Limited sympathectomy does not reduce postoperative compensatory sweating

Endoscopic transthoracic for upper limb hyperhidrosis: Limited does not reduce postoperative compensatory sweating:

Sympathetic chain ganglia are responsible for delivering information to the rest of the body regarding stress situations and the fight or flight response

Sympathetic chain ganglia are responsible for delivering information to the rest of the body regarding stress situations and the fight or flight response. These sympathetic ganglia are the structures that are destroyed during a sympathectomy.
http://www.ast.org/publications/Journal%20Archive/2009/9_September_2009/CE.pdf

After sympathectomy in rats there is an increase in osteoclast-mediated bone resorption as well as an increase in the number of osteoclasts on the sympathectomized side

Paper: Osteoclastic Activation In Periapical Lesions After NPY Knockout (IADR/AADR/CADR 87th General Session and Exhibition (April 1-4, 2009)): "After sympathectomy in rats there is an increase in osteoclast-mediated bone resorption as well as an increase in the number of osteoclasts on the sympathectomized side compared to the control. These findings suggest an inhibitory effect of the SNS on bone resorption via osteoclasts. Our objective was to determine if an SNS mediator, neuropeptide Y (NPY), affects osteoclastic activity after pulpal exposure."

Two-stage unilateral versus one-stage bilateral single-port sympathectomy for palmar and axillary hyperhidrosis

Compensatory sweating occurred in 25 (19%) patients of the one-stage group and in 6 (4%) of the two-stage group (P = 0.0001). No patients developed Horner’s syndrome.
CONCLUSIONS: Both two-stage unilateral and one-stage bilateral single-port video-assisted thoracoscopic sympathectomies are effective, safe and minimally invasive procedures. Two-stage unilateral sympathectomy can be performed with a lower occurrence of compensatory sweating, improving permanently the quality of life in patients with palmar and axillary hyperhidrosis. 
http://icvts.oxfordjournals.org/content/16/6/834.full.pdf+html 

Depletion of peripheral sympathetic noradrenaline led to significant decrements in escape and avoidance responding

PsycNET - Option to Buy: "Chemical sympathectomy and avoidance learning in the rat.
By Di Giusto, E. L.; King, M. G.
Journal of Comparative and Physiological Psychology, Vol 81(3), Dec 1972, 491-500.
Abstract
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. Implications for 2-process theory and the "Kamin effect," or "learned helplessness," are discussed. (40 ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)"

sympathectomy and avoidance learning

PsycNET - Option to Buy: "Chemical sympathectomy and avoidance learning in the rat.
By Di Giusto, E. L.; King, M. G.
Journal of Comparative and Physiological Psychology, Vol 81(3), Dec 1972, 491-500.
Abstract
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. Implications for 2-process theory and the "Kamin effect," or "learned helplessness," are discussed. (40 ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)"

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Surgeons should be aware of adverse effects such as bradycardia

Sympathectomy - a stress response attenuation: Surgeons should be aware of adverse effects such as bradycardia: "Surgeons should be aware of adverse effects such as bradycardia
The heart rate and systolic blood pressure decreased significantly after T2-T3 ganglionectomy.
A prolonged QT interval was also recorded (p<> 0.05). The decrease was significant in the sympathectomy group.
Our study also, it was revealed that sympathectomy significantly prolonged the QT interval.

Surgeons should be aware of adverse effects such as bradycardia during thoracic sympathectomy. This study suggested that careful monitoring was required during thoracic sympathectomy and early postoperative period.


Orhan YÜCEL, MD
GATA, Department of
Thoracic Surgery, Ankara,
TÜRKİYE/TURKEY"

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Blushing and Facial Blushing Causes, Treatment, Diagnosis

Blushing and Facial Blushing Causes, Treatment, Diagnosis: "The treatment of facial blushing and or facial sweating is a controversial subject. The uncontrolled and embarrassing situation of facial sweating and blushing was thought to be easily treated with ETS. This came about when ETS was done patients with sweaty hands. Among those patients who also suffered from facial blushing and/or facial sweating the results were also successful at reducing facial blushing and/or sweating. However over the years two observations were made when this operation was applied only patients with facial blushing and or facial sweating. Percentage wise these patients developed a higher rate of severe compensatory sweating. Also these patients experienced a higher degree of dissatisfaction due to the side effects. Side effects such as facial flushed feelings, loss of stamina, facial skin sensitivity, increased amount of fatigue and others led Dr. Reisfeld to the decision not to perm ETS when only facial blushing or facial sweating were involved. The clinical experience that was accumulated over the last several years is what has allowed Dr. Reisfeld to reach this assessment."

