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

Partial pulmonary sympathetic denervation

Noppen MM, Vincken WG.

Respiratory Division, Academic Hospital, University of Brussels, Belgium.

In patients with essential hyperhidrosis (EH), a pathological condition characterized by increased activity of the upper dorsal sympathetic ganglia D2-D3, anatomical interruption at the D2-D3 level by thoracoscopic sympathicolysis (TS) is a safe and effective treatment. The D2 and D3 ganglia, however, are also in the pathway of sympathetic lung innervation, which may influence the pulmonary diffusion capacity for carbon monoxide (expressed as transfer factor for CO:TLCO, and as transfer coefficient for CO:KCO). We therefore studied the effect of TS on TLCO and KCO in 50 EH patients: compared with pre-operative values, both TLCO (-6.7%, P < 0.001) and KCO (-4.2%, P = 0.002) were significantly decreased at 6 weeks after bilateral TS, an effect which was independent of the smoking status of the patients. In order to explain this phenomenon, the following pharmacological interventions were studied: (1) oral beta 1 + 2-adrenoreceptor blockade with propranolol caused a comparable decrease of TLCO (-6.3%) and KCO (-7.5%) in matched normal subjects, but had no effect on TLCO and KCO in EH patients prior to TS; and (2) subsequent inhalation of the beta 2-adrenoreceptor agonist salbutamol in a dosage suspected to cause alveolar beta-receptor stimulation had no effect on TLCO and KCO, neither in the normal subjects, nor in EH patients (before and after TS). Although the exact mechanism of the TS-induced decrease in TLCO and KCO remains speculative, these findings suggest that they may be related to a beta 1-adrenoreceptor-mediated change in pulmonary capillary membrane permeability, although TS-induced changes in pulmonary blood flow or an interplay of both mechanisms cannot be excluded.

Cervical sympathectomy reduces the heterogeneity of oxygen saturation in small cerebrocortical veins

H. M. Wei, A. K. Sinha and H. R. Weiss
Department of Anesthesia, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway 08854-5635.

This study evaluated the hypothesis that the peripheral sympathetic nervous system is one of the factors increasing the heterogeneity of venous O2 saturation in selective brain regions. Regional cerebral blood flow and O2 saturation were determined in the anterior cortex, posterior cortex, and medulla of either sham-operated or bilaterally sympathectomized Long-Evans rats. Cerebral venous O2 saturations, indicating the balance between local O2 supply and consumption, were found to be significantly more heterogeneous in the sham-operated group. In the anterior cortex, the coefficient of variation [100(SD/mean)] for the sham-operated animals was 22.4%. Sympathectomy significantly reduced this heterogeneity in the anterior cortex through a reduction in the number of low O2 saturation veins (coefficient of variation 11.7%). Blood flow and O2 consumption in the anterior cortex were not different between groups. The effects of sympathectomy in the posterior cortex were similar to those in the anterior cortex. However, sympathectomy did not alter any measured variables in the medulla. Thus, bilateral superior cervical ganglionectomy reduced the heterogeneity of cerebrocortical venous O2 saturation by reducing the number of low O2 saturation veins in the rostral part of the brain.

Patients should be informed of the bradycardia resulting from sympathectomy

We performed 24-hour Holter electrocardiographic recordings in 12 patients referred for bilateral sympathectomy. Surgery was performed at two distinct times allowing for the study of the consequences of unilateral right and bilateral sympathectomy. Results. Heart rate was 77 ± 8 beats per minute before surgery on the 24-hour recording and significantly decreased after bilateral (67.8 ± 6.5 beats per minute; p < 0.05) but not after unilateral right sympathectomy. Consistently spectral analysis variables significantly changed after bilateral surgery but showed no right-sided dominance. Little effect of sympathectomy was found on the QT interval, which tended to decrease after bilateral sympathectomy. Conclusions. Patients should be informed of the bradycardia resulting from sympathectomy. No right-sided dominance can be found consistently with the random distribution of substellate cardiac fibers reported in anatomic studies.
http://cat.inist.fr/?aModele=afficheN&cpsidt=14386364

Structural changes associated with parotid “Degeneration secretion” after post-ganglionic sympathectomy in rats

J. R. Garrett^{1, 2} and A. Thulin^{1, 2}

(1)	Department of Oral Pathology, King's College Hospital Dental School, London, England

(2)	Institute of Physiology, University of Lund, Lund, Sweden

(3)	King's College Hospital Dental School, SE5 8RX London, England

Received: 20 May 1975

Summary Parotid glands of rat have been examined 12, 24 and 48 hours after avulsion of the cervical sympathetic ganglion and compared with the normally innervated left glands. Formaldehyde-induced fluorescence showed a relatively normal complement of adrenergic nerves at 12 hours but most of the nerves had lost their noradrenaline content by 24 hours and no fluorescent nerves were detected at 48 hours. Ultrastructural degenerative changes in axons were rare at 12 hours, common at 24 hours, and the degenerating axons appeared to have disappeared by 48 hours. The glands looked whitish and pale and similar to the controls at 12 and 48 hours but were pinkish and oedematous on the sympathectomised side at 24 hours. Correspondingly the acini were loaded with secretory granules at 12 and 48 hours but were extensively depleted of granules at 24 hours. This loss of granules is considered to be due to sympathetic degeneration secretion caused by the release of noradrenaline from the degenerating adrenergic nerves between 12 and 24 hours after ganglionectomy. This is thought to be the first example of morphological change resulting from degeneration activation to be recorded microscopically.

sympathetic denervation of the hearts

Surgical sympathectomy of the heart in rodents and its effect on sensitivity to agonists

K Goto, PA Longhurst, LA Cassis, RJ Head, DA Taylor, PJ Rice and WW Fleming

A new procedure for sympathetic denervation of the hearts of rats and guinea pigs is described. Bilateral removal of the inferior and medial cervical ganglia results in almost complete loss of catecholamines from atria and ventricles, disappearance of catecholamine-associated histofluorescence from the region of the sinoatrial node and marked depression of the chronotropic concentration-response curve for tyramine in right atria of both species. Seven days after bilateral sympathectomy, the chronotropic concentration-response curve for isoproterenol is shifted to the left by a factor of 3.3 in the rat and 1.7 in guinea-pig right atria. The chronotropic concentration-response curve for histamine was not shifted by sympathectomy in the guinea-pig right atrium. Inasmuch as the rat atrium does not respond to histamine, similar experiments could not be done in the rat. The inotropic concentration-response curve for isoproterenol in electrically driven left atria was not affected by 7 days of sympathectomy in either species. These results indicate that chronic surgical sympathectomy of the heart can be successfully accomplished in the rat and guinea pig. Such sympathectomy induces a postjunctional supersensitivity in guinea- pig right atria which is qualitatively and quantitatively similar to that described previously for chronic treatment with reserpine. Bilateral surgical sympathectomy provides a valuable tool for future investigations of the cellular basis of supersensitivity in the myocardium.

