Does bilateral thoracic sympathectomy predispose to reflex bronchospasm following tracheal intubation?

Patients with essential hyperhidrosis have sympathetic overactivity, associated with compensatory high parasympathetic tone. Sympathectomy results in a decrease of plasma norepinephrine,³ and parasympathetic predominance4 which may increase airway resistance.⁵ Intraoperative bronchospasm is usually cholinergically-mediated. Thus, patients with essential hyperhidrosis who have undergone bilateral thoracic sympathectomy, may be more liable to develop reflex bronchospasm under light levels of anesthesia.
Ahed Zeidan, MD^*, Nazih Nahle, MD^* and Anis Baraka, MD FRCA
Canadian Journal of Anesthesia 52:997-998 (2005)
© Canadian Anesthesiologists' Society, 2005

The severity and manifestations of the autonomic hyperreflexia are affected by the level of the sympathectomy

Autonomic Hyperreflexia is caused by noxious stimulation below the level of the lesion in a patient with a sympathectomy at or above T6.

...The efferent sympathetic fibers recover from the initial injury but remain unaffected by central inhibitory input from the brain stem and hypothalamus.
The severity and manifestations of autonomic hyperreflexia are affected by the level of the sympathectomy. With mid-thoracic lesions below the level of cardiac accelerator fibers, hypertension is accompanied by reflex bradycardia transmitted via cardiac accelerator fibers and the vagus. In patients whose sympathectomy is above the level of the thoracic cardiac accelerator fibers, tachycardia may occur because cardiac accelerator fibers become part of the efferent sympathetic activity rather than part of the central inhibitory input from the brain stem and hypothalamus. Arrythmias and occasional heart block may accompany changes in heart rate.
Clinical manifestations of autonomic hyperreflexia include vasodilation, decresed sympathetic activity, and increased vagal activity above the level of the lesion such as nasal congestion, flushing, headache, dyspnea, nausea, and visceral muscle contraction. Vasoconstriction and increased sympathetic activity below the level of the lesion cause vasoconstrictive pallor, sweating, piloerection, and somatic muscle fasciculation. Patients also develop hypertension with headache, blurred vision, myocardial infarction, andretinal, subarachnoid and cerebral hemorrhages that may lead to syncope, convulsion and death.
Handbook of Neuroanesthesia
page 343

By Philippa Newfield, James E. Cottrell

Contributor Philippa Newfield, Stephen Onesti, James E. Cottrell

Published 2006, Lippincott Williams & Wilkins

Results deteriorate progressively

Intermediate-term results of endoscopic transaxillary T2 sympathectomy for primary palmar hyperhidrosis. Chiou T S-M, Chen S-C. Br J Surg 1999; 86: 45-47.

It was concluded that the results of endoscopic sympathectomy deteriorated progressively from the immediate outcome and the compensatory hyperhidrosis was the principal reason for dissatisfaction.

It can diminish the body's physical reaction to exercise and/or strong emotion, and thus is considered psychiatric surgery

ETS can alter many bodily functions, including sweating, heart rate, heart stroke volume, blood pressure, thyroid, baroreflex, lung volume, pupil dilation, skin temperature, goose bumps and other aspects of the autonomic nervous system. It can diminish the body's physical reaction to exercise and/or strong emotion, and thus is considered psychiatric surgery. In rare cases sexual function or digestion may be modified as well.
©2006 LVHyperhidrosis.com
http://web.archive.org/web/20060706140821/www.lvhyperhidrosis.com/ets.html

Dr Nagy, Las Vegas

Electrical instability of the heart following desympathization

Arkh Patol. 1981;43(6):18-24.Links

Beskrovnova NN, Ul'ianinskiĭ LS, Makarychev VA, Vikhert AM.

The time course of ultrastructural and electrophysiological disorders and their role in sudden death of ventricular fibrillation at various intervals of desympathization caused by reserpine administration were studied. Early in the effect of reserpine (up to 30 min), glycogen granules were found to accumulate in the sarcoplasm of cardiomyocytes. At later intervals (1-24 hours), along with glycogen accumulation destructive lesions of organoids were observed in the form of myofibrillar recontraction, destruction of mitochondria, degeneration of sarcolemma. These changes are morphologic reflections of metabolic disorders developing in the myocardium under conditions of acute desympathization of the patient, and may be one of the causes of increased vulnerability of the heart in fibrillation.

Sympathectomy and avoidance learning

Di Giusto, E. L.; King, M. G.

Journal of Comparative and Physiological Psychology. 1972 Dec Vol 81(3) 491-500

Reports results of 5 experiments with male Wistar rats (N = 108). Depletion of peripheral sympathetic noradrenaline induced by administration of 6-hydroxydopamine, ip, led to significant decrements in escape and avoidance responding when the required response was difficult, but not when it was relatively easy to acquire. Results are similar to previous findings obtained with adrenal-demedullated Ss. Findings clarify the role of the sympathetic nervous system in the motivation of behavior elicited by aversive stimulation.
http://psycnet.apa.org/index.cfm?fa=main.doiLanding&uid=1973-08610-001

Morphofunctional changes in the myocardium following sympathectomy

Vestn Akad Med Nauk SSSR. 1984;(2):80-5.

Related Articles, Links

Morphofunctional changes in the myocardium following sympathectomy and their role in the development of sudden death from ventricular fibrillation

Beskrovnova NN, Makarychev VA, Kiseleva ZM, Legon'kaia , Zhuchkova NI.

http://www.ncbi.nlm.nih.gov/pubmed/6711115?dopt=Abstract

Cervical sympathectomy causes photoreceptor-specific cell death in the retina

Jena J. Steinle, Naarah L. Lindsay and Bethany L. Lashbrook

Department of Physiology, Southern Illinois University School of Medicine, Carbondale, IL 62901, United State, 2005.

