Sympathectomy = nerve injury
For a full story on sympathectomy and consequences, look up nerve injury or denervation
"I think the surgeons may not be aware of the long term consequences of denervation" Ahmet Hoke M.D., Ph.D. FRCPC
Professor of Neurology and Neuroscience, Director, Neuromuscular Division Johns Hopkins School of Medicine, Department of Neurology
Wednesday, 1 February 2023
Postsympathectomy pain of such severity that parenteral narcotics afforded no relief
Fifty-six consecutive patients who subsequently underwent ninety-six lumbar sympathectomies were studied prospectively with regard to the development of postoperative pain. Pain after operation was observed in thirty-four extremities by twenty-five of the patients (35 per cent). It began abruptly an average of twelve days after operation and was often accentuated nocturnally. The pain was almost always described as a deep, dull ache and persisted two to three weeks before spontaneously remitting. Postsympathectomy pain of such severity that parenteral narcotics afforded no relief developed in two of these fifty-six patients and in nine additional patients. Treatment with carbamazepine produced dramatic reduction in the intensity of pain in seven of these nine patients within twenty-four hours after the institution of therapy. Two patients were given intravenous diphenylhydantoin and both experienced immediate relief of pain. The mechanisms of the syndrome and of the action of these drugs are uncertain.
http://www.sciencedirect.com/science/article/pii/0002961074902384
Saturday, 13 February 2016
Damage to part of these feedback loops leads to exaggerated pressor responses to stress
Psychosom Med. 1993 Jul-Aug;55(4):339-46.
Abnormal stress responses in patients with diseases affecting the sympathetic nervous system.
Abstract
Thursday, 30 July 2015
the clinical results of both surgical and neurolityc sympathectomy are uncertain
However, the clinical results of both surgical and neurolityc sympathectomy are uncertain. Indeed these procedures lead to a redistribution of the blood flow in the lower limbs from the muscle to the skin, with a concomitant fall of the regional resistance, mainly in undamaged vessels. The blood flow will be diverted into this part of the vascular tree, so that a "stealing" of the blood flow may occur.
Vito A. Peduto, Giancarlo Boero, Antonio Marchi, Riccardo Tani
Bilateral extensive skin necrosis of the lower limbs following prolonged epidural blockade
Anaesthesia 1976; 31: 1068-75.
Sunday, 7 June 2015
"Similar low values are observed in patients with sympathectomy and in patients with tetraplegia"
Patients with progressive autonomic dysfunction (including diabetes) have little or no increase in plasma noradrenaline and this correlates with their orthostatic intolerance (Bannister, Sever and Gross, 1977). In patients with pure autonomic failure, basal levels of noradrenaline are lower than in normal subjects (Polinsky, 1988). Similar low values are observed in patients with sympathectomy and in patients with tetraplegia. (p.51)
The finger wrinkling response is abolished by upper thoracic sympathectomy. The test is also abnormal in some patients with diabetic autonomic dysfunction, the Guillan-Barre syndrome and other peripheral sympathetic dysfunction in limbs. (p.46)
Other causes of autonomic dysfunction without neurological signs include medications, acute autonomic failure, endocrine disease, surgical sympathectomy . (p.100)
Anhidrosis is the usual effect of destruction of sympathetic supply to the face. However about 35% of patients with sympathetic devervation of the face, acessory fibres (reaching the face through the trigeminal system) become hyperactive and hyperhidrosis occurs, occasionally causing the interesting phenomenon of alternating hyperhidrosis and Horner's Syndrome (Ottomo and Heimburger, 1980). (p.159)
Disorders of the Autonomic Nervous System
By David Robertson, Italo Biaggioni
Edition: illustrated
Published by Informa Health Care, 1995
ISBN 3718651467, 9783718651467"
Saturday, 9 May 2015
Compensatory sweating is not a compensatory mechanism
Compensatory sweating was originally thought to be a mechanism of excessive sweating (in an anatomical region with an intact sympathetic nervous system) to maintain a constant rate of total sweat secretion.90 However, this theory was not confirmed by other studies, demonstrating that compensatory sweating represented a reflex action by an altered feedback mechanism at the level of the hypothalamus which is dependent on the level at which sympathetic denervation occurs. Sympathectomy at the level of the T2 ganglion leads to decreased negative feedback to the hypothalamus. When performing a sympathectomy at a lower level, the negative feedback to the hypothalamus is less inhibited, leading to a decrease in compensatory sweating. Chou et al.91 have proposed the term ‘reflex sweating’ to replace compensatory sweating. Other side effects described in a review article by Dumont89 are gustatory sweating, cardiac effects, phantom sweating, lung function changes, dry hands and altered taste. Besides these side effects there are significant risks of complications during and after surgery (arterial or venous vascular injury, pneumothorax, infection, Horner syndrome etc.).
JEADV 2012, 26, 1–8 Journal of the European Academy of Dermatology and Venereology
JEADV 2012, 26, 1–8 Journal of the European Academy of Dermatology and Venereology
Monday, 27 April 2015
Post-sympathectomy neuralgia is proposed here to be a complex neuropathic and central deafferentation/reafferentation syndrome
The formation of the spinal nerve from the dorsal and ventral roots. (Photo credit: Wikipedia) |
Pain. 1996 Jan;64(1):1-9.
Post-sympathectomy neuralgia: hypotheses on peripheral and central neuronal mechanisms.
Abstract
Saturday, 18 April 2015
Mast cells and nerve growth factor (NGF) have both been reported to be involved in neuroimmune interactions and tissue inflammation
Abstract
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