studies.

1: Ann Epidemiol. 2007 Aug;17(8):597-602. Epub 2007 Jun 18.
http://www.ncbi.nlm.nih.gov/pubmed/17574863

PMID: 17574863 [PubMed - indexed for MEDLINE]

Beta blockers as psychotropic drugs
Encephale. 1976;2(1):85-101.

CNS-related (side-)effects of beta-blockers with special reference to mechanisms of action
beta-Adrenoreceptor antagonists are liable to produce behavioural side-effects such as drowsiness, fatigue, lethargy, sleep disorders, nightmares, depressive moods, and hallucinations. These undesirable actions indicate that beta-blockers affect not only peripheral autonomic activity but also some central nervous mechanisms. In experimental animals beta-blockers have been found to reduce spontaneous motor activity, to counteract isolation-, lesion-, stimulation- and amphetamine-induced hyperactivity, and to produce slow-wave and paradoxical sleep disturbances. Furthermore, central effects such as tranquilizing influences are used for the treatment of conditions such as anxiety.
Peripherally mediated actions whereby beta-blockers induce changes in the autonomic activity in the periphery, which are relayed to the CNS to induce changes in activity of a variety of central systems.
1: Eur J Clin Pharmacol. 1985;28 Suppl:55-63
PMID: 2865151 [PubMed - indexed for MEDLINE]

Effect of betablockers on autonomic activation

Psychologist Alain Brunet of McGill University in Montreal (Canada) is looking for ways to make those improvements happen, through the use of an old-fashioned 'beta-blocker' drug called Propranolol. Primarily intended as heart medicine, beta blocker drugs like Propranolol have long been used "off label" to treat anxiety patients because they block or lessen "peripheral autonomic activation" (e.g., symptoms of anxiety occurring in the periphery of the body such as might be noticeable in the limbs e.g., clammy skin, sweating, shaking, etc.). A socially phobic patient who normally would freak out during a speech can take Propranolol and not notice their palms getting sweaty, etc. Because they are not distracted by arousal symptoms that do not occur (or occur with less force), they are better able to remain focused on their speaking task and to execute it without incident.

Propranolol may have another useful effect as well - in that it may suppress the long term storage of emotional memories. A Psychiatrist at Harvard, Dr. Roger Pitman, has shown that trauma patients treated with Propranolol immediately after traumas (accidents, rapes) show somewhat fewer PTSD-like symptoms than patients who did not receive Propranolol. The explanation for this is that Propranolol interferes with the formation of the strong emotional memories that might otherwise crystallize into true trauma memories.

The articles I've read about the Brunet and Pitman research suggest these researchers are thinking that the mechanism for the Propranolol effect lays in its ability to block the storage or re-storage of trauma memories. However, another explanation is also possible. It might be enough that the drug simply blunts the SNS arousal and activation that would normally occur when trauma memories are discussed.
Treating PTSD with Beta-Blockers
Posted by Mark Dombeck, Ph.D. on Tue, Apr 18th 2006

Reader's response to article: After reading your article I was greatly dismayed to note that you would class the memory suppression induced by beta blockers as beneficial. These drugs do not only 'supress' memory, they remove the emotional attatchment of memories both long and short term. They are also not selective about which memories will be be stripped of thier emotive content and can desensitise futher emotive responses, i.e. to graphic or disturbing imagery. Do you value the memory of your wife on your wedding day? The pivotal experiences through which you establish meaning in your life? Would you, for all your triumphs over adversity, through difficulties which have hindered you in some ways yet enriched your life in others think it worth it for them to be rendered obselete in a matter of hours? Is it a good thing to veiw images of injured and dying people and feel nothing? "If you disrupt those memories, remove continuity, what you have is an erosion of personhood." This was said by Dr. William B. Hurlbut, a consulting professor in biology at Stanford University and a member of the President's Council on Bioethics, I am deeply comforted that someone has the broad mindedness to consider the humanistic and ethical side of issues pertaining to the use of these drugs in an unbiased manner. I find the research alluded to in your article disturbing due to the casual nature in which it is expressed. An overdose or a mis-diagnoses due to oversensitivity to a beta-blocker such as propranolol can shatter somebodies life, or more to the point shatter somebody, leaving them with serious mental health difficulties and a complete inability to cope with the altered state in which they may find themselves.
http://www.mentalhelp.net/poc/view_doc.php?type=weblog&id=51&wlid=6&cn=1

lowering of heart can result in:

In a meta-analysis, lowering of heart rate was associated with increases in cardiac mortality, risk for nonfatal MI (Myocardial Infarction), and heart failure.

— Mark S. Link, MD

Published in Journal Watch Cardiology December 10, 2008




A review of 22 studies published in the medical journal The Lancet in January may suggest another reason to be wary of beta-blockers for high blood pressure. The review concluded that diuretics and beta-blocker treatments may increase the chances of developing type 2 diabetes.
http://www.news-medical.net/?id=22051