Volume 234, Issue 1, pp. 280-287, 07/01/1985

Changes in cardiocirculatory autonomic function

Marc Noppen^a, , Paul Dendale^b, Yves Hagers^b, Patrick Herregodts^c, Walter Vincken^a and Jean D'Haens^c

^a Respiratory Department of the University Hospital AZ-VUB, Free University, Laarbeeklaan 101, 1090, Brussels, Belgium

^b Cardiology Department of the University Hospital AZ-VUB, Free University, Brussels, Belgium

^c Neurosurgery Department of the University Hospital AZ-VUB, Free University, Brussels, Belgium

Essential hyperhidrosis (EH) is caused by an unexplained overactivity of the sympathetic fibers which pass through the upper dorsal sympathetic ganglia D2 and D3. Since the D2 and D3 ganglia are also involved in the sympathetic cardiac innervation, cardiocirculatory autonomic function may also be abnormal in EH. In order to study the function of the sympathetic nervous system in EH, and to assess the effects of thoracoscopic sympathicolysis, cardiocirculatory autonomic function tests were performed in 13 consecutive patients with EH, before (baseline) and 6 weeks after the thoracoscopic intervention. Baseline data were also compared with data obtained from 13 matched healthy volunteers: EH patients showed an increased heart rate at rest, but only in the standing position (94 ± 18.5 vs 78 ± 10.9 bpm, P <>), as well as an increased ratio of low to high frequency power of the heart rate variability in the standing position (5.92 ± 4.4 vs 2.8 ± 2.5, P <>P <>P <>P <>P <>P < 0.05) were also lowered after sympathicolysis. In conclusion, patients with EH show an overfunctioning of the sympathetic system which is characterised by an increased reaction to stress (standing, exercise), whereas resting sympathetic tone is unaffected. Thoracoscopic D2–D3 sympathicolysis corrects this hyperfunction and has a partial beta-blocker-like activity, which results in a decrease in heart rate at rest and during maximal exercise, and in the diastolic blood pressure response to the handgrip test. Further studies are needed to assess the long-term consequences of this procedure.

The truth is exactly the opposite

We would strongly disagree with the subtitle of this editorial (6 May 2000)-"Surgery and botulinum toxin are treatments of choice in severe cases." Collin and Whatling dismiss conventional medical therapy with anticholinergic drugs as "inconvenient, unpleasant and temporary. Patients usually stop using anticholinergic drugs because of a dry mouth."

The truth is exactly the opposite. Surgery is only rarely necessary and the editorial quite properly warns of numerous surgical pitfalls which include recurrence of hyperhidrosis, almost certain impotence, compensatory sweating, permanent neurological damage from anoxia and death (their words). Botulinum toxin, which they recommend for axillary or plantar hyperhidrosis, requires 12 injections per axilla and "tedious and uncomfortable 24-36 injections per foot." Even this horrendous procedure gives only 11 months relief and antibody formation may reduce long term efficiency.

The logical treatment is surely with anticholinergic drugs. We have used Glycopyrronium bromide (Robinul) 2mgs up to three times daily for 25 years with great success. The majority of patients we see are young women, whose hyperhidrosis is ruining their lives. Robinul greatly improves their quality of life and the inevitable dry mouth is accepted unreservedly.

Young women do not suffer any other unwanted effects, though it is obvious that older men (who do not as a rule present to us with hyperhidrosis) may well have problems with vision and micturition. The North East Thames Regional Drug Information Service could find no evidence of any long term side effects; some patients have used it for years.

Michael Klaber
Consultant Dermatologist and Hon Senior Lecturer.
Broomfield Hospital, Chelmsford, CM1 7ET

Michael Catterall
Consultant Dermatologist
Basildon Hospital, Basildon, SS16 5NL
http://www.bmj.com/content/321/7262/702

Surgeons and anaesthetists are reticent in publicizing such events

Jack Collin,
Consultant Surgeon
Oxford

Cameron`s claim that there has been only one death attributable to synchronous bilateral thoracoscopic sympathectomy is implausible. Surgeons and anaesthetists are reticent in publicizing such events and Civil Law Reports of settled cases are an inadequate measure of the current running total. The custom of a majority is no guarantee of safety and is seldom a guide to best medical practice.
http://www.bmj.com/cgi/eletters/320/7244/1221

Risks of lung deflation

Jack Collin,
Consultant Surgeon
Oxford

Send response to journal:
Re: Re: Treating hyperhidrosis



Editor- Cameron may not advocate that bilateral thoracoscopic sympathectomy should be staged but I certainly do .It may be eccentric but it is safe.Immediate sustained full reexpansion and perfect functioning of a lung that was completely deflated a few minutes before cannot be guaranteed. Residual pneumothorax is common,gas exchange may be impaired and the lung is at some risk of recollapse.To collapse the contralateral normal lung in such circumstances might be the practice of a majority of surgeons but it is still unwise.Collapse of one lung is a misfortune, collapse of both lungs is not compatible with life.

http://www.bmj.com/cgi/eletters/320/7244/1221

Irritant contact dermatitis of the hands following thoracic sympathectomy

Irritant contact dermatitis of the hands following thoracic sympathectomy

* Ming-Chien Kao

*
Division of Neurosurgery National Taiwan University Hospital 7 Chung-Shan South Road Taipei Taiwan 100 Republic of China
Volume 44 Issue 3 Page 200-200, March 2001

two cases of cerebral edema

Early complications of thoracic endoscopic sympathectomy: a ...
Cameron [16] has reported two cases of cerebral edema related to the use of .... Ng S.M., Hwang M.H. Thoracoscopic T2-sympathectomy block by clipping: a ...
ats.ctsnetjournals.org/cgi/content/full/71/4/1116 - Similar pages - Note this

TES is not as minor a procedure as usually asserted

Conclusions. Although morbidity was low, significant complications of TES occurred. Patients should be clearly warned that TES is not as minor a procedure as usually asserted. Complications as well as adverse effects should be considered when discussing this surgical indication.
http://ats.ctsnetjournals.org/cgi/content/abstract/71/4/1116

treatment for the cure of hand sweating - now read that again

Hyperhidrosis, a treatment for the cure of hand sweating, facial ...
By Dr. Alan Cameron, UK ETS-C is performed under general anaesthesia and involve ... Thoracoscopic T2-sympathectomy or sympathicotomy (without removal of ...
www.hyperhidrosis.com/ets_c.htm - 26k - Cached - Similar pages - Note this

Reflex sweating will not happen if hand sweating can be stopped without interrupting sympathetic tone to the human brain

Many studies have shown that there s no relationship between the sweating amount of hands and compensatory areas. In addition, reflex sweating is not found on lumbar sympathectomy for pure Hyperhidrosis plantaris. Why are there different postoperative responses between thoracic and lumbar sympathetic surgeries? Is traditional consideration of sympathetic innervation wrong?
New concepts and classifications of sympathetic disorders proposed can explain all postoperative phenomena in sympathetic surgery. We believe that they will become standard rules in sympathetic surgery.
Sweating after sympathetic surgery is a reflex cycle between the sympathetic system and the anterior portion of the hypothalamus according to our investigations.

