CS or compensatory hyperhidrosis is the most common and troublesome side-effect of hyperhidrosis surgery and is the leading cause of patient regret after sympathetic surgery.
A severe form of CS is the split-body syndrome, corposcindosis, which is deļ¬ned as an
autonomic neuropathy in which the sympathetic nerve function has been divided into two distinct
regions, one dead and the other hyperactive. In these cases, the patient feels like he or she is living
in two separate bodies.
The rates of CS in some series from the past 10 years are summarized in Table 4, with rates of mild CS varying from 14% to 90% and severe CS from 1.2% to 30.9%.
Some investigators only report on patients who have severe CS because they believe that almost all patients develop mild CS after sympathectomy.
Pascal DUMONT Thorac Surg Clin 18 (2008) 193–207
"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, November 27, 2009
produces the equivalent of a sympathectomy, preventing noradrenaline release
Bretylium
Class III
Mode of action
- increases action potential duration and refractory period of cardiac cells
- antifibrillatory effect on ventricular muscle - may be more important than class III effects in emergency treatment of malignant ventricular arrhythmias
- initially causes noradrenaline release and then produces the equivalent of a
sympathectomy, preventing noradrenaline release (class II effect)
Clinical use
- useful adjunct to DC shock in managing life-threatening ventricular
arrhythmias, especially refractory VF
- theoretical advantages of lignocaine but no advantage has been demonstrated clinically
Class III
Mode of action
- increases action potential duration and refractory period of cardiac cells
- antifibrillatory effect on ventricular muscle - may be more important than class III effects in emergency treatment of malignant ventricular arrhythmias
- initially causes noradrenaline release and then produces the equivalent of a
sympathectomy, preventing noradrenaline release (class II effect)
Clinical use
- useful adjunct to DC shock in managing life-threatening ventricular
arrhythmias, especially refractory VF
- theoretical advantages of lignocaine but no advantage has been demonstrated clinically