Sympathectomy significantly altered vascular responses

Vascular responses to warming were studied in hemiplegic patients and after sympathectomy, using venous occlusion plethysmography of foot and leg. Comparisons were made with corresponding age groups. The pattern of response was essentially unchanged in hemiplegic patients, but was altered substantially where sympathetic pathways had been interrupted.

Vasomotor Responses in the Extremities of Subjects with Various Neurologic Lesions

I. Reflex Responses to Warming

1. WALTER REDISCH, M.D.; 
2. FRANCISCO T. TANGCO, M.D.; 
3. LOTHAR WERTHEIMER, M.D.;
4. ARTHUR J. LEWIS, M.D.; 
5. J. MURRAY STEELE, M.D.; 
6. Dorothy Andrews, B.A.,

http://circ.ahajournals.org/content/15/4/518.abstract

Sympathectomy involves division of adrenergic, cholinergic and sensory fibers which elaborate adrenergic substances during the process of regulating visceral function.

G. SURGICAL SYMPATHECTOMY AND ADRENERGIC FUNCTIONPharmacol Rev March 1966 18:611-618;

Sympathectomy (ETS or ESB) can alleviate social phobia and common fears such as fear of flying, heights, open spaces, or the darkness

Is sympathectomy the new lobotomy?
"ESB may also alleviate social phobia and common fears such as fear of flying, heights, open spaces, or the darkness. In addition, it can be used to decrease trembling of the body, hands, and voice, even stuttering. It may help in alcoholism or drug withdrawal, because these are often linked with social anxiety. 
Sympathetic block is a gentle and exact endoscopic procedure. It is performed as day surgery under light anesthesia."

http://www.sympatix.fi/?lang=en

Intense pain as a side-effect of sympathectomy is a rarely mentioned consequence of the surgery/nerve injury

Intrapleural analgesia after endoscopic thoracic sympathectomy.

Patrícia Gomes da Silva, Daniele Cristina Cataneo, Fernanda Leite, Erica Nishida Hasimoto, Guilherme Antonio Moreira de Barros

Postgraduate Program in Anesthesiology, Botucatu School of Medicine, UNESP, Bauru, SP, Brazil.

PURPOSE To compare analgesia traditionally used for thoracic sympathectomy to intrapleural ropivacaine injection in two different doses. METHODS Twenty-four patients were divided into three similar groups, and all of them received intravenous dipyrone. Group A received intravenous tramadol and intrapleural injection of saline solution. Group B received intrapleural injection of 0.33% ropivacaine, and Group C 0.5% ropivacaine. The following aspects were analyzed: inspiratory capacity, respiratory rate and pain. Pain was evaluated in the immediate postoperative period by means of the visual analog scale and over a one-week period. RESULTS In Groups A and B, reduced inspiratory capacity was observed in the postoperative period. In the first postoperative 12 hours, only 12.5% of the patients in Groups B and C showed intense pain as compared to 25% in Group A. In the subsequent week, only one patient in Group A showed mild pain while the remainder reported intense pain. In Group B, half of the patients showed intense pain, and in Group C, only one presented intense pain. CONCLUSION Intrapleural analgesia with ropivacaine resulted in less pain in the late postoperative period with better analgesic outcomes in higher doses, providing a better ventilatory pattern.

http://lib.bioinfo.pl/meid:154350/pmid

On a metabolic basis, 'autosympathectomy' influences neural and muscle structures and leads also to peripheral vasodilatation

Radiology of Peripheral Vascular Diseases: With 198 Tables

 edited by Eberhard Zeitler, Ernst Ammann

Springer, 2000 - Medical - 712 pages

Brachial plexopathy is another well recognised but not disclosed side-effect of sympathectomy

Brachial plexus dysfunction (brachial plexopathy) is a form of peripheral neuropathy. It occurs when there is damage to the brachial plexus, an area on each side of the neck where nerve roots from the spinal cord split into each arm's nerves.

Damage to the brachial plexus is usually related to direct injury to the nerve, stretching injuries (including birth trauma), pressure from tumors in the area (especially from lung tumors), or damage that results from radiation therapy.

Brachial plexus dysfunction may also be associated with:

• Birth defects that put pressure on the neck area
• Exposure to toxins, chemicals, or drugs
• General anesthesia, used during surgery
• Inflammatory conditions, such as those due to a virus or immune system problem

In some cases, no cause can be identified.

Symptoms

• Numbness of the shoulder, arm, or hand
• Shoulder pain
• Tingling, burning, pain, or abnormal sensations (location depends on the area injured)
• Weakness of the shoulder, arm, hand, or wrist

http://www.nlm.nih.gov/medlineplus/ency/article/001418.htm

arteriovenous shunting, and microvascular thermoregulatory dysfunction impairs normal tissue perfusion and microvascular responses to injury - these are all expected concesquences of sympathectomy

Autosympathectomy with attendant sympathetic failure, arteriovenous shunting, and microvascular thermoregulatory dysfunction impairs normal tissue perfusion and microvascular responses to injury. These alterations can
subsequently be implicated in the pathogenesis of ulceration (63-67).


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the microcirculation. Diabetic Med 8:320-329, 1992.
64. Parkhouse N, Le Quesne PM. Impaired neurogenic vascular response
in patients with diabetes and neuropathic foot lesions. N Engl J Med
318:1306-1309, 1988.
65. Boulton AJM, Vileikyte L. Pathogenesis of diabetic foot ulceration
and measurements of neuropathy. Wounds 12(Suppl B):12B-18B,
2000.
66. Boulton AJ. The pathogenesis of diabetic foot problems: an overview.
Diabet Med 13(Suppl 1):S12-16, 1996.
67. Nabuurs-Franssen MH, Houben AJ, Tooke JE, Schaper NC. The
effect of polyneuropathy on foot microcirculation in Type II diabetes.
Diabetologia 45:1164-1171, 2002.

SEPTEMBER/OCTOBER 2006
VOLUME 45, NUMBER 5
DIABETIC
FOOT
DISORDERS
A CLINICAL
PRACTICE GUIDELINE
An official publication of the
American College of
Foot and Ankle Surgeons

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