Hyperhidrosis (excessive sweating). DermNet NZ

Hyperhidrosis (excessive sweating). DermNet NZ: "Localised hyperhidrosis may also be due to:

Stroke
Spinal damage
Peripheral damage
Surgical sympathectomy
Neuropathy
Brain tumour
Chronic anxiety disorder"

Right sympathectomy was associated with a 372% increase in PI (p < 0.0001), and left sympathectomy with a 316% increase in PI

Oximetry-derived perfusion index for intraop... [Ann Thorac Surg. 2005] - PubMed - NCBI: "Baseline oximetric waveforms were adequate in all subjects. Right was associated with a 372% increase in PI (p < 0.0001), and left with a 316% increase in PI (p < 0.029). This occurred as early as 1 minute after transection of the sympathetic chain. The PI in the reference probes as well as the hemodynamics remained constant."

Severity of compensatory sweating after thor... [Ann Thorac Surg. 2004] - PubMed - NCBI

Severity of compensatory sweating after thor... [Ann Thorac Surg. 2004] - PubMed - NCBI: "Compensatory sweating occurred in 89% of patients and was so severe in 35% that they often had to change their clothes during the day. The frequency of compensatory sweating was not significantly different among the three groups, but severity was significantly higher after Th2-4 sympathectomy for axillary hyperhidrosis (p = 0.04). Gustatory sweating occurred in 38% of patients, and 16% of patients regretted the operation.
CONCLUSIONS:
Compensatory and gustatory sweating were remarkably frequent side effects after thoracoscopic sympathectomy for primary hyperhidrosis."

http://www.ncbi.nlm.nih.gov/pubmed/15276490

Impaired skin vasomotor reflexes have been found in patients with sympathetic dystrophies, dysautomias, post-regional sympathectomy and diabetic neuropathies

Not surprisingly, diminished vasoconstrictor responses, similar to the current findings, have been found
in patients with sympathetic dystrophies [26], dysautomias [27], post-regional sympathectomy [28] and
diabetic neuropathies [11].


Additionally, there have been a few reports of EM patients benefitting from sympathectomy or neurolitic
irreversible blocks of the lumbar sympathetic ganglia [22,23], while others have found the symptoms of EM to be aggravated by such treatment [24,25], possibly as a result of denervation supersensitivity.
Clinical Science (1999) 96, 507ñ512 (Printed in Great Britain)
Roberta C. LITTLEFORD, Faisel KHAN and Jill J. F. BELCH
University Department of Medicine, Section of Vascular Medicine and Biology, Ninewells Hospital and Medical School,
Dundee DD1 9SY, Scotland, U.K.

Sympathectomy interrupts neural messages that ordinarily would travel to many different organs, glands and muscles

Sympathectomy involves dissection of the main sympathetic trunk in the upper thoracic region thus interrupting neural messages that ordinarily would travel to many different organs, glands and muscles. It involves division of adrenergic, cholinergic and sensory fibers which elaborate adrenergic substances during the process of regulating visceral function.
Journal of Applied Sciences Research, 6(6): 659-664, 2010

Vascular sympathetic denervation can lead to degeneration of the smooth muscle of arteries leading to medial arterial calcification and stiffening of the arteries

Sympathetic denervation of the peripheral arterial system may occur quite early in the evolution of neuropathy and has major effects on blood flow and vascular responses and causes structural changes in the arterial wall (Edmonds 2004). Vascular sympathetic denervation can lead to degeneration of the smooth muscle of arteries leading to medial arterial calcification and stiffening of the arteries. This calcification may assume the histological characteristics of bone.

   Unilateral lumbar sympathectomy in humans, both in diabetics and non-diabetics, has been show to result in medial wall calcification on the ipsilateral side (Goebel and Fuessl 1983). Unilateral sympathectomy in animals leads to excess deposition of cholesterol on the operated side and the occurrence of cholesterol sclerosis in the rabbit's aorta was accelerated by removal of the coeliac ganglion (Harrison 1938). Furthermore, in animal models, denervation of smooth muscle leads to striking pathological changes, including atrophy of muscle fibres with foci of degeneration (Kerper and Collier 1926). Arterial calcification in initiated within senescent atrophic smooth muscle (Morgan 1980).