Reflex sweating will not happen if hand sweating can be stopped without interrupting sympathetic tone to the human brain. We proved clinically from nervous mapping
that neither T2 nor T3, but t4 and lower ganglia provide the major sympathetic
innervation to hands. Major sympathetic fibers at the levels of T3 and
above innervate head and neck. Few or none from T2 and TS innervate the hands while the
fibers from T4 must definitely pass through T2 and TS to innervate hands. This is the
reason why T2-sympatnetic procedures can treat hyperhidrosis but with higher I
incidence and degree of reflex sweating. Thus, we know that ESB4 can treat
hyperhidrosis palmaris without interrupting sympathetic tone to the head
and neck, therefore no reflex sweating is predicted on ESB4 cases.

The Base of Designing New Procedures for Different Indications in

Sympathetic Surgery

Chien-Chih Lin, M.D., *Timo Telaranta, M. D.

Surgical Departments, Tainan Municipal Hospital Tainan, Taiwan;

*Pnvatix Clinic, Tampere, Finland

Presentations at the 4th International Symposium on Sympathetic Surgery

Dr Reisfeld saying 'yes' and 'no' at the same time on his website

Over the last several years more ETS procedures have been done and obviously since the number of cases has gone up tremendously also the number of cited side effects are on the rise. Side effects, such as fatigue, hair loss, loss of concentration, scalp itchiness, weight gain, shortness of breath, reduction of exercise ability and were all mentioned in an anecdotal fashion by different patients. It should be stressed that this is again on an anecdotal basis and not appearing in a significant number of patients. (sic!) Not every side effect could be related definitely to the sympathectomy but overall those kind of side effects were mentioned by patients in the past. Any question should be directed to the surgeon before making any decision about the operation.
http://www.sweaty-palms.com/sidefx.html

Changes in cardiocirculatory autonomic function

Noppen M, Dendale P, Hagers Y, Herregodts P, Vincken W, D'Haens J.

Changes in cardiocirculatory autonomic function after thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis. J Auton Nerv Syst 1996;60:115-20.

sympathectomy results in partial hyperthermia, with compensatory contralateral extremity hypothermia

sympathectomy results in partial hyperthermia, with compensatory contralateral extremity hypothermia, this result in the spread of pain in the contralateral extremity. Out of desperation, sympathectomy has been applied for treatment of causalgia since 1916 (7). The literature review of sympathectomy literature for treatment of CRPS shows high rates of failure. Welch et al (8) showed 13% successful results of sympathectomy in 8.4 years of long term follow-up.

Hooshang Hooshmand, Masood Hashmi, Eric M. Phillips

Neurological Associates Pain Management Center, Vero Beach, Florida, USA http://www.rsdinfo.com/thermography_part-_ii.htm

Sympathectomy for the treatment of polymorphic ventricular tachycardia

Bilateral thoracoscopic cervical sympathectomy for the treatment of recurrent polymorphic ventricular tachycardia.

Turley AJ, Thambyrajah J, Harcombe AA.
Despite potassium and magnesium supplements, beta blockade, implantation of a single then dual chamber implantable cardioverter defibrillator (ICD), amiodarone, nicorandil, and mexiletine, the patient continued to experience arrhythmia storms, receiving more than 700 ICD discharges over seven months. She was ultimately treated successfully with bilateral thoracoscopic cervicothoracic sympathectomies. This is the first reported bilateral thoracoscopic treatment of a patient with LQTS and symptomatic life threatening ventricular tachyarrhythmias refractory to current pharmacological and pacing techniques.

Cardiothoracic Division, The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK. andrew.turley@stees.nhs.uk

Heart. 2005 Jan;91(1):15-7.

http://www.ncbi.nlm.nih.gov/pubmed/15604323

London Arrhythmia Centre

Long QT syndrome is a genetic abnormality that can lead to VT and cardiac arrest. The diagnosis is usually made by a 12 lead ECG, but an exercise test may be required to identify those with latent long QT syndrome manifest as a lack of QT shortening during exercise. Beta-blockade remains the mainstay of treatment, especially in the type l and ll subtypes, but symptomatic patients despite beta-blockade may require defibrillator implantation or sympathectomy. Long QT type 3 patients are at particular risk as their first presentation may be sudden cardiac death, and prophylactic implantation of an ICD is recommended.
http://www.londonarrhythmiacentre.co.uk/diagnosis-ventricular-ventricular-tachycardia.html

Only for people with short life expectancy

Sympathectomy should be used only for patients
who have failed with every other form of therapy and when the patient has
a short life expectancy.
Chronic Pain: Reflex Sympathetic
Dystrophy Prevention and
Management
H. Hooshmand, M.D.

S for depression, anxiety

In 1946, Karnosh (a neuropsychiatrist at the Cleveland
Clinic), Gardner, and Stowell62reported the effects of tem-
porary cerebral sympathectomy accomplished by bilateral
stellate ganglion blocks on organic brain diseases and psy-
choses.60,61 This discovery occurred incidentally in January
1946 when a 38-year-old woman received bilateral stellate
blocks for cerebral embolus accompanied by hemiplegia
and Dejerine–Roussy syndrome. This led to the implemen-
tation of this procedure in a series of patients with cere-
bral vascular disease, brain atrophy, and Parkinson disease.
Most patients were enthusiastic about the improvement that
they claimed the procedure produced, although motion pic-
ture analysis revealed no improvement in motor function
and it was believed that this apparently impressive improve-
ment in mood was caused by the sympatholytic effects.
Karnosh and Gardner decided to try bilateral stellate gan-
glion procaine blocks in a small group of patients suffering
from depression and anxiety and in patients with known
schizophrenia. In three patients with depression, the tempo-
rary sympathetic block resulted in an improvement of af-
fect, a relative euphoria, transient relief from suicidal idea-
tion, and psychomotor retardation.
W. James Gardner: pioneer neurosurgeon and inventor
NARENDRANATHOO, M.D., PH.D., MARCR. MAYBERG, M.D., ANDGENEH. BARNETT, M.D.
Brain Tumor Institute and Department of Neurosurgery, Cleveland Clinic Foundation,
Cleveland, Ohio
J Neurosurg 100:965–973, 2004

arrhythmias are precipitated by emotional stimuli

JAMES W. JEFFERSON
Psychocardiology: Meeting place of heart and mind
Psychosomatics, Nov 1985; 26: 841 - 842.
......life-threatening, often fatal, arrhythmias are precipitated by emotional stimuli, and effective treatments such as high thoracic left sympathectomy are directed at the nervous sys-tem rather than the heart.

