Cardiovascular collapse caused by carbon dioxide insufflation during 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.
Australian Society of Anaesthetists 2002
Sympathetic regulation of the cerebral circulation by the carotid chemoreceptor reflex
After bilateral cervical sympathectomy (n = 9), carotid chemoreceptor reflex stimulation induced significantly different (P less than 0.01) effects on cerebral blood flow, which rose by 42 +/- 8%, and cerebral vascular resistance, which did not change.
In "sham" dogs, the repeat response to carotid chemoreceptor stimulation also induced significantly different effects from those in dogs with sympathectomy. Thus, in the conscious dog, stimulation of the carotid chemoreceptor reflex elicits significant sympathetically mediated vasoconstriction in cerebral vessels.
Am J Physiol Heart Circ Physiol 238: H594-H598, 1980;
Effect of adrenalectomy or sympathectomy on spinal cord blood flow
We conclude that adrenalectomy near-totally ablates the hypothermia-associated increase in RSCBF (regional spinal cord blood flow) measured in intact rats and that abdominal sympathectomy totally ablates it. This evidence complements morphological evidence for adrenergic innervation of the spinal cord vasculature.
Heart and Circulatory Physiology, Vol 260, Issue 3 827-H831, Copyright © 1991 by American Physiological Society
A. Iwai, W. W. Monafo and S. G. Eliasson
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110.
Sympathectomy leads to calcinosis
Of 20 patients who had no evidence of calcinosis
pre-operatively, 11 developed medial calcification after unilateral operation exclusively on the side of sympathectomy. In seven patients calcinosis was detected in both feet after bilateral operation. In conclusion, sympathetic denervation is one of the causes of Monckeberg's sclerosis regardless of diabetes mellitus.
Goebel FD, Fuessl HS.
Diabetologia. 1983 May;24(5):347-50.
Sympathectomy induced adrenal hypertropy
Journal of Hypertension. 17(7):933-940,
July 1999.
Qiua, Jingxin 1; Nelsona, Sharon H. 1; Spethb, Robert C. 2; Wanga, Donna H. 1,3Objective: Previous studies indicate that the adrenal gland plays a compensatory role in the maintenance of blood pressure in chemically sympathectomized rats. However, the mechanisms responsible for compensatory adrenal responses are poorly understood. This study examined the regulation of adrenal growth and type 1A, 1B, and type 2 angiotensin II (Ang II) receptor (AT1A, AT1B and AT2) expression in the adrenal gland induced by sympathectomy.
Definition of the sympathetic ganglionic chain, that is cut/clamped during surgery
sympathetic ganglionic chain
From: A Dictionary of Psychology | Date: 2001 | Author: ANDREW M. COLMAN
sympathetic ganglionic chain n. A string of ganglia running down each side of the spinal cord throughout most of its length, containing cell bodies of neurons that belong to the sympathetic nervous system and that project axons to muscles and glands, controlling the smooth muscles of the blood vessels, eyelids, hair follicles, sweat, tear, and salivary glands, respiratory organs, irises, and also the heart and other organs. Also called the chain ganglia or sympathetic trunk.[From Greek syn with + pathos suffering + ganglion a cystic tumour]
© A Dictionary of Psychology 2001, originally published by Oxford University Press 2001.
Nerve regeneration aka nerve sprouting leads to abnormal nerve function and pathological conditions
Regenerating sympathetic fibers create connections with nociceptive C-fibres, causing abnormal, sympathetically maintained pain conditions. Clinical studies in humans support the idea that nociceptors develop catecholamine sensitivity after complete or partial nerve lesions.
Sympathectomy, denervation has been linked to the development of Reflex Regional Pain Syndrome.
The regeneration of the sympathetic fibers is also responsible for the abnormal sweating during eating or smelling (food). This reaction can be triggered by any taste or smell, including spicy or hot food, apples, anything sour, chocolate, sweets etc. For the post-sympathectomy patient the otherwise anhydriotic areas of the face, upper body and arms will react with abnormal sweating and chills to these flavors/smells. The condition is called Frey's Syndrome and is caused by abnormal connections/interactions between the salivary gland and the sprouting sympathetic fibers.
Immune response and sympathectomy
Chemical sympathectomy of adult mice resulted in reduced antibody responses to T-dependent antigens. The interaction between sympathetic NA nerve fibers and cells of the immune system has been shown through the distribution of tyrosine hydrolase (TH+) nerve fibers among lymphocytes and macrophages in lymphoid organs, the expression of adrenoceptors on cells of the immune system, and the immunomodulatory effects of NA.
VOL. 31, NOS. 5 & 6, 2000 JOURNAL OF MEDICINE
Bone remodeling and resorption
Marta G. Ladizeskya, Rodolfo A. Cutrerab, Verónica Boggiob, Carlos Mautalena and Daniel P. Cardinalib, *
Received 27 May 1999;
Signals from the sympathetic nervous system regulate hematopoietic stem cell egress from bone marrow.Katayama Y,
Battista M,
Kao WM,
Hidalgo A,
Peired AJ,
Thomas SA,
Frenette PS.
Department of Medicine, Immunobiology Center and Black Family Stem Cell Institute, Mount Sinai School of Medicine, New York, NY 10029, USA
Worth considering:
If you damage your sympathetic nerve/chain - let's say - in a car accident, it it treated as a 'damage' and the symptoms that necessarily follow: 'illness'. You will - if lucky - have a diagnosis - most likely dysautonomia, the same condition (with numberless symptoms) people with spinal cord injuries suffer from. The imbalance between the (now disabled) sympathetic and parasympathetic nervous system will be responsible for the body's malfunctioning - physically and emotionally. So how can the same, destructive, surgical procedure be called CURE for people with non-life threating conditions, such as facial blushing, palmar or axillary sweating? And how can doctors, well aware of the impact the surgery will have, offer the surgery? When did the wellbeing of the patient become an obsolete aim?
This truly defies reason.
Patients with hyperhidrosis of the palm or soles, who fail to respond to topical agents, deserve a trial of conservative therapy, botulinum toxin, or iontophoresis, before aggressive surgical techniques that carry with them the risk of lifelong troublesome side effects are offered.Lewis P Stolman, MD, FACP, FRCP(C)
Department of Dermatology, New York University School of Medicine, New York, NY
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2344132