   Medial arterial calcification in the Pima Indians is significantly associated with an increased prevalence of cardiovascular mortality (Everhart et al 1988). Medial calcification may be important factor in development of peripheral vascular disease, which in diabetes shows a predilection for the distal arteries below the knee and is unexplained. Chantelau reported an association of below knee atherosclerosis to medial arterial calcification (Chantelau et al. 1995).

p. 653

Autonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System[Hardcover]

Christopher J. Mathias (Author), Roger Bannister (Author)

• Publisher: Oxford University Press, USA; 5 edition (July 24, 2013)
• Language: English
• ISBN-10: 0198566344
• ISBN-13: 978-0198566342

"Patients report that they feel less anxious in stressful situations. Stage fright is reduced. The results are usually permanent."

http://neuro.templehealth.org/content/ETShyperhidrosis.htm

Sympathectomy, (ETS, VATS, ESB and many other names for the same procedure) affects emotional responses, fear responses, arousal, etc. It changes a person's  ability to feel and respond to emotions. It changes drive, attention, mobilisation.
Patients sign up for a surgery to treat sweaty hands, and not 'adjustments' to their emotions and personality.

sympathectomy leads to fluctuation of vasoconstriction alternated with vasodilation in an unstable fashion

"To quote Nashold, referring to sympathectomy, "Ill- advised surgery may tend to magnify the entire symptom complex"(38). Sympathectomy is aimed at achieving vasodilation. The neurovascular instability (vacillation and instability of vasoconstrictive function), leads to fluctuation of vasoconstriction alternated with vasodilation in an unstable fashion (39). Following sympathectomy the involved extremity shows regional hyper - and hypothermia in contrast, the blood flow and skin temperature on the non- sympathectomized side are significantly lower after exposure to a cold environment (39). This phenomenon may explain the reason for spread of CRPS. In the first four weeks after sympathectomy, the Laser Doppler flow study shows an increased of blood flow and hyperthermia in the extremity (40). Then, after four weeks, the skin temperature and vascular perfusion slowly decrease and a high amplitude vasomotor constriction develops reversing any beneficial effect of surgery (39). According to Bonica , "about a dozen patients with reflex sympathetic dystrophy (RSD) in whom I have carried out preoperative diagnostic sympathetic block with complete pain relief, sympathectomy produced either partial or no relief (40)"

Chronic Pain: 

Reflex Sympathetic Dystrophy : Prevention and Management

Hooshang Hooshmand

CRC PressINC, 1993 - Medical - 202 pages

we stopped performing sympathectomies in 1994, since we were alarmed by the complication and failure rate

Physical  medicine
Russell,  Alan  L.  Patient  Care 13.2  (Feb  2002):  19. 

Seven cases of enlargement of the breast following sympathectomy for hyperhidrosis

The  phenomenon  of  hyperhidrosis  is  a  pathological  state  caused  by  unknown  stimulus  of  the  sympathetic  nervous  system.  When  a  variety  of  conservative  treatments have  failed,  surgery  which  involves  the  removal  of  some  ganglia  of  the  cervical  sympathetic  chain,  is  the  treatment  of  choice.  In  the  last  four  years  we  operated  on 253  patients  for  palmar  hyperhidrosis  using  the  transaxillary  approach  only. Recently,  a  new  side  effect  of  surgery  has  come  to  our  attention.  This  phenomenon  is enlargement  of  the  breast  on  the  operated  side.  Our  series  show  seven  cases  (2.4%)  of  women  operated  for  palmar  hyperhidrosis  who  manifested  this phenomenon,  two  of  them  bilaterally.  The  enlargement  of  the  breast  was  found  usually  by  the  second  follow-­up  visit  after  operation  when,  in  most  cases,  the  patient mentioned  it.Examination  of  the  breast  revealed  enlargement  of  a  few  centimeters  which  in  several  patients  required  a  change  to  a  larger  brassiere  size.  In  both  of our  patients  who  underwent  bilateral  surgery,  the  breasts  enlarged  until  they  were  equal  in  size.  The  women  then  did  not  complain  further.  


Enlargement  of  the  Breast-­-­A  New  Side  Effect  of  Transaxillary  Cervical  Sympathectomy:  Case  Report Kott,  Itamar;;  Hauptman,  Eli;;  Zelkovsky,  Avigdor;;  Reiss,  Raphael.  Vascular  and  Endovascular  Surgery 20.1  (Jan  1986):  50-­54. 