The current study was designed to determine whether changes induced by sympathetic denervation causes significant loss of photoreceptors and increased glial cell reactivity in the retina. Sympathetic denervation was performed followed by immunohistochemistry, TUNEL staining, and protein expression analysis to investigate photoreceptor loss. There was a significant reduction (30%) in photoreceptor numbers in the sympathectomized eye. This loss was due to apoptosis, as there was over a doubling in apoptotic cell numbers after sympathectomy. This loss of photoreceptors in the sympathectomized eye resulted in a significantly reduced width of the outer nuclear layer of the retina when compared to the contralateral eye. Increased glial fibrillary acidic protein (GFAP) staining was also noted after sympathectomy in the ganglion cell layer with streaking toward the bipolar cell layer. These results suggest that loss of sympathetic innervation may cause significant changes to the physiology of the choroid.

sympathectomy enhances the severity of EAE

Regarding the modulation of autoimmunity, it was previously demonstrated that depletion of SNS transmitters by chemical sympathectomy enhances the severity of EAE (Experimental Autoimmune Encephalomyelitis.
Chelmicka-Schorr, E., M. Checincski, B. G. M. Arnason. 1988. Chemical sympathectomy augments the severity of experimental allergic encephalomyelitis. J. Neuroimmunol. 17:347.[Medline]
The Journal of Immunology, 2003, 171: 3451-3458. Copyright © 2003 by The American Association of Immunologists

Sammy Bedoui*, Sachiko Miyake*, Youwei Lin*, Katsuichi Miyamoto*,
Shinji Oki*, Noriyuki Kawamura*, Annette Beck-Sickinger ,
Stephan von Hörsten and Takashi Yamamura2,*

Loss of sensory innervation induces remarkable changes in the nerves that remain

The autonomic nervous system: Dysfunctions

Chemical denervation and selected ganglionectomy studies have shown that loss of sympathetic or sensory innervation induces remarkable changes in the nerves that remain...
Following chronic guanethidine sympathectomy there is complete depletion of sympathetic cotransmitters NA and NPY from the dura mater but an increase in the the expression of NPY in non-sympathetic axons (lacking small dense covered vesicles) supplying cerebral vessels and the iris. (Mione et al. 1990). The source of increased cerebrovascular NPY is thought to be preexisting parasympathetic cranial ganglia...(Gibbins and Morris 1988).

Indeed, sympathectomy-induced increased DBH-immunoreactivity in the sphenopalatine (parasympathetic) ganglion occurs at the same time as a loss in VIP-immunoreactivity (Fan and Smith 1993). In the cerebral artery and uterine artery, loss of sympathetic nerves also leads to increased DBH-immunoreactvity in non-sympathetic nerves that lack TH and NA (Morris et al. 1987); Mione et al. 1991)

In the lung, sympathectomy induces a marked increse in CGRP-immunoreactive nerve density around the airways, blood vessels and also in the vicinity of the neurepithelial bodies of the pulmonary epithelium (Van Ranst and Lauweryns 1990).
page 110,

By Otto Appenzeller, P. J. Vinken, G. W. Bruyn,

Contributor Otto, Appenzeller, P. J. Vinken, G. W. Bruyn

Published 2000 Elsevier Health Sciences

Autonomic nervous system / Pathophysiology

histochemical comparison of the normal and chronically sympathectomized heart

Jones CE, Cannon MS.

Using histochemical techniques, the reactivities of selected enzymes and other metabolic components were examined in the myocardium, coronary arteries, and coronary arterioles of normal, two-week-sympathectomized, and sham-operated canine hearts. There were no differences in the histochemistry of coronary arteries in any of the hearts, but important differences were noted in the myocardium and especially in the arterioles. The reactivities of the enzyme glucose-6-phosphate dehydrogenase and the nucleic acids were increased in arterioles of the sympathectomized heart, possibly indicating an increased protein synthesis. The reactivities of succinate dehydrogenase, NAD-isocitrate dehydrogenase, and cytochrome oxidase were reduced in myocardium and arterioles of sympathectomized hearts as well as in arterioles of sham-operated hearts; the changes were greater in the sympathectomized arterioles where there was also observed an increase in reactivity of lactate dehydrogenase. These findings suggest a depression in aerobic metabolic capacity and, in the case of the sympathectomized arteriole, imply a possible shift in adaptation from aerobic to anaerobic metabolism.
Histochem J. 1980 Jan;12(1):9-22.

Upregulation of Neuropeptide Y

Migraine and Headache Pathophysiology - Google Books Result

by Lars Edvinsson, Lars Edvinsson Edvinsson - 1999 - Medical - 184 pages
The mRNA may thus only indicate the possibility of forming the receptor protein. After sympathectomy an upregulation of NPY, probably of parasympathetic origin can be seen in some target organs.
books.google.com.au/books?isbn=1853177377...

Increased ,&Nerve Growth Factor Messenger RNA and Protein

Peripheral NGF mRNA and protein levels following
sympathectomy
It has been shown previously that peripheral sympathectomy
causes a dramatic increase in NGF levels in the denervated
organs (Yap et al., 1984; Kanakis et al., 1985; Korsching and
Thoenen, 1985).
Increased ,&Nerve Growth Factor Messenger RNA and Protein
Levels in Neonatal Rat Hippocampus Following Specific Cholinergic
Lesions
Scott R. Whittemore,” Lena Liirkfors,’ Ted Ebendal,’ Vicky R. Holets, 2,a Anders Ericsson, and HBkan Persson
Departments of Medical Genetics and’ Zoology, Uppsala University, S-751 23 Uppsala, Sweden, and *Department of
Histology, Karolinska Institute, S-104 01 Stockholm, Sweden

Effect of sympathetic denervation on the rate of protein synthesis

On the other hand, clenbuterol or epinephrine (10-5 M) increased by 20% the rate of protein synthesis in soleus muscles from adrenodemedullated rats and prevented its decrease in muscles from fasted rats. The data suggest that the sympathetic nervous system stimulates protein synthesis in oxidative muscles, probably through the activation of {beta}2-adrenoceptors, especially in situations of hormonal or nutritional deficiency.
Luiz Carlos C. Navegantes, Neusa M. Z. Resano, Amanda M. Baviera, Renato H. Migliorini, and Isis C. Kettelhut

Department of Physiology, Biochemistry and Immunology, School of Medicine, University of São Paulo, 14049-900 Ribeirão Preto, São Paulo, Brazil

Submitted 18 August 2003 ; accepted in final form 28 November 2003

Recurrence of original symptoms

The global recurrence rate was 8.8%: 6.6% for palmar hyperhidrosis and 65% for axillary hyperhidrosis. Compensatory sweating was observed in 86.4% of the patients. It was considered as minor by 61% of them, as embarrassing by 31.5%, and as disabling by 7.5%. Other reported side effects were: Horner's syndrome in 3 patients (2.4%), healing in 2 of them; chronic rhinitis in 3 (2.4%); gustatory sweating in 9 (7.2%); and hand dryness in 42%.

Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis.

Gossot D, Galetta D, Pascal A, Debrosse D, Caliandro R, Girard P, Stern JB, Grunenwald D.

Thoracic Department, Institut Mutualiste Montsouris, Paris, France

http://www.ncbi.nlm.nih.gov/pubmed/12683540?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedarticles&logdbfrom=pubmed

Number of unsatisfied patients after T2, T3 Sympathectomy

moderate-to-severe reflex sweating was more common in the ETS2 and ETS3 groups. About 40% of ETS2 groups and 25% of ETS3 group patients were unsatisfied with their operation.

Mahdy T, Youssef T, Elmonem HA, Omar W, Elateef AA.

Department of Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Surgery. 2008 Jun;143(6):784-9. Epub 2008 Mar 20

sympathectomy impairs bone resorption

the sympathetic nervous system is not involved in osteoclast precursor recruitment; but has a significant effect on resorption by inhibiting preosteoclast differentiation and disturbing osteoclast activation. These data suggest that depletion of sympathetic mediators may disturb osteogenic cell-mediated osteoclast differentiation.
M Cherruau1, P Facchinetti2, B Baroukh1, J.L Saffar1

Received 2 November 1998; received in revised form 14 May 1999; accepted 9 July 1999.

http://www.journals.elsevierhealth.com/periodicals/bon/article/PIIS8756328299002112/abstract

Lumbar Sympathectomy - ejaculatory impotence and anorgasmia are almost certain consequences

European Handbook of Dermatological Treatments - Google Books Result

by Andreas D. Katsambas, Torello M. Lotti - 2003 - Medical - 804 pages
However, lumbar sympathectomy has no place in the treatment of pedal hyperhidrosis since ejaculatory impotence and anorgasmia are almost certain consequences ...

Mia: Lumbar Sympathectomy is still being offered by many surgeons as an effective and safe treatment for pedal hyperhidrosis.

Sympathalgia of the cervicobrachial region

Pain syndromes in the cervicobrachial region may be an expression of irritation of the
periarterial autonomic nervous system. They show a vasal, arterial topography (here of
the subclavian artery). If the cervical sympathetic chain is involved in the irritation, the
area supplied by the carotid artery, i.e. the homolateral half of the head is also affected.
Characteristics of these disturbances are their abnormal topography, which cannot be
classified either as a radicular nor a segmental pattern. In this region the perception of
pain is delayed. The quality of pain is protopathic (dull, intense, burning). In the
sympathalgia region there is lowering of the pain threshold (dysesthesia), vasomotor
disturbance (dyskinesia) local homeostatic disorders (dyscrasia), in certain circumstances
trophic disturbances (dystrophy) which are usually accompanied by marked depression
(dysthymia).
Gross D.
1: MMW Munch Med Wochenschr. 1979 Sep 14;121(37):1167-72.

local heterogeneous changes in cerebral blood flow

The local influence of sympathetic stimulation on the cerebral circulation during acute hypertension was investigated in anesthetized rats. From initial studies, intravenously administered angiotensin II was selected as the pressor agent. Local cerebral blood flow was measured with [14C]iodoantipyrine autoradiography during 1) unilateral electrical stimulation of the superior cervical ganglion plus moderate hypertension [mean arterial blood pressure (MABP) 162 +/- 2 mmHg], 2) unilateral stimulation plus severe hypertension (MABP 177 +/- 4 mmHg), and 3) unilateral preganglionic sympathetic nerve section (denervated) plus severe hypertension (MABP 186 +/- 4 mmHg). During moderate hypertension, blood flow was rather homogeneous and sympathetic stimulation produced modest (7-15%) regionally specific reductions in flow ipsilateral to the stimulation (P less than 0.05). During severe hypertension: 1) focal areas of marked hyperemia occurred throughout the brain, 2) local blood flow was similar within innervated and denervated hemispheres, and 3) with sympathetic stimulation the volume of hyperemic tissue was reduced ipsilaterally and blood flow was decreased by 7-25% in areas of basal ganglia, cerebral cortex, limbic system and thalamus. To conclude, 1) the local cerebral autoregulatory response is highly dependent on whether the area becomes hyperperfused and 2) sympathetic stimulation decreases brain blood flow by modestly reducing local tissue perfusion and by lessening the volume of extreme hyperemia.

U. I. Tuor
Division of Neonatology, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.

Am J Physiol Heart Circ Physiol 263: H511-H518, 1992;

Structural changes and in situ aortic pressure-diameter relationship in long-term chemical-sympathectomized rats

Chronic sympathetic denervation increased aortic diameter and compliance in 8D-GN rats, compared with those obtained at the same distending pressure in control rats, suggesting vascular smooth muscle relaxation. In contrast, in 5W-GN and 3M-GN rats, the distensibility pressure-curves were significantly shifted toward lower levels of distensibility and pressure, indicating a decreased aortic distensibility at the same level of arterial pressure. Sympathectomy produced a significant reduction in the content of elastin, one of the most distensible components of the arterial wall in 5W-GN and 3M-GN rats. These results suggest that intact sympathetic nerves are necessary to maintain normal functional and structural properties of large arteries in rat. The reduction in aortic distensibility, in long-term sympathectomized rats, could have resulted from complex interactions between local aortic denervation, change in the set point of distending pressure, and changes in aortic smooth muscle tone and/or wall composition.
Lacolley P, Glaser E, Challande P, Boutouyrie P, Mignot JP, Duriez M, Levy B, Safar M, Laurent S.

Department of Pharmacology, Institut National de la Santé et de la Recherche Médicale U. 337, Paris, France.

Am J Physiol. 1995 Aug;269(2 Pt 2):H407-16.

Hypoperfusion of the brainstem

.The sudden and profound sympathectomy ass/w neuraxial anesthesia at this level can produce apnea form hypoperfusion of the brainstem.

Clinical Anesthesiology, Chapter 17

Peripheral Nerve Blocks, p. 298~ 8/22/2004 3:07 PM

Increased Ocular Blood Vessel Numbers and Sizes Following Chronic Sympathectomy

These findings show that sympathetic innervation is critical in regulating choroidal and retinal vascularity, and that chronic loss of sympathetic activity may contribute to abnormal vascular proliferation in diseases such as age-related macular degeneration and diabetic retinopathy.

