spontaneous vasospasm 10 days after sympathectomy

We have observed spontaneous vasospasm in the hands on emotional disturbances within ten days after sympathectomy, but no clinical evidence of this in the feet. I believe that sensitization of the denervated smooth muscle in the digital arterioles to adrenine is a better explanation of this phenomenon than local sensitivity to cold (Lewis, 1930), incomplete sympathectomy (Adson, and Leriche and Fontaine, 1933), or the common argument that Raynaud's disease is moresevere in the hands than in the feet.
PROCEEDINGS OF THE TWENTY-SEVENTH ANNUAL MEETING OF THE
AMERICAN SOCIETY FOR CLINICAL INVESTIGATION
HELD IN ATLANTIC CITY, N. J., MAY 6, 1935

Effect of Sympathectomy on Blood Flow

These experimental hemodynamic considerations, in general, explain the occasional untoward effects of sympathectomy, and provide support for some of the empirically derived indications and contra-in- dications for sympathectomy.
Sympathectomy should be tailored to denervate only the ischemic area, if this is possible. Sympathectomy should not be performed where collateral channels do not exist, because of the danger of flow shifts. Sympathectomy probably should not be employed for relief of intermittent claudication.
Annals of Surgery August 1963

Reduced resistances of septal artery collateral channels after cardiac sympathectomy

Journal	Basic Research in Cardiology
Publisher	Steinkopff
ISSN	0300-8428 (Print) 1435-1803 (Online)
Issue	Volume 78, Number 4 / July, 1983

No increase in muscle blood flow following sympathectomy

Recent evidence suggests that this increase in total blood flow represents, in the main, arteriovenous shunting with little, if any, effect on the nutritive blood flow at the tissue level. Studies aimed at investigating the effect of lumbar sympathectomy on regional tissue circulation have utilized the local clearance of radioactive isotopes. No significant change in the clearance of these substances in muscle have been noted following lumbar sympathectomy in man. However, the data on skin clearance remains conflicting.
Vascular and Endovascular Surgery, Vol. 6, No. 5, 227-238 (1972)
http://ves.sagepub.com/cgi/pdf_extract/6/5/227

Imbalance of regional cerebral blood flow and oxygen consumption: effect of vascular alpha adrenoceptor blockade

Cerebral venous O2 saturations (a measure of cerebral O2 supply/consumption balance) were found to be significantly heterogeneous under control conditions. The coefficient of variation (CV = 100 x SD/mean) averaged 18%. The average cerebral venous O2 saturation was 59 +/- 11%. Administration of N-methyl chlorpromazine significantly reduced this heterogeneity through a reduction in the number of veins with low O2 saturations (CV = 11%). The average value increased slightly but significantly to 62 +/- 8%. Thus, N-methyl chlorpromazine eliminated many microregions of high O2 extraction. This indicated that vascular alpha adrenoceptors limit cerebral blood flow to some of the brain regions.
Neuropharmacology. 1993 Mar;32(3):297-302.

Long-term cardiopulmonary function after thoracic sympathectomy

Lung function tests revealed a significant decrease in forced expiratory volume in 1 second (FEV₁) and forced expiratory flow between 25% and 75% of vital capacity (FEF_25%–75%) in both groups (FEV₁ of –6.3% and FEF_25%–75% of –9.1% in the conventional thoracic sympathectomy group and FEV₁ of –3.5% and FEF_25%–75% of –12.3% in the simplified thoracic sympathectomy group). DLCO and heart rate at rest and maximal values after exercise were also significantly reduced in both groups (DLCO of –4.2%, DLCO corrected by alveolar volume of –6.1%, resting heart rate of –11.8 beats/min, and maximal heart rate of –9.5 beats/min in the conventional thoracic sympathectomy group and DLCO of –3.9%, DLCO corrected by alveolar volume of –5.2%, resting heart rate of –10.7 beats/min, and maximal heart rate of –17.6 beats/min in the simplified thoracic sympathectomy group). Airway resistance increased significantly in the group of patients undergoing conventional thoracic sympathectomy (+13%).
No significant differences were found between the conventional and simplified thoracic sympathectomy groups.
J Thorac Cardiovasc Surg 2010;139:405-410

The cerebral vessels became hypersensitive to epinephrine after cervical sympathectomy

The cerebral vessels became hypersensitive to epinephrine after cervical sympathectomy.
HERTZMAN, A. B., AND DILLON, J. B.
Annual Review of Physiology
Vol. 4: 187-214 (Volume publication date March 1942)

Importance of bilateral sympathetic innervation on cerebral blood flow autoregulation in the thalamus

Brain Res. 1987 Jun 16;413(2):297-301.

Effects of bilateral sympathetic innervation on the regulation of cerebral blood flow to the thalamus were examined in spontaneously hypertensive rats (SHR). The superior cervical ganglion was removed on one side or bilaterally, and blood flow in the thalamus was repeatedly measured with a hydrogen clearance technique during a stepwise increase in arterial pressure. Sympathectomy on one side neither had effects on the pressure-flow relationship nor on the blood pressure levels of upper limits of autoregulation in the ipsilateral thalamus. In contrast, bilateral sympathetic denervation impaired the autoregulatory function in the thalamus and the upper limits were significantly lower than those in intact rats: 206 +/- 8 vs 226 +/- 10 mm Hg, respectively (P less than 0.02).
PMID: 3607478 [PubMed - indexed for MEDLINE]

effect of electric stimulation of the sympathetic cord in the upper thoracic level on the middle cerebral artery blood flow

Source: CEREBROVASCULAR DISEASES Volume: 2 Issue: 6 Pages: 359-364 Published: NOV-DEC
1992
Times Cited: 20 References: 41
Abstract: The effect of electric stimulation of the sympathetic cord in the upper thoracic level on the middle cerebral artery blood flow veloCitY (V(MCA)) in humans was examined using transcranial Doppler sonography monitoring during surgery for palmar hyperhidrosis.
Sympathetic stimulation resulted in marked and rapid increases Of V(MCA). The responses were preceded by prompt increases of mean arterial blood pressure (MABP) and heart rate (HR).
Division of the sympathetic cord cranially or caudally to the stimulation site partially reduced the V(MCA), MABP and HR responses. Both these operations reduced sympathetic pathways to the heart as reflected by a decrease in HR and MABP. The integrity of the sympathetic pathway from the stimulation site through the superior cervical ganglion and the carotid plexus was not a prerequisite for a V(MCA) response. Our data suggest that the V(MCA) increase mainly results from stimulation of the heart and the cardiovascular system, resulting in marked increases of blood
pressure and heart rate.