Several reports have dealt with the alteration of antibody responses of spleen and lymph nodes following sympathectomy

http://www.ncbi.nlm.nih.gov/pubmed/8528891

Sympathectomy significantly alters 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 space, 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

The almost total absence of myelinated and amyelinated fibers following clip removal suggests that sympathectomy is NOT reversible

Ten days after clipping, all sympathetic chains displayed evident Wallerian degeneration. Twenty days after clipping, Wallerian degeneration of myelinated fibers was more widespread and also more striking. Thirty days after clipping, a very marked macrophagic reaction was visible, with multiple signs of phagocytosis of myelin debris. By 30 days post operation and 20 days after clip removal, a few residual myelin and amyelinated fibers were visible. These findings suggest that axon regeneration is not possible. CONCLUSIONS There are Wallerian degeneration and axon loss 10 days after clipping. The almost total absence of myelinated and amyelinated fibers following clip removal suggests that there was no nerve regeneration, and that therefore clipping cannot be considered a reversible technique.

Surg Endosc. 2012 May ;26 (5):1258-63  22083329 

Intense pain following sympathectomy, reduced inspiratory capacity

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 much publicised 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

cardiovascular effects, tremulousness and sweating produced by thyroid hormones can be reduced or abolished by sympathectomy

Although, plasma catecholamine levels are normal in hyperthyroidism, the cardiovascular effects, tremulousness and sweating produced by thyroid hormones can be reduced or abolished by sympathectomy. (p. 133)

Introduction To Endocrinology

ENDOCRINOLOGY CHANDRA S. NEGI

PHI Learning Pvt. Ltd., 2009 - Endocrinology - 455 pages

Trouble in the Gap: A Bioethical and Sociological Analysis of Informed Consent for High-Risk Medical Procedures - Springer

Trouble in the Gap: A Bioethical and Sociological Analysis of Informed Consent for High-Risk Medical Procedures - Springer: "we argue that “informed” consent is a process that is usually incomplete, despite trappings and assumptions that help to create the illusion of completeness."

Complications common after surgery for hand sweating and facial flushing

http://ltarkiv.lakartidningen.se/2001/temp/pda22739.pdf

Läkartidningen ƒ No. 15 ƒ ƒ 2001 Volume 98

in Swedish,

but you can read the English translation here

In the setting of sympathectomy, interference with any of the effectors evokes immediate, precipitous declines in blood pressure

David S. Goldstein

JHU Press, 01/04/2008 - Medical - 328 pages

"From the finding that removal of the sympathetic nerves did not affect blood pressure much, Cannon inferred that the sympathetic nervous system did not contribute to blood pressure in intact, undisturbed organism. In the 1980s, however, several reports showed  that sympathectomy compensatorily activates other effectors, such as the renin-angiotensin-aldosterone system, the vasopressin system, and the adrenal medulla, and compensatory activation of these effectors maintains blood pressure at approximately normal levels. In the setting of sympathectomy, interference with any of the effectors evokes immediate, precipitous declines in blood pressure. Because Cannon was so firmly convinced of the functional unity of the sympathoadrenal system, which would be activated only in emergencies, he never considered adequately the possibility that the sympathetic nervous system might indeed contribute to levels of blood pressure and other monitored variables under resting conditions." Adrenaline and the Inner World:  An Introduction to Scientific Integrative Medicine

after sympathectomy the extremity will be more apt to have disturbance of circulation and is left unprotected from fluctuation in circulation

1. Sympathectomy is analogous to the act of killing the messenger. The sympathetic nervous system has the critical job of properly controlling and preserving the circulation in different parts of the body, especially in the extremities. By paralyzing the system, the extremity will be more apt to have disturbance of circulation and is left unprotected from fluctuation in circulation.

Sympathectomy is similar to permanently removing the central heat and air-conditioning system and never replacing it because of malfunction.

Sympathectomy permanently damages the temperature regulatory system. The reason sympathectomy does not cause side effects other than ineffective control of pain as well as impotence and orthostatic hypotension is because it is invariably partial and incomplete.H. Hooshmand, M.D.: Chronic Pain

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9780849386671

Chronic Pain: Reflex Sympathetic Dystrophy Prevention and Management

Hooshang Hooshmand

ISBN 10: 0849386675 / 0-8493-8667-5 

ISBN 13: 9780849386671

Publisher: CRC Pr I Llc

Publication Date: 1993

Binding: Hardcover

Register all trials, report all results – it's long overdue

Register all trials, report all results – it's long overdue: "If researchers go to the effort of getting funds, recruiting patients, and following them up, you would think that they would be keen to publish the results. So it’s surprising that our best estimates show around half of all completed clinical trials have never been published in academic journals. And the half we have is biased towards trials with positive results."