Increased Ocular Blood Vessel Numbers and Sizes Following Chronic Sympathectomy in Rat

Jena J. Steinle^{b, a, f1}, Janet D. Pierce^a, Richard L. Clancy^a and Peter G. Smith^{b, a, f2}

Experimental Eye Research

Volume 74, Issue 6, June 2002, Pages 761-768

catecholamines modulating immune function

Experimental and clinical evidence has demonstrated extensive communication between the CNS and the immune system. To analyse the role of central catecholamines in modulating peripheral immune functions, we injected the neurotoxin 6-hydroxydopamine (6-OHDA) i.c.v. in rats. This treatment significantly reduced brain catecholamine content 2, 4 and 7 days after injection, and in the periphery splenic catecholamine levels were reduced 4 days after treatment. Central catecholamine depletion induced an inhibition of splenic and blood lymphocyte proliferation and splenic cytokine production and expression (interleukin-2 and interferon-γ) 7 days after injection. In addition, central treatment with 6-OHDA reduced the percentage of spleen and peripheral blood natural killer (CD161 +) cells, and T-cytotoxic (CD8 +) cells in peripheral blood. The reduction in splenocyte proliferation was not associated with a glucocorticoid alteration but was completely abolished by prior peripheral sympathectomy. These data demonstrate a crucial role of central and peripheral catecholamines in modulating immune function.

Central catecholamine depletion inhibits peripheral lymphocyte responsiveness in spleen and blood

Authors: Pacheco-López, Gustavo¹; Niemi, Maj-Britt¹; Kou, Wei¹; Bildhäuser, Andre¹; Gross, Claus M.¹; Goebel, Marion U.¹; del Rey, Adriana²; Besedovsky, Hugo O.²; Schedlowski, Manfred¹

Source: Journal of Neurochemistry, Volume 86, Number 4, August 2003 , pp. 1024-1031(8)

decreased conditioning-related activity in insula and amygdala

Critchley HD, Mathias CJ, Dolan RJ.
Wellcome Department of Imaging Neuroscience, 12 Queen Square, Institute of Neurology
and Institute of Cognitive Neuroscience, UCL, WC1N 3BG, London, United Kingdom.

The degree to which perceptual awareness of threat stimuli and bodily states of arousal
modulates neural activity associated with fear conditioning is unknown. We used
functional magnetic neuroimaging (fMRI) to study healthy subjects and patients with
peripheral autonomic denervation to examine how the expression of conditioning-related activity is modulated by stimulus awareness and autonomic arousal. In controls,
enhanced amygdala activity was evident during conditioning to both "seen" (unmasked)
and "unseen" (backward masked) stimuli, whereas insula activity was modulated by
perceptual awareness of a threat stimulus. Absent peripheral autonomic arousal, in
patients with autonomic denervation, was associated with decreased conditioning-related activity in insula and amygdala. The findings indicate that the expression of
conditioning-related neural activity is modulated by both awareness and representations
of bodily states of autonomic arousal.
Neuron. 2002 Feb 14;33(4):653-63. Links

Sympathectomy leads to hyperfunction of the serotoninergic system and pathology

We studied the balance of activity of sympathetic, parasympathetic, and serotoninergic divisions of the autonomic nervous system in the regulation of the heart function in rabbits. High activities of the sympathetic and parasympathetic system are associated with antagonistic interactions between them. Moderation of activity of these systems could be accompanied by activation of the serotoninergic system. Physiological sympathectomy and parasympathectomy lead to hyperfunction of the serotoninergic system and pathology.

Balance of Activity of Sympathetic, Parasympathetic, and Serotoninergic Divisions of the Autonomic Nervous System in Rabbits

Author: Lychkova, A.

Source: Bulletin of Experimental Biology and Medicine, Volume 140, Number 5, November 2005 , pp. 486-488(3)

Publisher: Springer

Depression following Sympathectomy

Depression accompanying compensatory hyperhidrosis following endoscopic thoracic sympathectomy

Authors: Hashim, N.; Wilson, N. J. E.

Source: Clinical & Experimental Dermatology, Volume 31, Number 6, November 2006 , pp. 818-819(2)

Publisher: Blackwell Publishing

norepinephrine depletion commonly is the desired effect

Although norepinephrine depletion commonly is the desired effect, other costored neurotransmitters (eg ATP, NPY and enkephalins) are depleted by sympathetic denervation. The multitude of research studying the effects of sympathetic loss is made possible by the morphologically defined anatomy of the postganglionic sympathetic chains, the sensitivity of postganglionic NA neurons to nerve growth factor (NGF) deprivation, and the phenotypic specialty of these neurons that allows for the selective uptake of neurotoxins."

Primer on the Autonomic Nervous System

By David Robertson

Published 2004

Both responses were abolished by sympathectomy

In control rats, nicotine caused a dose-dependent tachycardiac and pressor response. Both responses were abolished by sympathectomy, whereas the α-blockade left the tachycardiac response unaffected but inhibited the pressor response; the V₁ vasopressin receptor blockade had no effect on either the tachycardiac or pressor response. Conclusions: We conclude that in the conscious rat: (1) the pressor response to nicotine mainly depends on peripheral a-adrenergically-mediated vasoconstriction; (2) the vasomotor effect is caused by neural rather than adrenomedullary catecholamine release; (3) the nicotine-induced increase in heart rate (and presumably cardiac output) is per se unable to raise blood pressure, and (4) the nicotine-induced release of vasopressin plays no significant role in the pressor response.
MARANO G. ⁽¹⁾ ; RAMIREZ A. ^{(2 3)} ; MORI I. ^{(2 3)} ; FERRARI A. U. ^{(2 3 4)} ;
http://cat.inist.fr/?aModele=afficheN&cpsidt=1739277
Cardiovascular research ISSN 0008-6363 CODEN CVREAU

1999, vol. 42, n^o1, pp. 201-205 (18 ref.)

Surgeon declares result of sympathectomy "almost miraculous"

The results seem almost miraculous. In over 95% of all cases, the patients hands are dry and warm right after surgery. Hyperhidrosis of the feet is eliminated in about 60% of the cases. Facial sweating is helped in about 65% to 75% of the cases. Rapid heart rate and palpitations are also reduced dramatically. (Sic!)

http://users.rcn.com/szarnick/hidrosis.html

After the operation, some patients might experience some degree of sweating in other locations such as the thighs or back. Most patients say that they are not troubled by this extra perspiration and it is preferable to sweaty palms. In most cases, the condition improves over time.

