The results suggest that cardiac sympathectomy induced by epidural anesthesia can suppress partially baroreceptor function by interrupting sympathetic efferent fibers innervating the heart during high levels of epidural anesthesia, but that lumbar sympathectomy during epidural anesthesia is unlikely to affect baroreceptor activity.
Anesth Analg. 1983 Sep;62(9):815-20
http://www.ncbi.nlm.nih.gov/pubmed/6881570?dopt=Abstract
"Sympathectomy is a technique about which we have limited knowledge, applied to disorders about which we have little understanding." Associate Professor Robert Boas, Faculty of Pain Medicine of the Australasian College of Anaesthetists and the Royal College of Anaesthetists, The Journal of Pain, Vol 1, No 4 (Winter), 2000: pp 258-260
Friday, January 30, 2009
suppression of baroreflex function can be detrimental
In this study, baroreflex control of HR was completely inhibited in 9 of 21 patients in the depressor test but in only 1 of 19 patients in the pressor test. All patients who showed complete inhibition had received bilateral T2-3 sympathectomy. Responses to decreased blood pressure are mediated by the sympathetic nervous system, whereas responses to increased blood pressure predominantly involve vagal compensation (13). Therefore, it seems that the effects of sympathetic denervation were most prominent in the depressor test after ETS.
The suppression of baroreflex function can be detrimental during anesthetic management. In particular, a poorly preserved baroreflex response to decreasing blood pressure may exaggerate hemodynamic perturbation after a sudden loss of circulating blood volume. In addition, it is possible that patients who have received ETS will show unexpected HR responses after the administration of a vasopressor or vasodilator. We conclude that baroreflex response as a compensatory function for hemodynamic changes is suppressed in patients who receive ETS.Anesth Analg 2004;98:37-39
http://www.anesthesia-analgesia.org/cgi/content/full/98/1/37
Sexual dysfunction after sympathectomy
LS, like any other surgical procedure, is not without its share of complications which include failure of adequate denervation, brief paralytic ileus, hyperhydrosis in parts of the body which remain normally innervated, sexual dysfunction, and post-sympathectomy neuralgia.
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijs/vol18n1/lumbar.xml
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijs/vol18n1/lumbar.xml
Pathophysiology of Diarrhea and Malabsorption
Disordered motility
Post-vagotomy
Post-sympathectomy
Diabetic neuropathy
Hyperthyroidism
Addison’s disease (adrenal insufficiency)
Irritable bowel syndrome
http://ocw.tufts.edu/Content/48/lecturenotes/571075