Mental Phenomena: brain - body - environment

But maybe a better way of talking about it would be to say that mental phenomena arise through the interaction between brain and body and the environment and -- this is what Karl Popper says -- that whole interactive thing produces an emergent, which we call mind and spirit, and so on.

Karl Pribram

Changing the pattern of afferent information generated by the cardiovascular system can significantly influence perception and emotional experience

messages from the cardiovascular system have effect on the mental processing

when the communication of afferent signals from the heart
to the brain is compromised, there is less awareness
of feeling sensations in the body.

In summary, evidence now clearly demon-
strates that afferent signals from the heart signifi -
cantly influence cortical activity. Specifically, we now
know that afferent messages from the cardiovascular
system are not only relayed to the brain stem to ex-
ert homeostatic effects on cardiovascular regulation,
but also have separate effects on aspects of higher
perceptual activity and mental processing.
Rollin McCraty, Ph.D.

It has been shown that the processing of visual informaiton is significantly changed as heart rate and carotid pressure changed

For example, the effects of cardiac afferent
input on sensory perception have been studied by
looking at how these signals affect processing in the
visual system. It has been shown that the process-
ing of visual information is significantly changed
as heart rate and carotid pressure change. These
findings provide confirmation of the Laceys’ earlier
behavioral evidence that cardiovascular activity in-
fluences sensory intake.

Rollin McCraty, Ph.D.

Sympathectomy separates the viscera from the CNS

Elmer Green, Menninger Clinic
physician and pioneer of the biofeedback approach
to treatment of disease, offered an astute summation
of this highly debated topic: “Every change in the
physiological state is accompanied by an appropri-
ate change in the mental emotional state, conscious
or unconscious, and conversely, every change in the
mental emotional state, conscious or unconscious,
is accompanied by an appropriate change in the
physiological state.”


autonomic responses vary both quantitatively and qualitatively
with the degree of emotional intensity.

Individual differences in patterns of autonomic
discharge during emotional states have also been
identified and associated with personality charac-
teristics. For instance, individuals who have been
characterized as “impulsive” personality types dis-
play rhythmic bouts of palmar sweat secretion and
increases in heart rate even at rest, while in others,
little change occurs in these physiological parameters
under similar circumstances.

Afferent feedback from bodily organs has been
shown to affect overall brain activity and to exert a
measurable influence on cognitive, perceptual, and
emotional processes.
Rollin McCraty, Ph.D.
Heart–Brain Neurodynamics
The Making of Emotions

Sympathectomy causes a parasympathetic dominance

A u t o n o m i c N e r v o u s S y s t em


Sympathetic Pathway - Accelerator
High Effort - Adrenaline

Parasympathetic Pathway - Brake
Low Effort/Relaxation - Acetylcholine

www.macquarieinstitute.com.au/pdfs/

the critical role of ascending input from the heart and body to the brain in the generation of emotions

Heart-Brain Neurodynamics ENDY Heart–Brain Neurodynamics: The Making of Emotions By Rollin McCraty, Ph.D. The Making of Emotions Heart-Brain Neurodynamics explores recent scientific advances that clarify a number of central controversies in the understanding of emotion, including the relationship between intellect and emotion. A discussion of the critical role of ascending input from the heart and body to the brain in the generation of emotions culminates in a detailed presentation of a new model of emotion in which the brain functions as a complex pattern-matching system. From this perspective it is shown that the heart is a key component of the emotional system, providing a physiological basis for the link between the heart and our emotional life.

New Electrophysiological Correlates Associated with Intentional Heart Focus. Rollin McCraty, M.A., Mike Atkinson, & William A. Tiller, Ph.D.

the heart is a key component of the emotional system

Research has also shown that the heart is a key component of the emotional system. Scientists now understand that the heart not only responds to emotion, but that the signals generated by its rhythmic activity actually play a major part in determining the quality of our emotional experience from moment to moment. As described next, these heart signals also profoundly impact perception and cognitive function by virtue of the heart’s extensive communication network with the brain. Finally, rigorous electrophysiological studies conducted at the Institute of HeartMath have even indicated that the heart appears to play a key role in intuition. Although there is much yet to be understood, it appears that the age-old associations of the heart with thought, feeling, and insight may indeed have a basis in science.
Ph.D. Rollin McCraty

measure of autonomic arousal

Psychologists may try to measure autonomic arousal to see how stressed participants feel at any time. They cannot measure autonomic arousal, so they use other measures as a proxy, for example heart rate, blood pressure, breathing rate, or galvanic skin response.

Applying Regression and Correlation: A Guide for Students and Researchers

By Jeremy Miles, Mark Shevlin

Published 2001 SAGE

Regression analysis

272 pages

ISBN:0761962301

Changes in the level of activity of the peripheral autonomic nervous system often mirror arousal changes in the central nervous system

Arousal is both a behavioral and psychological construct. An aroused organism is alert. It is prepared to process incoming stimuli. An unaroused organism is comatose. It is not prepared to process stimuli and is unaware of of stimuli. Psychologically, arousal also refers to the excitatory state or the propensity of neurons to discharge when appropriately activated (neuronal preparation).
Changes in the level of activity of the peripheral autonomic nervous system often mirror arousal changes in the central nervous system.

The ability to sustain attention is termed vigilance. Arousal and vigilance are closely linked so that when arousal wanes, vigilance diminishes and vice versa.
By Richard J. Davidson, Kenneth Hugdahl
Published 1995
MIT Press

Cerebral dominance

735 pages

ISBN:0262540797

Arousal - behavior and performance

Research suggests that the interaction between increased arousal and accompanying psychological mood have a combined effect upon behavior and performance (Edwards & Hardy, 1996; Hardy, 1996b; Hardy & Parfitt, 1991; Janelle, Singer, & Williams, 1999; Thelwell & Maynard, 1998; Woodman, Albinson, & Hardy, 1997).

by D. Gant Ward , Richard H. Cox

Heart rate - Increases or decreases as arousal increases or decreases

Drive Theory essentially predicts that performance increases in a linear fashion as arousal increases. More precisely, drive theory predicts that performance is a function of the interaction between habit and drive (arousal).