Definition

Surgical Sumpathectomy and adrenergic function

Theodore Cooper, Department of Surgery, St Louis University School of Medicine

The excision on neutral structures which elaborate adrenergic substances during the process of regulating visceral function continues to be a valuable investigative and therapeutic maneuver. In the past several years, surgical sympathectomy has helped clarify certain aspects of adrenergic function. The operation as a therepeutic tool has been favorably reconsidered particularly since it has become clear that current reconstructive techniques do not provide cure or satisfactory palliation in all instances.
In general sympathectomy has been used for one or more of the following purposes:
1) to eliminate tonic or engendered responses which depend upon impulses in adrenergic nerves;
2) to eliminate visceral stores or adrenergic substances which depend upon the integrity of the postganglionic sympathetic innervation;
3) to eliminate postganglionic sympathetic tissue as a locus for the synthesis, uptake, binding, release and metabolism of adrenergic substances;
4) to eliminate visceral afferent fibers which are frequently distributed in common with autonomic nerves. The extent to which the surgical procedure is adjudged successful is usually related to the anatomical extent of the denervation and the time after operation at which the result is evaluated.
It is clear that "sympathectomy" is not a selective excision of adrenergic elements only. It is well recognized that preganglionic sympathectomy involves division of cholinergic elements ad sensory fibers.
Pharmacological Reviews, 1966 Vol. 18, No. 1. Part I

No pain from perforated ulcer after sympathectomy

Pain impulses from the stomach are carried by visceral afferent fibers that accompany sympathetic nerves. This fact is evident because pain of a recurrent peptic ulcer may persist after complete vagatomy, whereas patients who have had a bilateral sympathectomy may have a perforated peptic ulcer and experience no pain.

Clinically Oriented Anatomy, page 257

By Keith L. Moore, Arthur F. Dalley, A. M. R. Agur

Published 2006 Lippincott Williams & Wilkins

Human anatomy

1209 pages

ISBN:0781736390

Blocked the vomiting response...

Nausea and Vomiting: Recent Research and Clinical Advances - Google Books Result

by John Kucharczyk, David J. Stewart, Alan D. Miller - 1991 - Medical - 251 pages
Vagotomy and sympathectomy blocked the vomiting response, ... The role of visceral afferents in radiation sickness is discussed in Chapter 6, ...
books.google.com.au/books?isbn=0849367816...

Sympathectomy - impaired wound healing

The involvement of peripheral nerves in dermal wound healing, particularly in the inflammatory response has not been extensively studied. Therefore, this study was performed to examine the role of peripheral nerves in the healing of rat skin linear incisions. We report that chemical sympathectomy with 6-hydroxydopamine significantly impaired wound healing as measured on days 7, 11, and 14 postsurgery (by day 14, 48% of the sympathectomized rats were healed in contrast with 84% of the controls; p = 0.0104)...
These results support the hypothesis that sympathetic efferents are important for wound healing. Unlike previous research, which showed that peripheral nerves influence ischemic skin flaps, we are the first to demonstrate a role for peripheral nerves in the healing of skin incisions. Because inflammation is an important step in cutaneous wound healing, we propose that a reduction of neurogenic inflammation caused by sympathectomy may explain the impaired wound healing that we observed in our study.
Kim LR, Whelpdale K, Zurowski M, Pomeranz B.

Departments of Physiology and Zoology, University of Toronto, Toronto, Ontario, Canada.

http://www.ncbi.nlm.nih.gov/pubmed/9776863

Sympathectomy reduces immune responses

Sympathectomy Protects Denervated Skin from Graft-Versus-Host Disease

Mohamed A. Kharfan-Dabaja MDa, Claudio Anasetti MDa and James L.M. Ferrara MDb

Division of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa, Florida

Departments of Pediatrics and Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan

Biology of Blood and Marrow Transplantation
Volume 13, Issue 3, March 2007, Pages 369-370

T2 - innervation to the face/head

T2 Sympathetic Innervation to The Sweat Glands of the Face

Over several years of experience in treating patients with recurrent and/or persistent sweating of the face after undergoing T2 sympathectomy, Dr. Nielson has found that persistence of any sympathetic nerve innervation across the second rib level, just above the T2 ganglion, plays a significant role in persistent sweating conditions of the face after undergoing a T2. T3, or T4 sympathectomy.

It is apparent in some patients that there are neuronal contributions from lower levels such as the T3 that pass up over the second rib level on their way to the face that participate in the sweating symptoms of the face. Some physicians misunderstand the sympathetic nerve innervation of the face and believe in order to cure facial sweating it is important to cut the sympathetic nerve at the T1 level or above, thereby causing the dreaded Horner’s Syndrome. In Dr. Nielson's experience, he has found this not to be the case.

In summary, for successful treatment of facial sweating, it is imperative that all sympathetic nerve innervation crossing the second rib level be divided as opposed to clamped or having lower levels cut or clamped. Also, accessory nerve branch pathways bypassing the T2 ganglion can or may contribute to persistent facial symptoms.

http://www.hyperhidrosis-usa.com/Facial_Blushing.html

Every surgeon decides which complication and side effect to disclose:

ETS Side Effects | Potential Complications

Possible perforation of breast implants if present
Sensitive Pleurae (chest lining sensitivity) limiting exercise
Horners Syndrome occurrence rate 0.3%
Heat intolerance
Pneumothorax (collapsed lung)
Bleeding
Postop Neuralgia and parasthesias are uncommon
Possible hair loss
Bradycardia (slow heart rate) possibly requiring a pacemaker
Subcutaneous emphysema
Possible conversion to open thoracotomy
Possible recurrence of symptoms
Possible necessity for re-do operations

Gustatory sweating (increased sweating while smelling or eating) occurs in some patients.
http://www.hyperhidrosis-usa.com/SideEffects.html

MIA: DOES THIS SOUND LIKE A DESCRIPTION OF A SAFE PROCEDURE?!
The essential conflict lies in the fact that the surgeons are partly right: the surgery is relatively safe (to perform) and immediate outcome, if only palmar sweating is taken into account - would indicate it as an effective surgery. BUT at what cost?! The success rates decline with time, as sweating seems to return with nerve regeneration (even after cutting), in some cases within 6 months. (This is as long as the Botox treatment would last...without any of the adverse effects of the surgery....) Most importantly these exclamations re safety and effectiveness do not take into account the damage caused by the autonomic dysfunction. As the saying goes: The operation was successful, the patient did not make it...