Obviously, it is not simply a compensatory hyperhidrosis transposition from postoperative reduction

In contrast, it is of particular interest to find that patients with cerebroischemic syndrome who received thoracic sympathectomy rarely developed substantial postsympathectomy compensatory hyperhidrosis (PCH). The etiology of PCH is still unclear. Obviously, it is not simply a compensatory hyperhidrosis transposition from postoperative reduction of palmar sweating. Based on our observations, we postulated two possible mechanisms. The first of these mechanisms is denervation hypersensitivity of the surgically injured distal sympathetic stump. This could explain why CH may appear soon after sympathectomy, but is not found in patients who undergo local excision of axillary sweat glands or undergo local treatment. Another mechanism is regeneration of preganglionic fibers or collateral sprouting of sympathetic fibers from the proximal stump of the sympathetic trunk. This could explain the long-term existence of PCH.
Ann Thorac Surg 2001;72:667-668

Receptor hypersensitivity is a common problem after significant sympathetic injury, including clammy hands, erythema, and allodynia. When sympathetic nerves regenerate, they may establish aberrant connections to sensory receptors, muscles, or other sympathetics receptors; this may lead to an over-response or abnormal response.
http://wiki.cns.org/wiki/index.php/Injury,_Sympathetic_Nerve

Cervical sympathectomy and cerebral microvascular and blood flow responses to hypocapnic hypoxia

The number of perfused arterioles and capillaries was significantly higher under hypoxic conditions than under normoxic conditions in sham and ganglionectomized animals. During hypoxia, the percent of arterioles per squared millimeter perfused increased to 63 +/- 5% in sham-lesioned rats and to a significantly greater extent, 80 +/- 6%, in ganglionectomized rats. The percentage of capillaries per squared millimeter perfused changed similarly. The peripheral sympathetic nervous system appeared to play an important role in the control of cerebral microvascular response to hypoxia.
Am J Physiol Heart Circ Physiol 256: H460-H467, 1989;

http://ajpheart.physiology.org/cgi/content/abstract/256/2/H460

In patients with sympathetic failure, the orthostatic reduction in cerebral blood velocity and oxygenation is larger.

In patients with sympathetic failure, the orthostatic reduction in cerebral blood velocity and oxygenation is larger. Patients who become symptomatic within 5 minutes of standing are characterized by a pronounced orthostatic fall in blood pressure, cerebral blood velocity, and oxygenation manifest within the first 10 seconds of standing.
Stroke. 2000;31:1608-1614

Increased cerebral vasoconstriction or reduced vasomotion also may attenuate CBFV variability

Altered cerebral hemodynamics in early Alzheimer disease: a pilot study using transcranial Doppler.

J Alzheimers Dis. 2009 Jul;17(3):621-9.

Autonomic neural control of cerebral hemodynamics

it has been found that in humans CBFV in the middle cerebral artery decreased substantially during
lower body negative pressure (LBNP) and head-up tilt in the absence of systemic hypotension, which suggests the presence of cerebral vasoconstriction associated with augmented sympathetic nerve activity during orthostatic stress.
IEEE Eng Med Biol Mag. 2009 Nov-Dec;28(6):54-62.

SYMPATHETIC-NERVE STIMULATION IN HUMANS INCREASES MIDDLE CEREBRAL-ARTERY BLOOD-FLOW VELOCITY

The effect of electric stimulation of the sympathetic cord in the upper thoracic level on the middle cerebral artery blood flow veloCitY (V(MCA)) in humans was examined using transcranial Doppler sonography monitoring during surgery for palmar hyperhidrosis. Sympathetic stimulation resulted in marked and rapid increases Of V(MCA). The responses were preceded by prompt increases of mean arterial blood pressure (MABP) and heart rate (HR). Division of the sympathetic cord cranially or caudally to the stimulation site partially reduced the V(MCA), MABP and HR responses. Both these operations reduced sympathetic pathways to the heart as reflected by a decrease in HR and MABP. The integrity of the sympathetic pathway from the stimulation site through the superior cervical ganglion and the carotid plexus was not a prerequisite for a V(MCA) response. Our data suggest that the V(MCA) increase mainly results from stimulation of the heart and the cardiovascular system, resulting in marked increases of blood pressure and heart rate. CEREBROVASCULAR DISEASES Volume: 2 Issue: 6 Pages: 359-364 Published: NOV-DEC 1992

ETS suppresses the activation of the sympathetic nervous system slightly, similar to beta-blocker therapy

On the 123I-MIBG imaging studies, the early H/M ratio before EUTS was 2.35 ± 0.26 and postoperatively it was 2.29 ± 0.23. The delayed H/M ratio before EUTS was 2.59 ± 0.3 and after the procedure it was 2.66 ± 0.27. There was no significant difference between the H/M ratio before and after EUTS. The washout rate after EUTS (14.27 ± 4.71%) was significantly lower than that measured before EUTS (18.36 ± 5.13%; p < 0.01).

Endoscopic upper thoracic sympathectomy is a minimally invasive procedure; no local denervation was found after EUTS. Findings on 123I-MIBG imaging studies indicate that EUTS suppresses the activation of the sympathetic nervous system slightly, similar to beta-blocker therapy.

Journal of Neurosurgery March 2004 Volume 100, Number 3

a significant decrease in heart rate and ejection fraction, a significant decrease of ‘rest’ and ‘peak’ heart rate

In pulmonary function tests, we found a statistically significant decrease forced expiratory flow in small airways and an increase of residual volume, a significant decrease in heart rate and ejection fraction, a significant decrease of ‘rest’ and ‘peak’ heart rate, and a significant increase of oxygen pulse (O2 pulse) and oxygen peak uptake ( peak) after ETS (p < 0.05).

Eur J Cardiothorac Surg 2009;36:491-496. doi:10.1016/j.ejcts.2009.03.059

Significant reductions in maximal heart rate (HR) and oxygen and carbon dioxide uptakes were observed

The maximal midexpiratory flow was the only variable that showed significant changes, from 101% (SD, 26%) to 92% (SD, 27%) [p < 0.05]. Ten patients had positive bronchial challenge test results that remained positive 3 months after surgery, and 2 patients whose challenge test results were negative before surgery became positive after sympathectomy. Significant reductions in maximal heart rate (HR) and oxygen and carbon dioxide uptakes were observed during the maximal exercise test.
Chest. 2005 Oct;128(4):2702-5.

Changes in hemodynamics of the carotid and middle cerebral arteries before and after endoscopic sympathectomy in patients with palmar hyperhidrosis

Patients who underwent T-2 sympathectomy demonstrated a significant increase in blood flow volume and flow velocities of the CAs and MCA, especially on the left side. Asymmetry of sympathetic influence on the hemodynamics of the CAs and MCA was noted. The usefulness of sympathectomy for the treatment of ischemic cardiovascular and cerebrovascular disease deserves further investigation.
Journal on Neurosurgery March 1999 Volume 90, Number 3

http://thejns.org/doi/abs/10.3171/jns.1999.90.3.0463

Clinical significance of chemosensitivity in chronic heart failure

Increased chemosensitivity has been observed in HF (heart failure) and, in order to clarify its pathophysiological and clinical relevance, the aim of the present study was to investigate its impact on neurohormonal balance, breathing pattern, response to exercise and arrhythmic profile.

Those with enhanced chemosensitivity to both hypoxia and hypercapnia (i.e. HVR and HCVR), compared with those with normal chemosensitivity, had significantly (all P<0.01) higher noradrenaline (norepinephrine) and BNP (B-type natriuretic peptide) levels, higher prevalence of daytime and night-time CSR, worse NYHA (New York Heart Association) class and ventilatory efficiency [higher VE (minute ventilation)/VCO(2) (carbon dioxide output) slope], and a higher incidence of chronic atrial fibrillation and paroxysmal non-sustained ventricular tachycardia, but no difference in left ventricular volumes or LVEF. A direct correlation was found between HVR or HCVR and noradrenaline.

Clin Sci (Lond). 2008 Apr;114(7):489-97.

Impaired autonomic function results in impaired cerebral regulation

The absence of an increase in the power of 0.1 Hz blood pressure and cerebral blood flow velocity oscillations confirmed autonomic neuropathy in the diabetic patients. Gain analysis did not show altered cerebral regulation. The decrease in phase shift in the patients indicates a more passive transmission of neck suction-induced blood pressure fluctuations onto the cerebrovascular circulation, i.e. altered cerebral regulation, in the patients, and is therefore suited to identifying subtle impairment of cerebral regulation in these patients.
http://www.springerlink.com/content/14m7g478j7ux11hv/

Superior cervical ganglionectomy caused a marked decrease in noradrenaline concentrations in major cerebral arteries

Superior cervical ganglionectomy caused a marked decrease in noradrenaline concentrations in major cerebral arteries (−77%), although the reduction was less pronounced (−34%) in small pial vessels. Sympathectomy decreased by 33% 5-HT concentrations in the major cerebral arteries but was without effect on 5-HT levels in the small pial vessels.