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Bradycardia might occur secondary to unopposed vagal tone from a high sympathectomy

Bradycardia might occur secondary to unopposed vagal tone from a high sympathectomy, blockade of the cardio-accelerator fibers (T1-T4), and the Bezold-Jarisch reflex (slowing of the heart rate secondary to decreased venous return). Patients with underlying increased vagal tone (children and adults with resting heart rates < 60) are at an increased risk.

Anesthesia Secrets, 4th Edition by James Duke, 

Elsevier Health Sciences, 16/03/2010 - 574 pages

The effect of dysfunction of the autonomic nervous system on experienced feelings and emotions

Hohmann, G.W. : The effect of dysfunction of the autonomic nervous system on experienced feelings and emotions

Paper read at Conference on Emotions and Feelings at New School for Social Research, New York, Oct 1962.

Sherrington, C.S.: Experiments on the value of vascular and visceral factors for the genesis of emotion 

Proc. Roy.Soc., 1900, 66, 390-403

Wenger, M.A.: Emotion as visceral action: an extension of Lange's theory. In Reymert, M.L., Feelings and emotions: the Moosehart ymposium, New York: McGraw-Hill, 1950. Pp.3-10.

Wynne, L.C., and Solomon, R.L.: Traumatic avoidance learning: acquisition and extinction in dogs deprived of normal peripheral autonomic function. 

Genet. psychol. Monogr., 1955, 52, 241-84

Landis, C., and Hunt, W. A. Adrenalin and emotion. 

Psychol. Rev., 1932, 39, 467-85.

Schachter, S., and Wheeler, L.: Epinephrine, chlorpromazine, and amusement. 

J. of abnorm. soc. Psychol., 1962, 65, 121-28.

Complications of endoscopic sympathectomy - hypoxia, hypotension, haemothorax, pneumothorax

"there are some potentially serious anaesthetic sequelae. Despite the use of various analgesic techniques, including intrapleural bupivacaine and systemic opioids, postoperative chest pain is a common and distress- ing feature, with a duration of 12 hours or more.
In a recent prospective study of 58 patients undergoing this procedure, Jedeikin et al reported hypoxia (with an arterial oxygen saturation of 70%) and hypotension (with decrease in arterial pressure to < 50mmHg) as uncommon but important complications.
'These events maybe the result of compression of the mediastinum and major vessels by carbondioxide insufflation. In addition, during bilateral procedures, lesser degrees of hypoxia were common place with deflation of the lung on the second side, despite apparently adequate reinflation of the first lung. 15%  of patients had pneumothorax and 7% required underwater drainage for haemothorax or pneumothorax."

A C QUINN R E EDWARDS PJNEWMAN W J FAWCETT
BMJ VOLUME 306 26JUNE1993

It has been shown in animals that sympathectomy of one side of the body leads to an increase in the development of tumors on the denervated side

Coujard R, Heitz F. Cancerologic: Production de tumeurs malignes consecutives a des lesions des fibres sympathiques du nerf sciatique chez le Cobaye. C R Acad Sci 1957; 244: 409-411. 

Besedovsky H, DelRey A, Sorkin E, DaPrada M, Keller H. Immunoregulation mediated by the sympathetic nervous system. Cellular Immun 1979; 48:346-355. 

Stein-Werblowsky R. The sympathetic nervous system and cancer. Exper Neuro 1974; 42:97-100. 

Delrey A, Besedovsky H, Sorkin E, DaPrada M, Arrenbrecht S. Immunoregulation mediated by the sympathetic nervous system, II. Mol Immunol 1981; 63:329-334.

in the absence of autonomic arousal, behavior that appears emotional will not be experienced as emotional

"In the presence of a barking dog, for example, the sympathectomized cats manifested almost all of the signs of feline rage. Finally, Cannon notes the report of Dana (1921) that a patient with a spinal-cord lesion and almost totally without visceral sensation still manifested emotionality.
For either the Jamesian or the present formulation such data are crucial, since both views demand visceral arousal as a necessary condition for emotional arousal. When faced with this evidence, James's defenders (e.g., Wenger, 1950; Mandler, 1962) have consistently made the point that the apparently emotional behavior manifested by sympathectomizied animals and men is well-learned behavior, acquired long before sympathectomy. There is a dual implication in this position: first, that sympathetic arousal facilitates the acquisition of emotional behavior, and second, that sympathectomized subjects act but do not feel emotional. There is a small but growing evidence supporting these contentions. Wynne and Solomon (1955) have demonstrated that sympathectomized dogs acquire an avoidance response considerably more slowly than control dogs. Further, on extinction trials most of their 13 sympathectomized animals extinguished quickly, whereas not a single one of the 30 control dogs gave any indication of extinction over 200 trials. Of particular interest are two dogs who were sympathectomized after they had acquired the avoidance response. On extinction trials these two animals behaved precisely like the control dogs - giving no indication of extinction. Thus, when deprived of visceral innervation, animals are quite slow in acquiring emotionally-linked avoidance responses and in general, quick to extinguish such responses." (p. 163)