Emotion - memory

Phelps EA.

Department of Psychology, 6 Washington Place, 8(th) floor, New York, New York 10003, USA. liz.phelps@nyu.edu

The amygdala and hippocampal complex, two medial temporal lobe structures, are linked to two independent memory systems, each with unique characteristic functions. In emotional situations, these two systems interact in subtle but important ways. Specifically, the amygdala can modulate both the encoding and the storage of hippocampal-dependent memories. The hippocampal complex, by forming episodic representations of the emotional significance and interpretation of events, can influence the amygdala response when emotional stimuli are encountered. Although these are independent memory systems, they act in concert when emotion meets memory.

Curr Opin Neurobiol. 2004 Apr;14(2):198-202.http://www.ncbi.nlm.nih.gov/pubmed/15082325?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed

Feedback - integreation of emotion and bodily arousal

In health, emotions are integrated with autonomic bodily
responses. Emotional stimuli elicit changes in somatic
(including autonomic) bodily states, which feedback to
influence the expression of emotional feelings. In patients with
spinal cord injury (SCI), this integration of emotion and bodily
arousal is partially disrupted, impairing both efferent generation
of sympathetic responses and afferent sensory feedback of
visceral state via the spinal cord. A number of theoretical
accounts of emotion predict emotional deficits in SCI patients, particularly at the level of emotional
feelings, yet evidence for such a deficit is equivocal. We used functional MRI (fMRI) and a basic
emotional learning paradigm to investigate the expression of emotion-related brain activity
consequent upon SCI.

We suggest that the observed functional abnormalities including enhanced anterior cingulate and PAG reflect central sensitization of the pain matrix, while decreased subgenual cingulate activity may represent a substrate underlying affective vulnerability in SCI patients consequent upon perturbation of autonomic control and afferent visceral representation. Together these observations may account for motivational and affective sequelae of SCI in some individuals.

Alessia Nicotra1,2, Hugo D. Critchley1,3,4,
Christopher J. Mathias1,2 and Raymond J. Dolan3
Brain 2006 129(3):718-728; doi:10.1093/brain/awh699

Norepinephrine - motivation and pleasure

Both norepinephrine and dopamine (sometimes called the "feelgood" chemical, because it's associated with motivation and pleasure) are the triggers for communication along the pathways between the basal ganglia, deep in the brain, and the prefrontal cortex, sometimes referred to as the brain's command centre because it controls executive functions such as problem-solving, attention and reasoning. It's believed (though it's hard to find strong evidence) that ADHD results from function reduction in dopamine and/or norepinephrine levels in the brain.
Nikki Barrowclough

31 March 2007
The Age

Hypoperfusion - risk of cerebral infarct

Current Opinion in Neurology - Fulltext: Volume 15(2) April 2002 p ...
Other work has described variations in sympathectomy and omental ... studies that show regions of cortex at risk of infarct secondary to hypoperfusion. ...
www.co-neurology.com/pt/re/coneuro/fulltext.00019052-200204000-00007.htm;jsessionid=HysC8T2LJypVjsV5nPrwS... -

Sympathectomy - Neurologic disorder

Other neurologic disorders
• Idiopathic orthostatic hypotension
• Multiple sclerosis
• Parkinsonism
• Posterior fossa tumor
• Shy-Drager syndrome
• Spinal cord injury with paraplegia
• Surgical sympathectomy
• Syringomyelia
• Syringobulbia
• Tabes dorsales (syphilis)
• Wernicke’s encephalopathy

Dizziness in Orthopaedic Physical Therapy Practice: Classification
and Pathophysiology
Peter Huijbregts, PT, MSc, MHSc, DPT, OCS, MTC, FAAOMPT, FCAMT
Paul Vidal, PT, MHSc, DPT, OCS, MTC
The Journal of Manual & Manipulative Therapy
Vol. 12 No. 4 (2004), 199 - 214

Syncope and sudden loss of consciousness

Causes of *Collapse and Acute Decreased Conscious State
(* = collapse, as in sudden loss of consciousness)

*Syncope via autonomic failure:
i) Neuropathy with autonomic involvement
ii) Antihypertensives, esp. beta-blockers
iii) Surgical sympathectomy
iv) CNS autonomic failure: eg.primary autonomic failure, MSA, spinal cord lesion

www.medicine.utas.edu.au/teaching/year6/cam615_616/info/additionaltutes/additionaltutes/med.pdf

Orthostatic hypotension

Orthostatic hypotension is commonly associated with prolonged bed rest (24 hours or longer). It may also result from sympathectomy, which disrupts normal vasoconstrictive mechanisms. http://www.wrongdiagnosis.com/m/multiple_system_atrophy_msa_with_orthostatic_hypotension/causes.htm

Influence of sympathetic autonomic arousal on cortical arousal

Influence of sympathetic autonomic arousal on cortical arousal: implications for a therapeutic behavioural intervention in epilepsy.

Nagai Y, Goldstein LH, Critchley HD, Fenwick PB.

Negative amplitude shifts of cortical potential are related to seizure activity in epilepsy. Regulation of the cortical potential with biofeedback has been successfully used to reduce the frequency of some patients' seizures. Although such behavioural treatments are increasingly popular as an alternative to pharmacotherapy, there has been no investigation of the mechanisms that might bridge the behavioural index of peripheral autonomic activity and the central regulation of arousal. Galvanic Skin Response (GSR) is a sensitive measurement of autonomic arousal and physiological state which reflects one's behaviour. Thus we investigated the effect of peripheral autonomic modulation on cortical arousal with the future intention of using GSR biofeedback as a therapeutic treatment for epilepsy. http://www.ncbi.nlm.nih.gov/pubmed/15120749?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

Fear conditioning - the influence of awareness and autonomic arousal on functional neuroanatomy

Absent peripheral autonomic arousal, in patients with autonomic denervation, was associated with decreased conditioning-related activity in insula and amygdala. The findings indicate that the expression of conditioning-related neural activity is modulated by both awareness and representations of bodily states of autonomic arousal.
Critchley HD, Mathias CJ, Dolan RJ.