Journal of Neurochemistry

Volume 56 Issue 2, Pages 681 - 689

Published Online: 5 Oct 2006

Received March 28, 1990 revised manuscript received July 12, 1990; accepted August 14, 1990.

Experimental study of progressive facial hemiatrophy: effects of cervical sympathectomy in animals

Progressive facial hemiatrophy (Romberg's syndrome) is of unknown cause and uncertain pathogenesis. The main pathogenetic hypotheses are: sympathetic system alterations, localized scleroderma, trigeminal changes, possibly of genetic origin. To test the hypothesis of sympathetic system alterations, we designed an experimental model with ablation of the superior cervical sympathetic ganglion in rabbits, cats and dogs. All the animals were operated upon when 30 days old and were examined monthly for 1 year. During this period localized alopecia, corneal ulceration, keratitis, strabismus, enophthalmos, ocular atrophy, hemifacial atrophy and slight bone atrophy on the side of the sympathectomy were observed. Thus, cervical sympathectomy reproduces in animals the principal clinical alterations of Romberg's syndrome. Our data suggest that the sympathetic system is involved in the pathogenesis of this syndrome.

Rev Neurol (Paris). 1991;147(8-9):609-11.

sympathectomy causes qualitative alterations in bone modeling and remodeling

The results further support that a regional sympathectomy causes qualitative alterations in bone modeling and remodeling, leading to bone resorption.
J Auton Nerv Syst. 2000 Jan 14;78(2-3):113-6.

noradrenaline loss in the sympathetic nervous system of the heart

Symptoms or signs of abnormal autonomic nervous system function occur commonly in several neurological disorders.
Clinical evaluations have depended on physiological, pharmacological, and neurochemical approaches. Recently, imaging of sympathetic noradrenergic innervation has been introduced and applied especially in the heart. Most studies have used the radiolabeled sympathomimetic amine, (123)I-metaiodobenzylguanidine. Decreased uptake or increased "washout" of (123)I-metaiodobenzylguanidine-derived radioactivity is associated with worse prognosis or more severe disease in hypertension, congestive heart failure, arrhythmias, and diabetes mellitus. This pattern may reflect a high rate of postganglionic sympathetic nerve traffic to the heart. Many recent studies have agreed on the remarkable finding that all patients with Parkinson's disease and orthostatic hypotension have a loss of cardiac sympathetic innervation, whereas all patients with multiple system atrophy, often difficult to distinguish clinically from Parkinson's disease, have intact cardiac sympathetic innervation. Because Parkinson's disease entails a postganglionic sympathetic noradrenergic lesion, the disease appears to be not only a movement disorder, with dopamine loss in the nigrostriatal system of the brain, but also a dysautonomia, with noradrenaline loss in the sympathetic nervous system of the heart. As new ligands are developed, one may predict further discoveries of involvement of components of the autonomic nervous system in neurological diseases.
Semin Neurol. 2003 Dec;23(4):423-33.

Psychoneurological applications of endoscopic sympathetic blocks

In addition to more widely and longer known indications of ETS, various neurological disorders and psychologically stressful situations in their worst expressions might be alleviated by the reversible ESB procedure. The patients with social phobia, especially those who have also blushing and/or stage fright type of heart racing, benefit from the ESB. The disturbances of the sympathetic nervous system, e. g. in Parkinson's disease and multiple system atrophy might be alleviated with sympathetic block, especially the extrapyramidal symptoms in these diseases. In migraine, sympathetic surgery has been noted to give some help. The unilateral left-sided block has been effective in long QT-syndrome type arrhythmias. In schizophrenia, the phobic, paranoic or confusional reactions have been tentatively treated by the sympathetic block.
Clin Auton Res. 2003 Dec;13 Suppl 1:I20-1; discussion I21.

heart rate was significantly reduced at rest (14%), at sub-maximal exercise (12.3%)

heart rate was significantly reduced at rest (14%), at sub-maximal exercise (12.3%), and at peak exercise (5.7%), together with a significant increase in oxygen pulse (11.8, 12.7, and 7.8%, respectively). The rate pressure product (RPP) was also significantly reduced following the surgical procedure at all three study stages, while all other physiological variables measured remained unchanged. It is suggested that thoracic-sympathetic denervation affects the heart, sweating, and circulation of the respective denervated region

Eur J Appl Physiol. 2008 Sep;104(1):79-86. Epub 2008 Jun 10.

"Other therapies included sympathectomy, severing the nerves to blood vessels (a surgery with a great risk of complication!)"

Your money or your life: strong medicine for America's health care system

By David M. Cutler

Oxford University Press US, 2005

Carbon dioxide absorption into the blood during thoracoscopic surgery

Respiratory function and pulmonary gas exchange are affected in thoracoscopic procedures where a pneumothorax is introduced using CO2. Carbon dioxide absorption into the blood during thoracoscopic surgery using intrathoracic carbon dioxide insufflation may lead to respiratory acidosis, increased ventilation requirements, and possible serious cardiovascular compromise.
http://www.koreamed.org/SearchBasic.php?RID=173908&DT=1

lactic acidosis, complication of thoracoscopic sympathectomy

We report a case of severe lactic acidosis in a patient undergoing thoracoscopic sympathectomy under general anesthesia who received repeated albuterol.
Lactic acidosis can occur in two different clinically distinguishable categories. The first (type A) occurs when oxygen delivery to the tissues is compromised. The second (type B) occurs when either lactate production is increased or lactate removal is decreased without obvious oxygen delivery problems. ^7,8
β-2 Receptor activation produces excess glycogenolysis and lipolysis. ¹⁰ Increased glycogenolysis eventually leads to increased concentrations of pyruvate. Pyruvate is converted to acetyl CoA, which enters the citric acid cycle. If pyruvate does not enter this aerobic pathway, it is converted to lactate instead, thereby potentially causing lactic acidosis.
journals.lww.com › Home › August 2003 - Volume 99 - Issue 2

sympathectomy further increases muscle protein degradation of acutely diabetic rats

Muscle & Nerve

Volume 38 Issue 2, Pages 1027 - 1035

Unilateral Pulmonary Edema with Contralateral Thoracic Sympathectomy

A case is presented of pathologically proved unilateral pulmonary edema due to uremia and blood transfusion.
The lung that was spared had been denervated by a thoracic sympathectomy eight years earlier. That this
denervation may have been responsible for the unilaterailty of the pulmonary edema is suggested by experimen-
tal evidence supporting a neurogenic etiology of noncardiac pulmonary edema.
1975;68;736-739 Chest

respiratory and hemodynamic changes due to both CO2 absorption and the effects of increased intraperitoneal pressure

Carbon dioxide pneumoperitoneum has been shown to produce respiratory and hemodynamic changes due to both CO₂ absorption and the effects of increased intraperitoneal pressure. We have measured the blood gas, end-tidal CO₂, and hemodynamic changes produced during extraperitoneal CO₂ insufflation (n=22). These have been compared with the changes occurring during CO₂ pneumoperitoneum (n=11) under standardized anesthetic conditions.
Our results suggest that extraperitoneal CO₂ insufflation may be safer than CO₂ pneumoperitoneum in patients with preexisting cardiorespiratory disease.
http://www.springerlink.com/content/327x6038183t5321/

autonomic denervation causes salivary gland atrophy

Extended periods of autonomic denervation, liquid diet feeding (reduced reflex stimulation) or duct ligation cause salivary gland atrophy. The latter two are reversible, demonstrating that glands can regenerate provided that the autonomic innervation remains intact. The mechanisms by which nerves integrate with salivary cells during regeneration or during salivary gland development remain to be elucidated.
Autonomic Neuroscience Volume 133, Issue 1, Pages 3-18 (30 April 2007)