"A line of thought stimulated by the Wynne and Solomon (1955) and the Hohmann (1962) studies may indeed be the answer to Cannon's observations that there can be emotional behavior without visceral activity. From the evidence of these studies, it would appear, first, that autonomic arousal greatly facilitates the acquisition of emotional behavior but it is not necessary for its maintenance if the behavior is acquired prior to sympathectomy; and second, that in the absence of autonomic arousal, behavior that appears emotional will not be experienced as emotional." (p. 167)

Psychobiological Approaches to Social Behavior

P. Herbert Leiderman, David Shapiro, Harvard Medical School. Dept. of Psychiatry, United States. Office of Naval Research - 1964 - 203 pages

Recurrent hyperhidrosis is another potential side effect from hyperhidrosis surgery

The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis -- Cerfolio et al. 91 (5): 1642 -- The Annals of Thoracic Surgery: "Recurrent hyperhidrosis is another potential side effect from hyperhidrosis surgery. Incidence rates vary considerably and have been described as 0% to 65%"

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The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis -- Cerfolio et al. 91 (5): 1642 -- The Annals of Thoracic Surgery

The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis -- Cerfolio et al. 91 (5): 1642 -- The Annals of Thoracic Surgery: "Because the goal of this procedure is to improve quality of life, complications should be minimal and essentially eliminated. The primary side effects of hyperhidrosis surgery include CH, bradycardia, and Horner's syndrome. It is important for patients to be aware, however, of all of the possible complications that can occur. In general, "the higher the level of blockade on the chain, the higher is the expected regret rate" [26]."

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The vasodilating effect of spinal dorsal column stimulation is mediated by sympathetic nerves - Springer

The vasodilating effect of spinal dorsal column stimulation is mediated by sympathetic nerves - Springer: "Immediately after sympathectomy, the contralateral right arm became increasingly cold and cyanotic and the patient complained of chronic painful coldness and severe cold-intolerance in the right arm. Attempts to pharmacologically vasodilate the arm with felodipine did not affect the local vasoconstriction and pain. Dorsal column stimulation (associated with symmetrical paraesthesia in both arms) induced an immediate and marked (ten-fold) increase in skin blood flow in the right arm (and in the leg), whereas skin blood flow in the left arm remained unaffected. The lack of vasomotor response in the left arm was not due to maximal vasodilatation at rest, since skin blood flow in the left arm showed a normal capacity for axon reflex vasodilatation following antidromic activation of sensory afferents. The results suggest that the marked vasodilatation induced by dorsal column stimulation is mediated by sympathetic vasomotor fibres, via modulation of central neuronal circuits involved in the regulation of skin sympathetic discharge."

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Medical Board Disciplines ETS surgeon Dr Nielson

Nielson,  David  Hugh,  M.D.,  Lic.  #K0962,  San  Antonio  TX
On  February  5,  2010,  the  Board  and  Dr.  Nielson  entered  into  an  agreed  order  requiring  Dr. Nielson  to  complete  15  hours  of  CME  in  medical  record-­keeping,  risk  management  and  ethics within  one  year;;  and  pay  an  administrative  penalty  of  $4,000  within  60  days.  The  action  was based  on  the  Board’s  finding  that  Dr.  Nielson  failed  to  keep  adequate  medical  records,  failed to  use  proper  diligence  in  his  professional  practice,  and  failed  to  adequately  supervise  the activities  of  those  acting  under  his  supervision.  The  Board  found  that  digital  photos  that  were part  of  patient  records  were  inadvertently  deleted  and  that  Dr.  Nielson  authorized  a  person  to represent  his  clinic  and  that  person  misrepresented  risks  and  procedures  for  Dr.  Nielson’s treatment  of  rosacea. 
http://www.tmb.state.tx.us/news/press/2010/021710.php

BioEdge: Leveson Inquiry recommends reform of science reporting

BioEdge: Leveson Inquiry recommends reform of science reporting: "Remember patients: don't call something a "cure" that is not a cure."