Neuron. 2002 Feb 14;33(4):653-63.

http://www.ncbi.nlm.nih.gov/pubmed/11856537

irritation of the periarterial autonomic nervous system

Pain syndromes in the cervicobrachial region may be an expression of irritation of the periarterial autonomic nervous system. They show a vasal, arterial topography (here of the subclavian artery). If the cervical sympathetic chain is involved in the irritation, the area supplied by the carotid artery, i.e. the homolateral half of the head is also affected. Characteristics of these disturbances are their abnormal topography, which cannot be classified either as a radicular nor a segmental pattern. In this region the perception of pain is delayed. The quality of pain is protopathic (dull, intense, burning). In the sympathalgia region there is lowering of the pain threshold (dysesthesia), vasomotor disturbance (dyskinesia) local homeostatic disorders (dyscrasia), in certain circumstances trophic disturbances (dystrophy) which are usually accompanied by marked depression (dysthymia).
1: MMW Munch Med Wochenschr. 1979 Sep 14;121(37):1167-72.
http://www.ncbi.nlm.nih.gov/pubmed/114792

Sympathalgia can last for years in some patients

In addition, sympathectomy can cause postsympathectomy pain called sympathalgia in up to 44% of patients undergoing this procedure....
The sympathalgia secondary to sympathectomy usually starts around the first 2 weeks of the surgical procedure. It is a dull and cramping pain and occasionally can be a sharp pain. Although it is temporary in some patients, in others it can persist for several months or years.

H. Hooshmand, M.D.
Chronic Pain, page 156

for the treatment of anxiety

page 165:
Psychosurgery
Case series have been reported of patients with severe treatment resistant social anxiety disorder undergoing surgical procedures including capsulotomy and endoscopic thoracic sympathectomy. Given the limited evidence for the effectiveness of these interventions in conjunction with the significant associated surgical risk, we cannot recommend such procedures, though they would understandlable warrant consideration by those patients who are especially disabled by the disorder and who have not responded to either psychotheraphy or pharmacotherapy.

Principles of Psychopharmacology for Mental Health Professionals (Paperback)

by Jeffrey E. Kelsey (Author), Charles B. Nemeroff (Author), D. Jeffrey Newpor (Author)
Published by John Wiley & Sons, Inc., 2006

more likely to develop autoimmune disorders after sympathectomy

page 71:
Lewis rats are much more likely to develop autoimmune disorders after sympathectomy (Dimitrova and Felten, 1995). This finding suggests that if sympathetic regulation were impaired in a genetically predisposed individual, an autoimmune disease might develop.

from Back Matter:

Changes in serum growth hormone and pro- lactin levels, and in hypothalamic growth hormone-releasing hormone, thyrotropin-releasing hormone and somatostatin content after superior cervical sympathectomy in rats. ...

Betrayal by the Brain: The Neurologic Basis of Chronic Fatigue Syndrome, Fibromyalgia Syndrome and Related Neural Network Disorders
by Jay A. Goldstein
published by The Haworth Medical Press, 1996

nerves that sent blood-pressure-raising flight-or-fight signals to the brain were cut

page 187:
It was a grueling operation called sympathectomy, in which the nerves that sent blood-pressure-raising flight-or-fight signals to the brain were cut...The nerve cutting scrambled signals to her circulatory system. She was cold on one side of her body and warm on the other.

The Happy Bottom Riding Club: The Life and Times of Pancho Barnes (Paperback)

by Lauren Kessler (Author)

prevents them from responding to reflex or emotional changes in the central nervous system

page 87:
All the sympathetic ganglia that send postganglionic nerve fibres to structures in the head, neck and upper limb receive preganglionic fibres from the central nervous system only through the white rami communicates of the upper thoracic ventral rami. These preganglionic fibres ascend in the trunk and reach its ganglia directly and outlying ganglia through branches of the trunk. Thus destruction of the trunk at the root of the neck, whether as a result of a surgery (cervical sympathecotmy) or of some pathological condition, 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 (Oxford Medical Publications)
G. J. Romanes
Paperback - Nov 20, 1986
http://www.amazon.com/gp/reader/0192631403/ref=sib_dp_srch_pop?v=search-inside&keywords=sympathectomy&go.x=14&go.y=11&go=Go%21

Denervation sensitivity and sympathectomy

Somatic effectors are dependent on their innervation to maintain structural and functional integrity. When denervated, they eventually atrophy. This is the fate of denervated voluntary muscles as noted in lower motor paralysis. Autonomic effectors are not wholly dependent on their innervation. Denervated involuntary muscles, cardiac muscle, and glands continue to function. For example the transplanted heart might function reasonably well. However, when deprived of autonomic nervous system influences, these effectors are abnormal in that they do not respond as effectively as they should to satisfy the changing demands of the organism.
When an effector is deprived of it's innervation, it may become extremely sensitive to chemical mediators (neurotransmiters)...
Denervation hypersensitivity is noticeable in clinical situations following sympathectomy. In Horner's syndrome, the pupil of one eye is constricted and does not normally dilate because it is deprived of sympathetic stimulaiton. However, when a patient with a Horner's syndrome is extremely excited, the epinephrine and norephinephrine released by the adrenal medulla can stimulate the hypersensitive denervated dilator muscle or the iris to respond sot htat the pupil dilates; this is known as the paradoxical pupillary resonse.
page 368
The Human Nervous System: Structure and Function
Charles R. Noback, David A. Ruggiero, Robert J. Demarest, Norman L. Strominger
sixth edition
Humana Press

sympathectomy reduces fear

Experiments in animals demonstrate that sympathectomy may retard aversive conditioning (DiGiusto and King, 1972), most likely because sympathectomy reduces fear..."

Clinical Neuropsychology (Medicine) by Kenneth M. Heilman and Edward Valenstein (Hardcover - Feb 13, 2003)
page 458

RSD?

page 328:
It is a lie that sympatholysis may specifically cure patients with unqualified "reflex sympathetic dystrophy." This was already stated by the father of sympathectomy, Rene Leriche, more than half a century ago.

Writing and Defending Your Expert Report
Steven Babitsky, James J., Jr. Mangraviti

The hemodynamic consequences can be dramatic

Excerpt - page 375: "... It is not uncommon, therefore, to have a near total sympathectomy with spinal anesthesia. The hemodynamic consequences can be dramatic. ..."