Permanent pain following sympathectomy

The mean inpatient pain scores were significantly higher in the biportal group (1.2±0.6) than that in the uniportal group (0.8±0.5, P=0.025). For the first three weeks after operation, four out of 20 (20%) patients in the uniportal group constantly suffered from mild or moderate residual pain while eight out of 25 (32%) cases in the biportal group (P=0.366). Among them, two cases in the uniportal group and five cases in the biportal group need to take analgesics.
Chinese Medical Journal, 2009, Vol. 122 No. 13 : 1525-1528

three-phase bone scan (TPBS) after sympathectomy are identical to those reported in early RSD

Three-phase bone scan (TPBS) after sympathectomy are identical to those reported in early RSD and these alterations bear no relationship to the success of sympathectomy regarding pain relief. The mechanisms underlying alterations of TPBS as well as the potential mechanisms of sympathectomy failures are discussed.
The Clinical Journal of Pain: June 1994 - Volume 10 - Issue 2

marked dysaesthesia over the front of the chest and in the axilla

Thirty-five patients were followed up after an average of 7.8 years (range 2-17 years). In one patient unilateral reoperation was carried out four months after the first operation. Since the first operation 34 patients had suffered from neither palmar nor axillary sweating. However 20 had permanent compensatory hyperhidrosis, and 15 suffered from gustatory facial sweating, which had usually started within six months of operation. Four, in whom two spinal thoracic nerves had also been resected, reported marked dysaesthesia over the front of the chest and in the axilla, lasting for several years.
http://www.ncbi.nlm.nih.gov/pubmed/1114879

Recurrent sweating occurred in only 17.6% of patients

http://thejns.org/doi/abs/10.3171/spi.2005.2.2.0151

The results of endoscopic sympathectomy deteriorate progressively from the immediate outcome

This report examines the intermediate-term results of endoscopic transaxillary T2 sympathectomy for palmar hyperhidrosis.

Fifteen patients (16 per cent) developed recurrent sweating, but none required reoperation.

Twelve patients (13 per cent) were dissatisfied with the operative results, mainly owing to compensatory hyperhidrosis, which occurred in 88 patients (97 per cent) within the first year.

The results of endoscopic sympathectomy deteriorate progressively from the immediate outcome.

British Journal of Surgery

Volume 86 Issue 1, Pages 45 - 47

Published Online: 2 Jan 2003

phantom sweating - autonomic neuropathy symptom

Phantom sweating is a sensation in which the patient feels that sweat is about to burst out of skin pores, but in which sweating never actually occurs. In a series of 100 patients undergoing bilateral upper dorsal sympathectomy for palmar hyperihidrosis, 82 patients were specifically questioned and 48 (59%) reported phantom sweating. Phantom sweating started soon after the operation, was triggered by the same stimuli that caused hyperhidrosis preoperatively, lasted for a few seconds, and tended to diminish with time. In an average follow-up of 18 months, the phenomenon disappeared in 11 patients (23%). Phantom sweating is probably a symptom of residual sympathetic activity.
http://www.ncbi.nlm.nih.gov/pubmed/911065
Angiology. 1977 Nov;28(11):799-802.

Patients who have undergone sympathectomy are not suitable controls. Why?

Again, patients admitted with any malignancy, cholecys- tectomy, thyroidectomy, renal disease, cardiac disease, sympathectomy, or vascular graft were eliminated as controls.

This article reviews the evidence that neuroleptics may increase the risk of breast cancer via their effects on prolactin secretion.

Paul M. Schyve; Francine Smithline; Herbert Y. Meltzer
Neuroleptic-induced Prolactin Level Elevation and Breast Cancer: An Emerging Clinical Issue
Arch Gen Psychiatry, Nov 1978; 35: 1291 - 1301.

bilateral ganglionectomy resulted in minor decreases in the cerebrovascular contents of ACh

The effects of uni- or bilateral surgical ablation of the SPG, a putative origin of the cholinergic cerebrovascular innervation, were investigated on these two specific cholinergic markers at various postoperative times. ChAT activity and ACh levels were enriched in the cerebral as compared to the peripheral arteries. Among the cerebrovascular tissues tested, ACh levels were particularly high in the circle of Willis and the vertebrobasilar segments and, to a lesser extent, in the middle cerebral artery. Lower levels were found in the small pial vessels and choroid plexus. Overall, ChAT activity measured in different arterial beds paralleled the distribution of ACh. Following uni- or bilateral removal of the SPG, slight reductions were observed in ChAT activity in rostral cerebral arteries and pial vessels overlying the frontal cortex. Similarly, bilateral ganglionectomy resulted in minor decreases in the cerebrovascular contents of ACh in these same vascular segments.
J Cereb Blood Flow Metab. 1991 Mar;11(2):253-60.

Sympathethetic influence on Cerebral Blood Volume following excsion of the superior cervical ganglia

Shortly after operation there is a leakage of the noradrenaline transmitter from the degenerating nerve terminals with and accompanying activation of the vascular receptor (the CVB was foudn to be reduced by 28%). When the transmitter has disappeared from the degenerating terminals, the neural influence of the vessels is abolished (the blood volume was increased by 34% compared to unoperated controls). About 2 weeks later, a pronounced denervation supersensitivity of the vascular receptors to circulating catecholamines develops (the CVB became nromal or even subnormal).
Another circumstance giving the impression of inconsistent results after denervation is that a difference in the effects of pre- and postganglionic operation is usually not fully considered.
Cellular and Molecular Life Sciences
Volume 28, Number 7 / July, 1972

Cervical sympathectomy causes alveolar bone loss

Both superior cervical ganglionectomy and oral challenge with P. gingivalis resulted in accelerated alveolar bone loss. Gingival tissues in the superior cervical ganglionectomy group showed increased expression of the cytokines interleukin-1alfa, tumor necrosis factor-alfa and interleukin-6. The density of neuropeptide Y-immunoreactive fibers was decreased following superior cervical ganglionectomy. Osteoclasts were observed in the superior cervical ganglionectomy and P. gingivalis-challenged groups. Conclusion:  Both superior cervical ganglionectomy and oral challenge with P. gingivalis induced alveolar bone loss.

http://www.ingentaconnect.com/content/mksg/per/2009/00000044/00000006/art00002

73% of patients suffered form 'gustatory sweating' and variety of phenomena

In a series of 100 bilateral upper dorsal sympathectomies performed for palmar hyperhidrosis,
gustatory sweating and other gustatory phenomena were reported by 68 of 93 patients (73%),
followed up for an average of 11/2 years. These gustatory phenomena were quite different from
physiologic gustatory sweating: a wide range of gustatory stimuli caused a variety of phenomena in
varied locations. There was a negative correlation between the incidence of these phenomena and the
occurrence of Horner's syndrome after sympathectomy. Analysis of our observations, and of clinical
and experimental work of others, leads to the conclusion that gustatory phenomena after upper
dorsal sympathectomy are the result of preganglionic sympathetic regeneration or collateral sprouting
with aberrant synapses in the superior cervical ganglion.
•
Arch Neurol. 1977;34(10):619-623.