Commonly used measures of AROUSAL
Brain activity - Changes are thought to reflect changes in arousal; alpha activity is thought to reflext low arousal (relaxation), whereas beta activity is thought to reflect higher levels of arousal

Heart rate - Increases or decreases as arousal increases or decreases

Cortisol - A stress hormone released during an encounter with a stressor or challenge (physical or psychological)

Introduction to Exercise Science - By Stanley P. Brown

Published 2000 - Medical - page 321
Lippincott Williams
& Wilkins

one of the components of anxiety as a dispositional characteristic was "drive"

Anxiety was a pivotal concept in psychodynamic theories. In my dissertation, supervised by Spence and conducted in his laboratory, I elected to investigate whether one of the components of anxiety as a dispositional characteristic was "drive" (the energetic component of the Hullian motivational complex). Quite simply, I investigated, whether chronically anxious individuals would classically condition more rapidly than less anxious individuals. As it turned out, they did (Taylor, 1951)

Models of Achievement: Reflections of Eminent Women in Psychology

By Agnes N. O'Connell, Nancy Felipe Russo
Published 1988
Lawrence Erlbaum
Associates

pneumothorax, leading rapidly to hypotension, electromechanical dissociation and asystole

Small pneumothorax, leading rapidly to hypotension, electromechanical dissociation and asystole during thorascopic sympathectomy. Patient resuscitated successfully.

Adverse events in anaesthetic practice: qualitative study of definition, discussion and reporting
A.F. Smith, D. Goodwin, M. Mort and C. Pope
British Jounal of Anaesthesia 96 (6): 715-21 (2006)

SNS dysregulation is a critical component of the immune system dysregulation

D. Lorton, C. Lubahn and D. Bellinger

Abstract:

Evidence that the SNS can enhance or suppress inflammation and immune function, that SNS dysregulation is a critical component of the immune system dysregulation which drives RA pathology, and that the SNS may be targeted in RA to restore immune system homeostasis and prevent disease pathology, will be presented.
Handbook of Neurochemistry and Molecular Neurobiology
Neuroimmunology
Abel Lajtha, Armen Galoyan and Hugo O. Besedovsky

high and low blood pressure has simultaneously influenced the behavior

Data are consistent with the hypothesis that strains selectively bred for some behavioral feature may also differ in central arousal, which will interact with task difficulty to determine performance differences. Data also indicate that selective breeding for high and low blood pressure has simultaneously influenced the behavioral properties of these 2 strains. (31 ref) (PsycINFO Database Record (c) 2007 APA)

Two-way shuttle box and lever-press avoidance in the spontaneously hypertensive and normotensive rat.

Sutterer, James R.; Perry, John; de Vito, William

http://psycnet.apa.org/index.cfm?fa=main.doiLanding&uid=1981-07293-001

Use of stellate ganglion block for the treatment of psychiatric and behavioral disorders

The present invention is directed to a method for the treatment of a patient suffering from psychiatric and behavioral disorders, including post partum depression, post traumatic stress disorder, compulsive smoking, attention deficit hyperactivity disorder, gambling addiction, comprising the step of administering a stellate ganglion block to the patient to alleviate the symptoms. The stellate ganglion block may be followed by a sympathectomy to provide permanent relief.

United States Patent 20070135871

Kind Code: A1

http://www.freepatentsonline.com/y2007/0135871.html

surgically induced autonomic failure

2004 - David S. Goldstein MD, Ph.D., senior clinical investigator for the National Institute of Neurological Disorders and Stroke calls sympathectomy "surgically induced autonomic failure".

Arousal - drive and feedback

Emotion is persistently regarded as energizing and organizing...

One virtue of identifying arousal with drive is that it relates differing views (as well as bringing into the focus of attention data that may otherwise be neglected).

The feedback from cortical functioning makes intelligible Mowrer's equating anxiety aroused by threat of pain, and anxiety aroused in some way by cognitive processes related to the ideas of self. Solomon and Wynne's results with sympathectomy are also relevant, since we must not neglect the arousal effect of interoceptor activity; and so is clinical anxiety due to metabolic and nutritional disorders, as well as that of some conflict of cognitive processes.
Obviously these are not explanation that are being discussed, but possible lines of future research; and there is one problem in particular that I would urge should not be forgotten. This is the cortical feedback to the arousal system, in psysiological terms: or in psychological terms, the immediate drive value of cognitive processes, without intermediary. This is psychologically demonstrable, and has been demonstrated repeatedly.

DRIVES AND THE C.N.S. (CONCEPTUAL NERVOUS SYSTEM)[1]

D. O. Hebb (1955)

First published in Psychological Review, 62, 243-254.

15.2% drop in ejection fraction

The study was approved by the local ethics committee, and in agreement with the Helsinki II declaration written informed consent was obtained in each case. Healthy (ASA I) patients scheduled for thoracoscopic sympathectomy for flushing syndrome were asked to participate in the study, and all patients were evaluated for presence of cardiac disease prior to anaesthesia.

Fourteen participants (12 f; 2 m) with a median age of 32.5 (range: 26–70) yr were successively enrolled in the study. All participants were unmedicated and had no history of previous cardiac illness. Preoperative cardiac risk assessment, including ECG and chest X-ray, revealed no evidence of manifest cardiac disease.
Transthoracic TDE image acquisition and subsequent analysis was possible in all participants. Full TTS from apical four- and two-chamber views was not possible in four of 14 individuals, mainly due to poor signal/noise ratio in apical segments.
Propofol anaesthesia induction resulted in significant attenuation in blood pressure but no change in HR was observed (Table 1). TDE variables (PSV, TTD, and TTS) declined significantly, whereas TTP was unchanged (Table 1).

Limitations of the current study: As the primary objective was to evaluate LV function by measuring myocardial velocities, no LV area calculations were performed. TTS was attempted in order to form the basis for comparison with currently used methods. As noted, TTS was not possible in some patients; however, the results from 10 patients were conclusive (15.2% drop in ejection fraction) (P = 0.009). Similarly, as the study population consisted of healthy patients undergoing short-duration minor surgery no invasive pressures were coupled with TDE.