Principles of Geriatric Medicine and Gerontology (Principles of Geriatric Medicine & Gerontology) (Hardcover - Fifth Edition)

Publisher: McGraw-Hill Incorporated | Publish Date 06/03 | Copyright 2003
by William R. Hazzard (Author), John P. Blass (Author), Jeffrey B. Halter (Author), Joseph G. Ouslander (Author), Mary Tinetti (Author)

Procedures which may induce bradycardia - sympathectomy

page 30:
Procedures which may induce bradycardia
1 Elective replacement of permanent pacemaker generator
2 Cardiac surgery
3 Neurosurgical procedures
4 Thoracic sympathectomy
5 Carotid surgery
6 Right coronary angioplasty
Implantable Cardiac Pacemakers and Defibrillators: All You Wanted to Know
Anthony W C Chow, Alfred E Buxton
Published 2006
Blackwell Publishing

sympathectomy may impair heat loss and result in hyperthermia.

The problems becomes worse in persons with disroders that impair sweating, such as hypohidriotic extodermal dysplasia, who may develop hyperthermia after even moderate exercise. Even if the sweat glands are intact, dysfunction of the neurologic pathways that control sweating (including anticholinergic agents and sympathectomy) may impair heat loss and result in hyperthermia.
Pediatric Diagnostic Examination
Donald Greydanus, Arthur N Feinberg, Dilip R Patel, Douglas N Homnick
page: 49

Disorders associated with adrenal medullary hypofunction

page 338:
Table 12-7. Disorders associated with adrenal medullary hypofunction.
Insulin dependent diabetes mellitus
Familial dysautonomia
Shy-Drager syndrome
Parkinson's disease
Tabes dorsalis
Syringomyelia
Cerebrovascular disease
Idiopathic orthostatic hypotension
Congenital adrenal hyperplasia
Sympathectomy
Drugs: antihypertensives, antidepresants

Pathophysiology of Disease
Stephen J. McPhee, Vishwanath R. Lingappa, William F. Ganong

sympathectomy predisposes to venous pooling

"The sympathectomy produced by the block predisposes the patient to venous pooling ..."
page: 486

CURRENT Obstetric & Gynecological Diagnosis & Treatment (Paperback)

by Alan H. DeCherney (Author), Lauren Nathan (Author)

SYMPATHECTOMY-INDUCED CHANGES IN CYTOKINE PRODUCTION AND IMMUNE EFFECTOR FUNCTION

Lacrimal Gland, Tear Film, and Dry Eye Syndromes

by David D. Sullivan, Darlene A. Dartt, Michele A Meneray - 1998 - Medical - 1051 pages
Published 1998
Springer
Lacrimal apparatus
/ Physiology/ Congresses
SYMPATHECTOMY-INDUCED CHANGES IN CYTOKINE PRODUCTION AND IMMUNE EFFECTOR FUNCTION
page 544:
Our laboratory has shown that following a single intraperitoneal injection of 6-OHDA, splenic NE levels in mice are reduced by approximately 90%.

sympathectomy also can interfere with peripheral perfusion

Complications in Anesthesiology
Emilio B Lobato, Nikolaus Gravenstein, Robert R Kirby
Wolters Kluwer/Lippincott Williams & Wilkins
page 131:
Hypoperfusion
Peripheral hypoperfusion is often caused by low cardiac output secondary to hypovolemia, cardiac failure, myocardial ischemia or dysrythmia. Decreased systemic vascular resistance related to sepsis, catecholamine depletion or sympathectomy also can interfere with peripheral perfusion, either because of low perfusion pressure or due to poor distribution of systemic blood flow.

The effect of cervical sympathectomy on cochlear electrophysiology

Tinnitus: Theory and Management by James B. Snow (Hardcover - Oct 1, 2004)

Excerpt - page 67: "... Nuttall AL, Brown MC, Lawrence M. The effect of cervical sympathectomy on cochlear electrophysiology. Acta Otolaryngol (Stockh) 1982;94:439-44. 88.

Hypotension caused by sympathectomy

Drug Therapy in Nursing by Diane S Aschenbrenner and Samantha J Venable (Hardcover - Feb 1, 2008)

Excerpt - page 531: "... hypotension is caused by one of the following conditions: pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, MI, blood transfusion, and drug reac- tions. ...

secondary hyperemia of the pulp following the cervical sympathectomy

Kaplan OAT, 2009-2010 Edition (Kaplan OAT) by Kaplan (Paperback - Jun 3, 2008)

Excerpt - page 33: "... due to secondary hyperemia of the pulp following the cervical sympathectomy.

sympathectomy induced relative hypovolemia

A Practical Approach to Cardiac Anesthesia (Practical Approach)
Frederick A Hensley, Donald E Martin, Glenn P Gravlee
page 43: Ephedrine
d) Advantages
(v) Nearly ideal to correct sympathectomy induced relative hypovolemia and decreased SVT after spinal or epidural anesthesia

Publisher: Wolters Kluwer/ Lippincott Williams & Wilkins
Forth Edition 2008

Sympathectomy - disorder associated with autonomic insufficiency

Greenspan's Basic & Clinical Endocrinology (Lange Medical Books)
David G. Gardner, Dolores M. Shoback

page 437: Table 12-6.
Disorders associated with autonomic insuffiency.
Familiar dysautonomia
Shy-Drager syndrome
Parkinson's disease
Tabes dorsalis
Cerebrovascular disease
Diabetes melitus
Idiopathic orthostatic hypotension
Sympathectomy
Drugs: antihypertensive, antidepressants

Autonomic dysfunction can produce serious symptoms related to circulation and temperature regulation

Spitz And Fisher's Medicolegal Investigation Of Death: Guidelines For The Application Of Pathology To Crime Investigation
Werner U., M.D. Spitz, Daniel J., M.D. Spitz, Ramsey Clark, Russell S. Fisher

page 1070: Autonomic dysfunction can produce serious symptoms related to circulation and temperature regulation. Complete or substantial lesions of the cervical or upper thoracic cord may produce the effect of sympathectomy manifesting with bradycardia (unopposed vagal action) and hypothermia (heat loss due to vasodilation). These effects must be sorted out from the other possible injuries such as shock due to blood loss or infection. These individuals may not be able to able to generate fever, thus masking the presence of infection. They often remain at least partially poikilothermic and are vulnerable to high or low environmental temperatures.

Cardiac Arrest

Lin, CC. et al. Intraoperative Cardiac Arrest: A Rare Complication of T2-3-Sympathectomy for Treatment of Hyperhidrosis Palmaris. Eur J Surg 1994; Suppl 572: 43-45