36% intense 'compensatory sweating'

The results and complication rates have not necessarily been similar in reports worldwide. This can be explained in part due to the lack of clear-cut definitions for the indications, success, complications, side effects, and short- and long-term follow-up data of the procedures. It is well known that sympathectomy is often complicated by CH; the reported incidence rates vary greatly from 30% to 84% [15]. In our series it has been noted in 62.5% of the patients (26.5% moderate and 36% intense).

Although VATS sympathectomy is a simple and quick procedure, unusual complications such as chylothorax may occur [16]. However, lethal or potentially serious complications have also been reported [8, 17, 18], such as subclavian artery injury, damage to brachial plexus, large hemothorax, cerebral edema, neurologic sequelae, sinus bradycardia, and cardiac arrest.
Ann Thorac Surg 2003;76:886-891

significant decrease of MAP, cardiac arrythmia, cardiac arrest and hypoxemia - complications of ETS surgery

Both MAP 1 and MAP2were reduced after sympahtectomy (P < 0.05). Heart rate was reduced transiently after the sympahtectomy and returned to the baseline value. PaO2 was reduced in 10 min after each right lung ventilation (P < 0.05) and left lung ventilation (P < 0.05).

Since thoracoscopic sympathectomy can rarely cause a significant decrease of MAP, cardiac arrythmia, cardiac arrest and hypoxemia, we concluded that invasive BP monitoring should be used for early detection of those complications and immediate arterial sampling.
Department of Anesthesiology and Pain Medicine, College of medicine, Kyung Hee University, Seoul, Korea
2004; 8: 147-153

perioperative alterations in hemodynamic changes

Our purpose was to examine perioperative alterations in hemodynamic changes with head-up tilt (HUT) in patients undergoing endoscopic thoracic sympathectomy (ETS).
Methods. The subjects were 11 patients with essential hyperhidrosis scheduled to undergo ETS (ETS group) and 9 age-matched volunteers undergoing minor surgery (control group). HUT was performed (40°; 5 min) before and after the surgery, under nitrous oxide anesthesia. Orthostatic hypertension and hypotension in response to HUT were defined as changes of 10% or greater in systolic blood pressure.
Results. The increase in heart rate in response to HUT was significantly reduced after surgery in the ETS group (from 34 ± 18 to 14 ± 11 beats·min−1; P < 0.001), but not in the control group (from 23 ± 18 to 22 ± 12 beats·min−1; P = 0.911). Orthostatic hypertension disappeared completely after ETS (from 5 of 11 to none of 11 patients; P = 0.035), whereas the prevalence of orthostatic hypotension increased significantly after ETS (from 3 of 11 to 9 of 11 patients; P = 0.030). In the control group, the prevalence of neither orthostatic hypertension nor orthostatic hypotension changed after surgery.

	Journal of Anesthesia
ISSN	0913-8668 (Print) 1438-8359 (Online)
Issue	Volume 16, Number 1 / February, 2002

controversial subject

The treatment of facial blushing and or facial sweating is a controversial subject. The uncontrolled and embarrassing situation of facial sweating and blushing was thought to be easily treated with ETS. This came about when ETS was done for patients with sweaty hands. Among those patients who also suffered from facial blushing and/or facial sweating the results were also successful at reducing facial blushing and/or sweating. However over the years two observations were made when this operation was applied only for patients with facial blushing and or facial sweating. Percentage wise these patients developed a higher rate of severe compensatory sweating. Also these patients experienced a higher degree of dissatisfaction due to the side effects. Side effects such as facial flushed feelings, loss of stamina, facial skin sensitivity, increased amount of fatigue and others led Dr. Reisfeld to the decision not to perform ETS when only facial blushing or facial sweating were involved. The clinical experience that was accumulated over the last several years is what has allowed Dr. Reisfeld to reach this assessment. More time is needed to reach a definite conclusion with regard to the most appropriate procedure for patients who suffer from only facial blushing and/or facial sweating.
http://www.sweaty-palms.com/blushing.html

haemodynamic instability during surgery

Rapid and excessive carbon dioxide insufflation into the closed chest cavity may create a tension pneumopthorax, displace the mediastinum, and compress the lungs and great vessels with consequent haemodynamic instability. During carbon dioxide insufflation using endobronchial intubation, Hartrey and colleagues reported a decrease in systolic arterial pressure of > 20 mm Hg in 21% of patients. Similarly, we have reported sudden hypotension and bradycardia after injudicious carbon dioxide insufflation.

In common with other surgical procedures, routine monitoring during thorascopic sympathectomy should include ECG, pulse oximetry and capnography. However, during thorascopic surgery, SpO2 and end-tidal carbon dioxide have the additional function of monitoring the surgical technique.
BJA 1997;79: 113-119

collateral effects of thoracic sympathectomy not disclosed to patients

Several reports also demonstrate significantly lower heart rate increases during exercise in subjects who have undergone bilateral ISS [9–12] compared to pre-surgical levels. In spite of this high occurrence, recent reviews on the usual collateral effects of thoracic sympathectomy still do not include these possible cardiac consequences [6].
Eur J Cardiothorac Surg 2001;20:1095-1100

Compensatory sweating occurred in 87% of the patients - serious in 36% and incapacitating in 6%

Ann Thorac Surg. 2004 Nov;78(5):1801-7.

The rates of compensatory sweating and gustatory sweating were 93.5% and 49.4%, respectively

Surgical Endoscopy
Volume 23, Number 7 / July, 2009

Patients decide in what form the surgery should be performed!

The 25 patients with palmar hyperhidrosis who insisted on receiving ETS of T4 experienced no compensatory hyperhidrosis. Of the 54 patients with facial blushing who received ESB of T2, 23 experienced compensatory hyperhidrosis.
http://www.springerlink.com/content/j6k17332rhqjv663/

90 % of patients experienced severe compensatory sweating

Postsurgery, severe compensatory sweating was experienced in 90% of patients (P < 0.0001). The sites of
compensatory sweating were the back (75%), abdomen (51%), feet (23%), groin and thigh (13%), chest (13%), andaxillae (8%). Transient whole-body sweating for no apparent reason was experienced in 30% of patients.

Thirty-seven patients (11%) regretted having undergone the surgical procedure.

Main outcome measures included the incidence of dry hands, compensatory sweating, chest pain, upper-limb muscle weakness, shortness of breath, and gustatory phenomena;

Surg Laparosc Endosc Percutan Tech. 2000 Aug;10(4):226-9.

Gustatory sweating 56 %, recurrence rate 38% after Sympathectomy

Gustatory sweating in the neck was reported by nine patients (56%), which usually occurred in response to
hot or spicey foods.
The symptoms are not troublesome for most patients, but in severe cases furhter surgery might be required.
Six patients (38%/) also had mild recurrent sweating of the hands, especially in response to either extreme heat,
anxiety or food.
A return of sweating in the hands is common occurrence in patients followed up for sufficient length of time.

Annals of the Royal College of Surgeons of England (1989) vol. 7.1

Results support our hypothesis that blockade of the sympathetic nervous system substantially degrades ligament

2004, vol. 96, n^o2, pp. 711-718 [8 page(s) (article)] (44 ref.)