Propofol reduces tissue-Doppler markers of left ventricle function: a transthoracic echocardiographic study

J. R. Larsen^1,2,*, P. Torp¹, K. Norrild¹ and E. Sloth¹

¹ Department of Anaesthesiology and Intensive Care
² Department of Experimental and Clinical Research, Skejby Sygehus, Aarhus University Hospital, DK-8200 Aarhus N, Denmark

http://bja.oxfordjournals.org/cgi/content/full/98/2/183

Symptoms became worse after bilateral sympathectomy

In an attempt to control his hypertension, bilateral syrnpathectomy was performed in 1968. Following this procedure, the patient's hypertension improved, but his symptoms exacerbated. His lassitude and dyspnea on exertion increased and, in addition, he had frequent episodes of angina pectoris. He also complained of severe palpitations and dizziness during physical activity. It is noteworthy that following the initial episode of chest pain in 1984, the patient had been free of any form of chest discomfort until after the sympathectomy.

The history of this patient seems particularly noteworthy in that his symptoms became worse after bilateral sympathectomy and subsequent improvement in the control of his hypertension. When the blood pressure became lower, the dyspnea on exertion worsened, angina pectoris appeared and dizziness on physical activity was noted for the first time.
DOI 10.1378/chest.57.1.87 1970;57;87-90
Chest
Eduardo Moreyra, Pieter Knibbe and Albert N. Brest
Hypertension and Muscular Subaortic Stenosis

Cardiac hypertrophy accelerated by left cervical sympathectomy in spontaneously hypertensive rats

T. Matoba¹ , H. Toshima¹, K. Adachi¹, K. Ohta¹ and T. Ito¹

(1)	Department of Medicine, Kurume University School of Medicine, Kurume, (Japan)

(2)	Department of Medicine, Kurume University School of Medicine, 67 Asahimachi, 830 Kurume, Japan

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.

This work was supported by a grant of the Ministry of Education for 1980.
http://www.springerlink.com/content/k584578m848n8838/

sympathectomy - protection against noise-induced hearing loss

Strategies to enhance CBF for protection against noise

A number of the experimental and clinical approaches to protection against noise-induced hearing loss involve mechanisms related to CBF and the oxygenation of the cochlea. These are such diverse procedures as sympathectomy, hyperbaric oxygen treatment and carbogen respiration. It is not within the scope of this review to address the literature concerning these and other approaches comprehensively, but is useful to consider a few examples and their relative success. Strategies in relation to ROS are covered in the next section.

Year : 1999 | Volume : 2 | Issue : 5 | Page : 17-31

Sound-induced cochlear ischemia/hypoxia as a mechanism of hearing loss

Nuttall Alfred L Department of Otolaryngology, NRC04, Oregon Health Sciences University, Portland, Oregon, USA and Kresge Hearing Research Institute, University of Michigan, Ann Arbor, MI 97201-3098, USA,

long-term and repeated stellate ganglion block affect the pituitary secretions of ACTH and TSH.

The present results suggest that cervical sympathectomy in the rat increases ACTH secretion and decreases TSH secretion in the pituitary. These effects seem to be due to a mildly increased secretion of melatonin in the pineal body that probably in turn increases corticotropin-releasing factor (CRF) secretion and decreases thyrotropin-releasing hormone (TRH) secretion in the hypothalamus. Extrapolation of these findings to humans suggests that long-term and repeated stellate ganglion block would affect the pituitary secretions of ACTH and TSH. (adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH)
J Anesth (1996) 10:181-184
Cervical sympathectomy affects adrenocorticotropic hormone
and thyroid-stimulating hormone in rats
Hiroshi Iwama, Mamoru Adachi, Choichiro Tase, and Yoichi Akama
Department of Anesthesiology, Fukushima Medical College, 1 Hikarigaoka, Fukushima 960-12, Japan

Selective lung ventilation during thoracoscopy: effects of insufflation on hemodynamics

RESULTS: Cardiac index, mean arterial pressure, and left ventricular stroke work index decreased, whereas pulmonary artery and central venous pressures increased (p < 0.05) at insufflation pressures of 5 mm Hg and greater. CONCLUSIONS: Positive-pressure insufflation during thoracoscopy resulted in significant hemodynamic compromise despite the use of selective lung ventilation. Conversion to thoracotomy may be an alternative if positive-pressure insufflation is necessary to perform the thoracoscopic procedure.
Hill RC, Jones DR, Vance RA, Kalantarian B
Ann Thorac Surg 1996; 61:945-8.

Haemodynamic changes during thoracoscopic surgery the effects of one-lung ventilation compared with carbon dioxide insufflation.

One-lung ventilation via a double-lumen endobronchial tube is safe and convenient for video-assisted thoracoscopic surgery. It has no further consequences on haemodynamic variables, whereas the compression of the lung by carbon dioxide insufflation may cause circulatory dysfunction.
Brock H, Rieger R, Gabriel C, Pölz W, Moosbauer W, Necek S
Anaesthesia 2000;55:10-6.
http://journals.elsevierhealth.com/periodicals/ymai/medline/record/MDLN.10594427

complications of CO2 insufflation

Catastrophic complications such as delayed recognition of tension
pneumothorax from left sided CO2 insufflation, leading to fatal and
disabling consequences was reported.

Author: Dr. Mohamed Ismail, Mansoura University, Department of
Cardiothoracic Surgery, Mansoura University, 71 el-sedek st., Ahmed Maher
St., Mansoura, 050 Egypt
Interactive CardioVascular and Thoracic Surgery 3 (2004) 437–441

Severe systemic hypotension and bradycardia have been observed during carbon dioxide insufflation in some patients undergoing sympathectomy

Anesthetic considerations for thoracic and thoracoscopic neurosurgical procedures are considered, emphasizing the need to provide anesthetic stability during prolonged periods of one-lung ventilation, while optimizing conditions for intraoperative monitoring of spinal cord integrity.
Severe systemic hypotension and bradycardia have been observed during carbon dioxide insufflation in some patients undergoing sympathectomy.

Current Opinion in Anaesthesiology. 13(1):65-69, February 2000.
Adams, David C.; Eisenkraft, James B.

Cardiovascular collapse caused by carbon dioxide insufflation during one-lung anaesthesia for thoracoscopic sympathectomy

Carbon dioxide insufflation into the pleural space during one-lung anaesthesia for thoracoscopic surgery is used in some centres to improve surgical access, even though this practice has been associated with well-described cardiovascular compromise. The present report is of a 35-year-old woman undergoing thoracoscopic left dorsal sympathectomy for hyperhidrosis. During one-lung anaesthesia the insufflation of carbon dioxide into the non-ventilated hemithorax for approximately 60 seconds, using a pressure-limited gas inflow, was accompanied by profound bradycardia and hypotension that resolved promptly with the release of the gas. Possible mechanisms for the cardiovascular collapse are discussed, and the role of carbon dioxide insufflation as a means of expediting lung collapse for procedures performed using single-lung ventilation is questioned. Australian Society of Anaesthetists 2002 Harris, R. J. Benveniste, G. Pfitzner, John http://digital.library.adelaide.edu.au/dspace/handle/2440/5894

Right vs left side thoracoscopic sympathectomy: effects of CO2 insufflation on haemodynamics

CONCLUSIONS: Compared to left side TS (thoracoscopic sympathectomy), direct compression by CO2 against the venae cava and right atrium and ventricle during right side TS caused reduction of the venous return and hence low CO (cardiac output), CI (cardiac index) and SV (stroke volume).