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catecholamine released from sympathetic nerves, acquires the capacity to activate pain pathways after tissue or nerve injury

What Is Reflex Sympathetic Dystrophy Syndrome or RSD?: "According to the National Institute of Neurological Disorders and Stroke (NINDS), RSD is "a chronic pain condition that is believed to be the result of dysfunction in the central or peripheral nervous systems." According to MedicineNet, RSD involves "irritation and abnormal excitation of nervous tissue, leading to abnormal impulses along nerves that affect blood vessels and skin."

Animal studies indicate that norepinephrine, a catecholamine released from sympathetic nerves, acquires the capacity to activate pain pathways after tissue or nerve injury, resulting in RSD. Another theory suggests that RSD, which follows an injury, is caused by triggering an immune response and symptoms associated with inflammation"

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Transection below T8-T10 is not accompanied by reflex sweating

Reflex sweating in patients with spina... [Arch Phys Med Rehabil. 1977] - PubMed - NCBI: "Sweat glands derive their innervation from the sympathetic nervous system. The spinal sympathetic structures that are located in the intermediolateral areas extend from T1-L2 segments and are under the control of hypothalamic centers. Cord transection abolishes the supraspinal control of sudorimotor function. Since sympathetic innervation does not follow a clear segmental distribution, normal sweating may be preserved at a higher or lower level than skin sensation. Nonthermoregulatory reflex sweating is an indication of unchecked spinal cord facilitation and is precipitated by afferent stimuli from bladder, rectum, and various other sources. It is usually a manifestation of mass reflex or autonomic crisis and occurs particularly in cervical or high thoracic lesions. Transection below T8-T10 is not accompanied by reflex sweating. The phenomenon of thermal relfex sweating is controversial. Although some aspects of nonthermoregulatory reflex sweating are still unclear, proper immediate and continuing preventive management will reduce the incidence of this and other autonomic manifestations. "

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Hemodynamic changes in vertebral and carotid arteries were observed after sympathicotomy for hyperhidrosis

T3 sympathicotomy segment was the most frequent transection done (95.83%), as only ablation (25%) or in association with T4 (62.50%) or with T2 (8.33%). It was observed increase in RI and PI of the common carotid artery (p < 0.05). The DPV of internal carotid artery decreased in both sides (p < 0.05). The SPV and the DPV of the right and left vertebral arteries also increased (p < 0.05). Asymmetric findings were observed so that, arteries of the right side were the most frequently affected.
CONCLUSIONS: Hemodynamic changes in vertebral and carotid arteries were observed after sympathicotomy for PH. SPV was the most often altered parameter, mostly in the right side arteries, meaning significant asymmetric changes in carotid and vertebral vessels. Therefore, the research findings deserve further investigations to observe if they have clinical inferences.
http://www.ncbi.nlm.nih.gov/pubmed/16186983 

Sympathectomy vs sympathotomy

Sympathectomy vs sympathotomy. Sympathectomy, with use of ganglionectomy and by definition, must sever the primary axon from the neuron in the intermediolateral cell column of the spinal cord (red) before primary or collateral synapse in the T2 ganglion. This injures all the neurons at this level of the spinal cord, some of which may die, and may predispose the patient to spinal cord reorganization and severe compensatory hyperhidrosis. Sympathotomy interrupts only axons after potential T2 ganglion synapses, a less injurious effect on the neuron, and is the least destructive procedure possible with successful treatment of palmar hyperhidrosis. StG, stellate ganglion. 
Atkinson JLD, Fealey RD. Sympathotomy instead of sympathectomy for palmar hyperhidrosis: minimizing postoperative compensatory hyperhidrosis. Mayo Clin Proc 2003;78:167-172.

Gustatory sweating, flushing and other responses after sympathectomy

Gustatory sweating on the head, neck and arms, often occurs after cervico-thoracic sympathectomy. Haxton (1948) reported an incidence of 36 percent, the same as in the present series. It was thought that some information about regeneration in the cervical sympathetic might be revealed by investigation of this surgical curiosity.

Although sweating is the common gustatory response after cervical sympathectomy, other changes are experienced. Haxton (1948) described associated paresthesia and flushing, gooseflesh may occur (Herxheimer, 1958) and vaso-constriction is reported in this paper. These occur together or separately and occasionally sweating might be absent. The subject has been confused by comparison with post-parotidectomy gustatory sweating which has a different mechanism (Glaister et al.,1958; Bloor, 1958).