Supersensitivity to noradrenaline and chronic neuropathic pain conditions

Supersensitivity to noradrenaline contributes to certain vascular disorders (e.g., hypertension) and chronic neuropathic pain conditions (e.g., complex regional pain syndrome). We aimed to develop a procedure for inducing adrenergic supersensitivity that could be used to investigate the role of catecholamines in these clinical conditions.
These observations indicate that prolonged depletion of adrenergic stores by guanethidine induces adrenergic supersensitivity in cutaneous vessels, and that adrenergic supersensitivity enhances thermal hyperalgesia in the presence of noradrenaline.
Autonomic Neuroscience
Volume 88, Issues 1-2, 12 April 2001, Pages 86-93

Darren M. Lipnicki and Peter D. Drummond^,

School of Psychology, Murdoch University, Murdoch, Western Australia 6150, Australia

increased blood flow after sympathectomy is due to increased nonnutritive AVA flow

In the acute canine model, increased blood flow after sympathectomy is due to increased nonnutritive arteriovenous anastomoses (AVA) flow, with no change in total hindlimb capillary flow, both at rest and during reactive hyperemia.

Surgery. 1977 Jul;82(1):82-9.

sympathectomy on cerebral blood flow

CBF increased significantly after the elevation of systemic blood pressure compared with that in the control group, and cerebral autoregulation was impaired. After a 1-hour study, the specific gravity of the cerebral tissue in the treated group significantly decreased; electron microscopic studies at that time revealed brain edema. It is suggested that depletion of brain noradrenaline levels causes a disturbance in cerebral microvascular tone and renders the cerebral blood vessels more vulnerable to hypertension.
J Neurosurg. 1991 Dec;75(6):906-10.

sympathectomy leading to an extracranial steal phenomenon.

The incidence and extension of brain infarcts was increased in animals with additional ipsilateral cervical preganglionic sympathectomy. Sympathectomy did not affect markedly the respiration and systemic circulation. The effect of sympathectomy was attributed to a cutaneous vasodilation, leading to an extracranial steal phenomenon.
J Neurol Neurosurg Psychiatry. 1983 August; 46(8): 768–773.

ventilation technique may prevent hypoxemia during endoscopic sympathectomy

The near-sitting position, a single-lumen tube, and a continuous two-lung ventilation technique is simple and may prevent hypoxemia during endoscopic transthoracic sympathectomy.
Journal of Cardiothoracic and Vascular Anesthesia
Volume 10, Issue 2, February 1996, Pages 210-212

chronic sympathectomy on muscle fibre composition

It is concluded that sympathectomy induces several biochemical changes in skeletal muscle which constitute a change and increase in fast myosin light chain synthesis and a corresponding fibre type transformation.
Received 24 August 1987; accepted 26 October 1987

Clinical Physiology and Functional Imaging

"We have previously reported functional and histological studies in five beagle dogs with unilateral lumbar sympathectomy. Three months later, fatiguability in the gracilis muscles was increased on the denervated sides, and this was associated with an increase in the relative distribution of FT fibres. Biochemical studies now show that these changes were associated with an increase in cytosolic protein without change in DNA content; this is consistent with an increase in cell size. There was a reduction in the proportion of slow myosin light chain isoforms from 50 +/- 7 to 34 +/- 6%. Noradrenaline levels were increased on the denervated sides but this may reflect greater vascularity. Calcium content did not correlate with fibre type but there was a positive relation with both noradrenaline content (r = 0.73; P less than 0.05) and DNA content (r = 0.84; P less than 0.05). It is concluded that sympathectomy induces several biochemical changes in skeletal muscle which constitute a change and increase in fast myosin light chain synthesis and a corresponding fibre type transformation."

Journal: Clinical physiology (Oxford, England) (Clin Physiol), published in ENGLAND.

Reference: 1988-Apr; vol 8 (issue 2) : pp 181-91

Dates: Created 1988/06/08; Completed 1988/06/08; Revised 2004/11/17;

PMID: 3359751, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

Sympathectomy--how much side-effects are acceptable?

Lakartidningen 2001 Oct 10;98(41):4494-5

[Article in Swedish]

Berglund F, Berglund E.

Publication Types:

Letter

PMID: 11699265 [PubMed - indexed for MEDLINE]

Cardiac Arrest during Endoscopic Thoracic Sympathicotomy with One Lung Ventilation

Korean J Anesthesiol. 2007 Apr;52(4):479-483. Published online 2007 April 30. doi: 10.4097/kjae.2007.52.4.479.

Cardiac Arrest during Endoscopic Thoracic Sympathicotomy with One Lung Ventilation under General Anesthesia - Two cases report -
Sang Woo Jung, M.D., Sung Wook Park, M.D.,* and Moo Il Kwon, M.D.*
Department of Anesthesiology and Pain Medicine, Seoul Sacred Heart Hospital, Seoul, Korea.
*Department of Anesthesiology and Pain Medicine, College of Medicine, Kyung Hee University, Seoul, Korea.
Corresponding author (Email: kwonmooil@yahoo.co.kr )
Received November 10, 2006.

Effect of Endoscopic Transthoracic Sympathicotomy on Heart Rate Variability

Endoscopic transthoracic sympathicotomy is a recently developed technique to reduce pain and ischemia in patients with severe angina pectoris.
ETS caused a shift of sympathovagal balance toward parasympathetic tone.
The American Journal of Cardiology
Volume 79, Issue 11, 1 June 1997, Pages 1447-1452

Does the autonomic nervous system play a role in the development of insulin resistance?

vAn altered balance of the parasympathetic and sympathetic nervous activity, mainly explained by an attenuated parasympathetic activity, might contribute to the development of insulin resistance and Type 2 diabetes.
Diabet Med. 2003 May;20(5):399-405.

Dysregulation of the autonomic nervous system can be a link between visceral adiposity and insulin resistance.

Obes Res. 2005 Apr;13(4):717-28.

Lindmark S, Lönn L, Wiklund U, Tufvesson M, Olsson T, Eriksson JW.

Department of Medicine, Umeå University Hospital, S-901 85 Umeå, Sweden. stina.lindmark@medicin.umu.se

Limited sympathectomy does not reduce postoperative compensatory sweating

Journal of Vascular Surgery
Volume 37, Issue 1, January 2003, Pages 124-128

Causes of Orthostatic Hypotension:

Neurologic (involving autonomic dysfunction) -

Central

Multiple system atrophy (previously Shy-Drager syndrome)

Parkinson's disease

Strokes (multiple)

Spinal cord

Tabes dorsalis

Transverse myelitis

Tumors

Peripheral

Amyloidosis

Diabetic, alcoholic, or nutritional neuropathy

Familial dysautonomia (Riley-Day syndrome)

Guillain-Barré syndrome

Paraneoplastic syndromes

Pure autonomic failure (formerly called idiopathic orthostatic hypotension)

Surgical sympathectomy

http://www.merck.com/mmpe/sec07/ch069/ch069d.html

Pulmonary functional abnormalities after upper dorsal sympathectomy

http://chestjournal.chestpubs.org/content/77/5/651.abstract

NIH Clinical Studies book includes Sympathectomy among Neurocardiologic disorders

Perhaps everyone considering ETS surgery should see this: the National Institute of Health (NIH) Clinical Studies book, where sympathectomy is listed as a "Neurocardiologic Disorder", right alongside Parkinson's Disease, etc.

http://www.truthaboutets.com/Pages/NIH.html

I think it is fair to assume that of the thousands of people who have undergone sympathectomy for excessive sweating or facial blushing, few if any of them understood they were consigning themselves to a permanent autonomic system disorder.

Abnormal HRR recovery after maximal exercise

Abnormal HRR was defined as a decrease in heart rate < or = 12 beats at 1 minute after maximal exercise.

Patients with abnormal HRR had significantly more mild or greater coronary heart disease.