A A El-Dawlatly, A Al-Dohayan, A Samarkandi, F Algahdam, A Atef Department of Anaesthesia, College of Medicine, King Saud University, Riyadh, Saudia Arabia.

Ann Chir Gynaecol. 2001 ;90 (3):206-8 11695797

Sympathectomy is effective treatment of Long QT Syndrome

Current Medical Diagnosis and Treatment 2007 (Current Medical Diagnosis and Treatment)
Stephen J. McPhee, Maxine A. Papadakis, Lawrence M. Tierney

page 390:
5. Long QT Syndrome
Because this is a primary electrical disorder, usually with no evidence of structural heart disease or LV dysfunction, the long-term prognosis is excellent if arrhytmia is controlled. Long-term treatment with beta-blockers, permanent pacing, or left cervicothoracic sympathectomy is frequently effective.

Disorders 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 insufficiency
Familial dysautonomia
Shy-Drager Syndrome
Parkinson's disease
Tabes dorsalis
Cerebrovascular disease
Diabetes melitus
Idiopathic orthostatic hypotension
Sympathectomy

Decrease in peripheral vascular resistance

AWHONN's Perinatal Nursing: Co-Published with AWHONN (Simpson, Awhonn's Perinatal Nursing)
Kathleen Rice Simpson, Patricia A Creehan

page 63:
Epidural anesthesia causes a sympathectomy and a marked decrease in peripheral vascular resistance that may cause a decrease in venous return, resulting in decreased cardiac output.

Orthostatic hypotension - Sequelae of surgical sympathectomy

Current Diagnosis and Treatment: Emergency Medicine (Current Emergency Diagnosis and Treatment)
C. Keith Stone, Roger L. Humphries, Sep 14, 2007
page 270
Causes of orthostatic hypotension:
Sequelae of surgical sympathectomy

Nervous system dysfunction - Syncope

Harrison's Principles of Internal Medicine, 17th Edition (Harrison's Principles of Internal Medicine)
Anthony S. Fauci, Eugene Braunwald, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, Joseph Loscalzo

page 139:
Section 3 - Nervous system dysfunction by Mark D. Carlson
Table 21 - 1
Causes of Syncope:
Sympathectomy

Sympathectomy incompatible with life

Danielopolu later declared cervicothoracic sympathectomy to be disastrous, from the therapeutic point of view, and concluded that removal of the stellate ganglion for angina was incompatible with life.
Landmarks in Cardiac Surgery
By Stephen Westaby, Cecil Bosher

Published 1998
Informa Health Care
Heart
683 pages
ISBN:1899066543

Complications in Cardiothoracic Surgery: Avoidance and Treatment

The most common complications of sympathectomy are related to manipulation of the autonomic nervous system.
By Alex G. Little
Published 2004
Blackwell Publishing
Prevention & control
464 pages
ISBN:0879934271

Neurophysiological Basis of Cerebral Blood Flow

In contras, the CM-Pf elicited cerebrovasodilation is shown to be, in part dependent on the integrite of the sympathetic innervation arising from the SCG (Mraovitch et al., 1986).
After ipsilateral sympathectomy, the CP-Pf-elicited rCBF was significantly reduced on the denervated side. For example, in the frontal cortex CM-Pf stimulation increased rCBF up to 130+-11ml/100g/min. Following sympathectomy the CM-Pf elicited increase was only 102+-4ml/100g/min.
The mechanism by which acute sympathectomy coupled to the CM-Pf stimulation reduces elevated cortical blood flow remains to be elucidated.

Effects of cervical sympathectomy on secondary vasodilation

Following unilateral transection of the cervical sympathetic trunk, the DMRF stimulation increased CBF bilaterally in all brain regions. In the cortical regions (frontal and parietal cortices) and in the caudate nucleus, the increase in CBF was slightly but significantly higher in the denervated side. Thus, the DMRF elicited cerebrovascular dilation is in part dependent on sympathetic excitation. However, the finding that the DMRF elicited cortical and caudate cerebrovasodilation following blockade of nerve traffic through the SCG increases in magnitude is in opposition to the finding that sympathectomy coupled to the DMRF stimulation decreased CBF responses. The reasons for this discrepancy is presently unknown.
Neurophysiological Basis of Cerebral Blood Flow
By Mraovtich, Sima Mraovitch, Richard Sercombe
Published 1996
John Libbey Eurotext
Cerebral circulation
424 pages
ISBN:0861962729

THE EFFECT OF SYMPATHECTOMY ON THE FATTY DEPOSIT IN CONNECTIVE TISSUE

A. B. L. Beznák 1 and Z. Hasch 1

1 The Institute of Experimental Pathology, University of Budapest

1. Unilateral section of both splanchnic nerves in cats diminishes the degree of fall in the amount of perirenal fat which follows laparotomy under ether anæsthesia. On the splanchnicotomised side the perirenal fat weighs 100-300 per cent. more than on the intact side.

2. The same difference is found if the cats starve after splanchnicotomy, or if cats with very little perirenal fat are fattened after the splanchnicotomy.

3. When cats are fed with a diet containing fat stained with Sudan III. the stained fat is deposited in the perirenal fat on both sides in equal concentrations. When they are starved after unilateral splanchnicotomy, the amount of the perirenal fatty tissue on the ipsilateral side is greater than on the normal. The concentration of Sudan III., however, remains on both sides the same as it was previous to the splanchnicotomy and starvation.

4. If cats and rats are kept on normal unstained diets for various periods after unilateral splanchnicotomy, are then fed with a diet containing fat stained with Sudan III. and are killed 18 hours after the feeding, the concentration of Sudan III. on the splanchnicotomised side is about of that on the normal side.

5. The conclusion is reached that, in consequence of the splanchnicotomy, changes take place in the perirenal connective tissue which slow both the deposition of fat and its mobilisation. The mobilisation is retarded more than the deposition.

Serum dopamine- -hydroxylase: decrease after chemical sympathectomy.

