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

Saturday, July 9, 2011

blunted hypoxic pulmonary vasoconstriction due to partial interruption of the sympathetic nerve supply to the lung by bilateral thoracic sympathectomy

Anaesth Intensive Care. 2003 Oct;31(5):581-3.

Orthodeoxia--an uncommon presentation following bilateral thoracic sympathectomy.

Source

Departments of Intensive Care and Vascular Surgery, Sir Charles Gairdner Hospital, Pharmacology Unit, School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia.

Abstract

We present a case of orthodeoxia (postural hypoxaemia) which resulted from a combination of lung collapse/consolidation and blunted hypoxic pulmonary vasoconstriction due to partial interruption of the sympathetic nerve supply to the lung by bilateral thoracic sympathectomy.
http://www.ncbi.nlm.nih.gov/pubmed/14601286

Bezold-Jarisch Reflex and Sympathectomy

Much attention has been focused on the Bezold-Jarisch Reflex as the cause of sudden acute bradycardia during spinal or epidural anesthesia. The basis of this reflex is a decrease in stretch tension on mechanoreceptors located in the left ventricle. A sudden empty left ventricle triggers this paradoxical reflex which resulst in increased parasympathetic activity. Sympathetic output is also inhabited. Anything that decreases left ventricular end-diastolic volume suddenly, such as spinal anesthesia may rigger his reflex.
   By contrast, bradycardia that is slow on onset, developing after administration of spinal anesthesia, has been recognized and attributed to decreased activity of the cardioaccelerator nerves to the heart. This is a different phenomenon than the sudden bradycardia or asystole in the patient presented above. Complete sympathectomy of the heart itself reduces heart rate by about 20%.

Complications of regional anesthesia

Front Cover
Springer, 2007 - 506 pages

An unopposed vagal tone secondary to sympathectomy

1.) An unopposed vagal tone secondary to sympathectomy. This sympathectomy occurs 2-6 dermatomes higher than sensory block, so that a sensory block of T6 can conceivably inhibit all of the sympathetic innervation to the heart.

2.) The Bezold-Jarisch reflex – which may be widely under appreciated phenomenon. You’ll be surprised how many clinicians are not well versed in this essential physiology.

Sympathectomy → reductions in venous tone → profound decreased venous return. This activates mechanoreceptors embedded within the walls of the myocardium → stimulating vagal afferents → vasomotor center of medulla → increased vagal tone to the heart, thus slowing or stopping the heart entirely to allow enough filling time to generate an effective stroke volume.
http://allnurses.com/certified-registered-nurse/sympathectomies-and-atropine-124910.html

A drastic reduction in tissue noradrenaline, adrenaline, and dopamine levels occurred after sympathectomy

Selective upper abdominal sympathectomy increased basal acid output in rats but was without effect on stimulated acid output, serum gastrin concentration, and gastric mucosal histidine decarboxylase activity. The sympathectomy was verified by fluorescence histochemistry and determination of tissue catecholamines. A drastic reduction in tissue noradrenaline, adrenaline, and dopamine levels occurred after sympathectomy, and fluorescence microscopy showed a complete loss of adrenergic nerve fibers. Vagotomy reduced catecholamine levels in the stomach wall by 50% but did not affect the catecholamine content in the pancreas and small bowel. Surprisingly, combined vagotomy and upper abdominal sympathectomy resulted in lower catecholamine levels than sympathectomy alone in extragastric but not in gastric tissues.

http://www.ncbi.nlm.nih.gov/pubmed/6515311