Am J Cardiol. 2009 Mar 1;103(5):611-4. Epub 2009 Jan 12.

short and long-term effects on QT dispersion and autonomic balance after endoscopic sympathicotomy (ETS)

Heart rate variability reflects autonomic balance of the heart. QT dispersion is a marker of cardiac electrical instability in patients with ischemic heart disease.

The HRV analysis showed a significant change of indices reflecting sympatho-vagal balance indicating significantly reduced sympathetic and increased vagal tone. These changes still persisted after 2 years. Global HRV increased over time with significant elevation of SDANN after 2 years. QT dispersion was significantly reduced 1 month after surgery and the dispersion was further diminished 2 years later.
Int J Cardiol. 1999 Aug 31;70(3):283-92.

Cardiopulmonary exercise testing following bilateral thoracoscopic sympathicolysis in patients with essential hyperhidrosis

Essential hyperhidrosis is characterised by an overactivity of the sympathetic fibres passing through the upper dorsal sympathetic ganglia D2-D3. Anatomical interruption at the D2-D3 level is a highly effective treatment for essential hyperhidrosis but also causes (partial) cardiac denervation and, after surgical sympathicolysis, important impairment of cardiopulmonary exercise function has been observed.
Thorax. 1995 Oct;50(10):1097-100.

Plasma catecholamine concentrations in essential hyperhidrosis and effects of thoracoscopic D2-D3 sympathicolysis

Preoperative NA and A plasma levels were all within the normal limits used in our laboratory. After TS, mean NA plasma levels are significantly decreased, whereas mean A are unchanged. We conclude that sympathetic overactivity in EH is limited to the upper dorsal sympathetic ganglia and that some of the cardiovascular and pulmonary effects that are observed after TS may be associated with the decrease in NA.
Eur J Clin Invest. 1997 Mar;27(3):202-5.

prolongation of the isometric (tension) period (TP) of the left ventricle occurred in the majority (72 per cent) of all cases after sympathectomy

The prolongation of the isometric (tension) period (TP) of the left ventricle which occurred in the majority (72 per cent) of all cases after unilateral or bilateral transthoracic sympathectomy (without or with unilateral or bilateral transthoracic splanchnicotomy) indicates a diminution of inotropic cardiac action. It can be assumed to correspond to the cholinergic (vagal) preponderance which results from a partial or complete sympathetic denervation of the heart. Reduction of the pulse pressure oc-
curred in 56 per cent of the cases, probably due to the same mechanism.

www.chestjournal.org/content/38/4/423.full.pdf
by W RAAB - 1960

collateral effects of thoracic sympathectomy not disclosed to patients

Several reports also demonstrate significantly lower heart rate increases during exercise in subjects who have undergone bilateral ISS [9–12] compared to pre-surgical levels. In spite of this high occurrence, recent reviews on the usual collateral effects of thoracic sympathectomy still do not include these possible cardiac consequences [6].

To the best of our knowledge, this is the first report on the effect of unilateral and bilateral ISS on heart rate response to exercise in the same patients. A significant decrease in the heart rate to workload relationship during exercise is constantly observed a few weeks after surgery, but does not seem to exclusively result from right-sided surgery as previously suggested.
Patients are generally aware of severe but infrequent complications. They should also be informed of the relative exercise bradycardia resulting from this kind of surgery.
Eur J Cardiothorac Surg 2001;20:1095-1100

Cervico-thoracic sympathectomy for Long QT Syndrome

Left cervicothoracic sympathetic ganglionectomy should be reserved for patients with LQTS who are intolerant of beta-blockers or have recurrent syncope that is refractory to beta-blocker.
Cardiovasc Surg. 1995, 3:475–478

sympathectomy tended to accelerate the sclerodermatous and trophic ulcerative processes

by RJ Calvert - 1955

Peripheral sympathectomy prevents the normal occurrence of a variety of bodily changes

"Peripheral sympathectomy prevents the normal occurrence of variety of bodily changes and hence, a fortiori, prevents sensory feedback of those changes" (p.68)
Biology and emotion By Neil NcNaughton
Cambridge University Press 1989

”The practice of surgical and chemical sympathectomy is based on poor quality evidence, uncontrolled studies and personal experience.“

Cochrane Database Syst Rev. 2003;(2):CD002918.

autonomic neuropathy in which the sympathetic nerve function has been divided into two distinct regions

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 defined 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

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

alterations in the relative abundance of TH mRNA mediate changes in TH activity induced by chronic stress or sympathectomy

These results indicate that alterations in the relative abundance of TH mRNA mediate changes in TH activity induced by chronic stress or sympathectomy, and that these changes require an intact sympathetic input.

Journal of Neuroscience Research

Volume 16 Issue 1, Pages 13 - 24

Published Online: 11 Oct 2004

Cardiac hypertrophy accelerated by left cervical sympathectomy

Cardiac hypertrophy in spontaneously hypertensive rats was accelerated by denervation of the left cervical sympathetic ganglia. Supersensitivity due to denervation may also exist in cardiac muscles.

	Biomedical and Life Sciences
SpringerLink Date	Tuesday, August 02, 2005

The HPA axis regulates the secretion of glucocorticoids (GCs), which play important roles in diverse brain functions, including cognition, emotion

Several neurological diseases are frequently accompanied by dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis regulates the secretion of glucocorticoids (GCs), which play important roles in diverse brain functions, including cognition, emotion, and feeding. Under physiological conditions, GCs are adaptive and beneficial; however, prolonged elevations in GC levels may contribute to neurodegeneration and brain dysfunction. In the current study, we demonstrate that apolipoprotein E (apoE) deficiency results in age-dependent dysregulation of the HPA axis through a mechanism affecting primarily the adrenal gland.
The Journal of Neuroscience, March 1, 2000, 20(5):2064-2071

peripheral sympathetic denervation may modulate immune function via activation of the hypothalamic-pituitary-adrenal (HPA) axis

Together, these findings suggest that peripheral sympathetic denervation may modulate immune function via activation of the hypothalamic-pituitary-adrenal (HPA) axis.

Ann N Y Acad Sci. 2000;917:923-34.

Increasing evidence suggests that the detrimental effects of glucocorticoid (GC) hypersecretion occur by activation of the hypothalamic-pituitary-adrenal (HPA) axis in several human pathologies, including obesity, Alzheimer's disease, AIDS dementia, and depression. The different patterns of response by the HPA axis during chronic activation are an important consideration in selecting an animal model to assess HPA axis function in a particular disorder.

Detrimental effects of chronic hypothalamic-pituitary-adrenal axis activation. From obesity to memory deficits
Raber J Mol Neurobiol 1998 Aug; 18(1): 1-22

Renin-Angiotensin activation following sympathectomy

"After sympathectomy, BP is maintained at nearly normal levels mainly through activation of the renin angiotensin system. (Heart and Circulatory Physiology, Vol 259, Issue 5 1337-H1342, Copyright © 1990 by American Physiological Society).

We should note that baroreflex response for maintaining cardiovascular stability is
suppressed in the patients who received the ETS.
Anesthesiology 2001; 95:A160

“cervical sympathectomy isolates all these sympathetic ganglion cells from the central nervous system and prevents them from responding to reflex or emotional changes in the central nervous system." Cunningham's Manual of Practical Anatomy: Volume III: Head, Neck and Brain, 1986

The renin-angiotensin system (RAS) is a major regulatory system of cardiovascular and renal function. Many new aspects of this system have been revealed in recent years, leading to new therapeutic approaches. It's well known that RAS blocking agents have potent antiatherosclerotic effects, which are mediated by their antihypertensive, anti-inflammatory, antiproliferative, and oxidative stress lowering properties. Inhibitors of RAS are now first-line treatments for hypertensive target organ damage. Their effects are greater than expected by their ability to lower blood pressure. Angiotensin receptor blockers reduce the frequency of atrial fibrillation and stroke, are also able to prevent cardiovascular and renal events in diabetic patients. Thus, blockade of RAS represents one of the most important strategies in order to reduce cardiovascular risk.