R Weinshilboum
J Axelrod

Dopamine-beta- hydroxylase is an enzyme that is localized to catecholamine-containing vesicles in sympathetic nerves and the adrenal medulla, and is also found in the serum. Treatment of rats with 6-hydroxydopamine, a drug which destroys sympathetic nerve terminals, leads to a decrease in serum dopamine-beta-hydroxylase activity. The decrease is not due to an effect on the adrenal medulla or to an increase in circulating inhibitor or inhibitors of enzyme. These data represent evidence that at least a portion of the circulating dopamine-beta-hydroxylase activity arises from sympathetic nerve terminals.

Sympathectomy and the immue system

In rodents, chemical sympathectomy attenuates primary
splenic antibody responses to systemic immunisation and lymph-node antibody responses to footpad challenge, suppresses cytotoxic T-cell responses to allogeneic cells, and reduces delayed-type hypersensitivity reactions; it is also associated with an enhancement of in-vivo lymphoproliferation in some lymph nodes and an increase in natural killer (NK) cell activity.'[ 11, 12] Chemical sympathectomy also increases the severity of experimental allergic encephalomyelitis[ 13] and adjuvant-induced arthritis in susceptible strains of rats. [ 14]
Psychoneuroimmunology: Interactions between the nervous system and the immune system.

Source: Lancet, 1/14/95, Vol. 345 Issue 8942, p99, 5p,

Author(s): Ader, Robert; Cohen, Nicholas

Cerebral venous blood oxygen content and brain blood flow

Cerebral venous blood oxygen content and brain blood flow

In both groups of patients the internal jugular blood oxygen concentration was reduced significantly from the recumbent value (p < 0.01). Comparable increases in the cerebral arteriovenous oxygen differences were observed. The increase in this oxygen difference after three minutes of tilt was significant in the patients studied after sympathectomy (p < 0.02), but was not in the pa- tients with essential hypertension. The decreases in the -oxygen content of cerebral venous blood after 20 minutes of tilt cannot be attributed to significant reductions in cerebral blood flow in either
group.

Cerebral oxygen consumption

Although the cerebral arteriovenous oxygen difference increased only 10% in the hypertensives, the 9% increase in cerebral oxygen consumption after 20 minutes of tilt proved to be highly significant (p < 0.01). Cerebral oxygen con- sumption was not increased in the postsympathetomy group.
Cerebrovascular resistance

The cerebral blood flow of the patients after sympathectomy was decreased 1 1% with a 26% reduction in "effective" mean cerebral pressure.
This can be explained by the fact that the cerebrovascular resistance decreased 17%o from 2.3 to 1.9 units, indicating a highly significant relaxation of cerebral vessels during the tilt period. A comparable reduction in cerebrovascular resistatice
was found both in the hypertensive patients and in the normotensive subjects.

By JOSEPH H. HAFKENSCHIEL, CHARLES W. CRUMPTON,2 HENRY A.
SHENKIN, JOHN H. MOYER,3 HAROLD A. ZINTEL, HERBERT
WENDEL,4 AND WILLIAM A. JEFFERS, WITH THE TECHNICAL
ASSISTANCE OF SALLY CONLIN HARNED, NELLYJ. KEFFER, AND GERALDINE CROFT

Sympathectomy-induced increases in calcitonin gene-related peptide (CGRP)-, substance P- and vasoactive intestinal peptide (VIP)-levels

The neuropeptide contents of rat salivary glands were increased four weeks after sympathetic postganglionic denervation (but not after preganglionic denervation): calcitonin gene-related peptide (CGRP) by 400 and 65% in the parotid and submandibular glands, respectively; substance P by 30% in the submandibular gland; and vasoactive intestinal peptide (VIP) by 30% in the parotid gland. The sensory neurotoxin capsaicin prevented the expected increases of CGRP and substance P in the submandibular glands and of VIP in the parotid glands. The CGRP-increase in the parotid gland was, however, only reduced (by 65%). Parasympathetic otic ganglionectomy reduced the peptide levels in the parotid glands (CGRP – 50%, VIP – 98% and substance P – 99%). From these residual levels, CGRP increased almost 8-fold and substance P 3-fold in response to the sympathetic denervation, while VIP was unaffected. In the parasympathetically denervated glands, the capsaicin-sensitive contribution to the CGRP-response to sympathetic denervation was roughly estimated to be more than 25% but less than 40%, while the corresponding contribution to the substance P-response was roughly estimated to be more than 6% but less than 58%. Most likely not only CGRP/substance P-containing sensory C-fibres (submandibular and parotid glands) but also parasympathetic VIP-containing secretomotor and vasomotor fibres (parotid glands) contributed to the capsaicin-sensitive response to sympathetic denervation.
J. Ekströma R. Ekman
2005

altering Ca2+ activity of actomyosin ATPase

Also, Sympathectomy may impair cardiac functional capacity by altering Ca2+ activity of actomyosin ATPase.

Effects of thyroid deficiency and sympathectomy on cardiac enzymes

K. M. Baldwin, P. J. Campbell, A. M. Hooker and R. E. Lewis
AJP - Cell Physiology, Vol 236, Issue 1 30-C34, Copyright © 1979

compensatory activation of these effectors maintains blood pressure at approximately normal levels

Compensatory activation of alternative effectors, such as the adrenomedullary hormonal system, arginine vasopressin system, and renin-angiotensin-aldosterone system explains why destruction of the sympathetic nervous sytem produces only relatively small influence on blood pressure. This misled Cannon into thinking that the sympathetic nervous system was unimportant in the regulation of blood pressure in organisms at rest...
In the 1980s, however, several reports showed that sympathectomy compensatorily activates other effectors...and compensatory activation of these effectors maintains blood pressure at approximately normal levels. In the setting of sympathectomy, interference with any of the other effectors evokes immediate, precipitous declines in blood pressure...
It also took decades after Cannon's death before researchers began to demonstrate effects on 'nonemergency' stressors, such as mental challenge and exercise, on sympathetic outflow to the heart. One index of this outflow is the rate of entry of norepinephrine, the main neurotransmitter released by the sympathetic nerves, into the veins draining the heart (norepinephrine spillover).

David S. Goldstein: Adrenaline and the Inner World: An Introduction to Scientific Integrative Medicine.

Norephineprine - Emotion - Memory

Dr. Walling studied the contribution of emotion to the formation of memory. Norepinephrine, a neurotransmitter released during states of heightened arousal, is considered to be the primary candidate mediating the effects of emotion on memory. Dr. Walling's study on rats provides support for the hypothesis that that short-term and long-term memory processes may be modulated by separate and distinct memory mechanisms.

Beta-blockers impair working memory

Nielson KA, Jensen RA. (1994) Beta-adrenergic receptor antagonist antihypertensive medications impair arousal-induced modulation of working memory in elderly humans. Behav Neural Biol. 62: 190-200.