Neurol Sci. 2008 Sep;29 Suppl 2:S277-8.

Renin-angiotensin system and stroke.

Marcheselli S, Micieli G.

Patients may develop bradycardia after surgical procedure

Upper-Thoracic Sympathectomy; Patients may develop bradycardia after surgical procedure
Heart Disease Weekly. Atlanta: Feb 23, 2003. pg. 71

sympathectomy-induced increases in choroidal thickness, vascular luminal area and large venules and large arterioles

Sympathetic denervation for 6 weeks resulted in increased choroidal thickness, vascular luminal area, numbers of large venules and large arterioles, and capillaries in the outer nuclear layer. Capsaicin pretreatment prevented sympathectomy-induced increases in choroidal thickness, vascular luminal area and large venules and large arterioles, whereas pterygopalatine ganglionectomy was without effect."
Biotech Week. Atlanta: Jan 21, 2004. pg. 396

83% of patients reported severe 'compensatory sweating'

Fully 83% of patients who underwent T2 sympathectomy reported severe compensatory sweating one year after surgery and the majority of those reported they regretted the decision to have the surgery.
Heather Ennis. Medical Post. Toronto: Feb 15, 2005. Vol. 41, Iss. 7; pg. 17, 2 pgs

sympathectomy increased the bacterial tissue burden

sympathectomy increased the bacterial tissue burden, which was caused by a reduction in corticosterone tonus, and decreased both interleukin-4 secretion from peritoneal cells and the influx of lymphocytes into the peritoneal cavity. In both models, the peritoneal wall was the critical border for systemic infection. These results show the dual role of the sympathetic nervous system in sepsis. It can be favorable or unfavorable, depending on the innate immune effector mechanisms necessary to overcome infection.
The Journal of Infectious Diseases. Chicago: Aug 15, 2005. Vol. 192, Iss. 4; pg. 560, 13 pgs

pineal gland and extracerebral blood vessels folowing sympathectomy

Following removal of the superior cervical ganglion (SCG), large molecular weight (MW) NGF species, including proNGF-A, were increased in distal intracranial SCG targets, such as pineal gland and extracerebral blood vessels (bv).

Brain Research; Research from Miami University provides new data about brain research

Science Letter. Atlanta: May 15, 2007. pg. 1746

Neuronal Source of Plasma Dopamine

Determinants of plasma norepinephrine (NE) and epinephrine concentrations are well known; those of the third endogenous catecholamine, dopamine (DA), remain poorly understood. We tested in humans whether DA enters the plasma after corelease with NE during exocytosis from sympathetic noradrenergic nerves. We reviewed plasma catecholamine data from patients referred for autonomic testing and control subjects under the following experimental conditions: during supine rest and in response to orthostasis; intravenous yohimbine (YOH), isoproterenol (ISO), or glucagon (GLU), which augment exocytotic release of NE from sympathetic nerves; intravenous trimethaphan (TRI) or pentolinium (PEN), which decrease exocytotic NE release; or intravenous tyramine (TYR), which releases NE by nonexocytotic means. We included groups of patients with pure autonomic failure (PAF), bilateral thoracic sympathectomies (SNS-x), or multiple system atrophy (MSA), since PAF and SNS-x are associated with noradrenergic denervation and MSA is not. Orthostasis, YOH, ISO, and TYR increased and TRI/PEN decreased plasma DA concentrations. Individual values for changes in plasma DA concentrations correlated positively with changes in NE in response to orthostasis (r = 0.72, P < 0.0001), YOH (r = 0.75, P < 0.0001), ISO (r = 0.71, P < 0.0001), GLU (r = 0.47, P = 0.01), and TYR (r = 0.67, P < 0.0001). PAF and SNS-x patients had low plasma DA concentrations. We estimated that DA constitutes 2%-4% of the catecholamine released by exocytosis from sympathetic nerves and that 50%-90% of plasma DA has a sympathoneural source. Plasma DA is derived substantially from sympathetic noradrenergic nerves.
David S Goldstein, Courtney Holmes. Clinical Chemistry. Washington: Nov 2008. Vol. 54, Iss. 11; pg. 1864, 8 pgs

sympathectomy decreased cardiac sympathetic nerve density and norepinephrine level

Cardiac sympathetic innervation was visualized by means of a glyoxylic catecholaminergic histofluorescence method. Transient outward current (I-to) of ventricular myocytes was recorded with the whole-cell configuration of the patch clamp technique. We observed that sympathectomy (i) decreased cardiac sympathetic nerve density and norepinephrine level, (ii) reduced the protein expression of Kv4.2, Kv1.4, and Kv channel-interacting protein 2 (KChIP2), (iii) decreased current densities and delayed activation of I-to channels, (iv) reduced the phosphorylation of extracellular signal-regulated kinase 1 and 2 (ERK1/2) and cAMP response element-binding protein (CREB), and (v) increased the severity of ventricular fibrillation induced by rapid pacing.
Heart Disease Weekly. Atlanta: Dec 28, 2008. pg. 54

Pain following endoscopic sympathectomy

The mean postoperative follow-up period was 11.5 months (range, 3-25 months). The hands of all patients were warm and dry after operation. No conversion to open surgery was necessary, and no operative mortality was recorded in either group. The mean inpatient pain scores were significantly higher in the biportal group (1.2 +/- 0.6) than that in the uniportal group (0.89 +/- 0.5, P=0.025). For the first three weeks after operation, four out of 20 (20%) patients in the uniportal group constantly suffered from mild or moderate residual pain while eight out of 25 (32%) cases in the biportal group (P=0.366). Among them, two cases in the uniportal group and five cases in the biportal group need to take analgesics.
Medical Devices & Surgical Technology Week. Atlanta: Sep 6, 2009. pg. 203

Laparoscopic surgery is associated with an increased incidence of postoperative atelectasis

Atelectasis occurs regularly after induction of general anesthesia, persists postoperatively, and may contribute to significant postoperative morbidity and additional health care costs. Laparoscopic surgery has been reported to be associated with an increased incidence of postoperative atelectasis.
Anesth Analg 2009; 109:1511-1516
© 2009 International Anesthesia Research Society

significant adverse effects on cardiopulmonary physiology

Because of technologic advances and improved postoperative recovery, endoscopic surgery has become the technique of choice for many thoracic surgical procedures^{6 and 25}; however, endoscopic visualization of intrathoracic structures requires retraction or collapse of the ipsilateral lung, which can have significant adverse effects on cardiopulmonary physiology. These cardiopulmonary changes can be further affected by the pathophysiologic changes associated with the disease process requiring the surgical procedure.

Because acute changes in cardiopulmonary function can compromise patient safety severely, a clear understanding of the dynamic interaction between the anesthetic–surgical technique and patient physiology is essential. This article discusses the effect of thoracoscopic surgery and the impact of various anesthetic interventions on cardiovascular and pulmonary physiology. In addition, some recommendations for “damage control” are made.

Anesthesiology Clinics of North America
Volume 19, Issue 1, 1 March 2001, Pages 141-152

Surgical Upper Thoracic Sympathectomy Reduces Arterial Oxygenation During One-Lung Ventilation

References and further reading may be available for this article. To view references and further reading you must purchase this article.

Journal of Cardiothoracic and Vascular Anesthesia
Volume 19, Issue 5, October 2005, Pages 703-704