Sweating is produced by cholinergic sympathetic fibres. In normal individuals both vasocontriction and gooseflesh are adrenergic. This also holds in gustatory responses.  Figure 2 shows blocking of sweating by atropine, whilst gooseflesh continues unchanged.
   The tingling sensations were described as being unlike normal sensation, and likened to plucking out of hair. In one patient in was so unpleasant that she refused to take a test stimulus. Flushing usually occurs on the upper chest and neck, and is an erythema with sharp demarcation, not associated with a rise in skin temperature.
   Of the patients, 29 were found to have gustatory responses, and 24 were studied in detail. Of 22 patients with sweating who could be studied, 11 had gooseflesh, 10 tingling, 6 flushing, and 4 vasoconstriction. Four patients, however, had no sweating and their gustator responses consisted of gooseflesh and tingling in one, tingling alone, and flushing in two. None of these four showed vasoconstriction.
   The stimulus for testing used was usually Worcester sauce, but specificity of the response was sometimes great, and one patient reacted only to boiled sweets made by one particular firm.

http://brain.oxfordjournals.org/content/92/1/137.extract   &
http://ang.sagepub.com/content/17/3/143.extract

No compensatory sweating after botulinum toxin treatment of palmar hyperhidrosis

No compensatory sweating after botulinum toxin... [Br J Dermatol. 2005] - PubMed - NCBI: "Recordings were made at 16 skin areas and compared with subjective estimates of sweating.
RESULTS:
Following treatment, palmar evaporation decreased markedly and then returned slowly towards pretreatment values, but was still significantly reduced 6 months after treatment. No significant increase of sweating was found after treatment in any nontreated skin area.
CONCLUSIONS:
Successful treatment of palmar hyperhidrosis with botulinum toxin does not evoke compensatory hyperhidrosis in nontreated skin territories."

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not exposing patients to the risk of experiencing the side effects of sympathectomy

The use of oxybutynin for treating ... [An Bras Dermatol. 2011 May-Jun] - PubMed - NCBI: "Treatment of facial hyperhidrosis with oxybutynin is a good alternative to sympathectomy, since it presents good results and improves quality of life, in addition to not exposing patients to the risk of experiencing the side effects of sympathectomy."

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rates and characteristics of the paresthesia following needlescopic VATS are similar to those observed after conventional VATS

Incidence of chest wall paresthesia ... [Eur J Cardiothorac Surg. 2005] - PubMed - NCBI: "Paresthetic discomfort distinguishable from wound pain was described by 17 patients (50.0%). The most common descriptions were of 'bloating' (41.2%), 'pins and needles' (35.3%), or 'numbness' (23.5%) in the chest wall. The paresthesia resolved in less than two months in 12 patients (70.6%), but was still felt for over 12 months in three patients (17.6%). Post-operative paresthesia and pain did not impact on patient satisfaction with the surgery, whereas compensatory hyperhidrosis in 24 patients (70.6%) did (P=0.001). The rates and characteristics of the paresthesia following needlescopic VATS are similar to those observed after conventional VATS."

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Botulinum toxin type A should be PBS listed for treatment of palmar hyperhidrosis | Medical Journal of Australia

Botulinum toxin type A should be PBS listed for treatment of palmar hyperhidrosis | Medical Journal of Australia:

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Chronic pain can occur after peripheral nerve injury, infection, or inflammation - sympathectomy is a nerve injury

Blocking sympathetic function, whether by surgical sympathectomy, systemic phentol- amine, or systemic guanethidine, relieves partial nerve injury-induced neuropathic pain in laboratory animal models as well as humans (8, 35, 146, 239, 278). Indeed, sympathectomy does not just relieve pathological pain in the body region ipsilateral to the CRPS-initiating event; rather, it also relieves pain arising from anatomically impossible mirror-image sites, that is, the identical body region contralateral to the initiating event (278). Thus sympathetectomy must somehow quiet the contralateral spread of spinal cord hyperexcitability underlying mirror- image pain.

Alterations in sympathetic fibers rapidly follow pe- ripheral nerve injury. This occurs as sprouting of sympa- thetic fibers, creating aberrant communication pathways from the new sympathetic terminals to sensory neurons (35). Sympathetic sprouting has been documented in the region of peripheral terminal fields of sensory neurons (262), at the site of nerve trauma (57), and within the dorsal root ganglia (DRG) containing cell bodies of sen- sory neurons (248, 343). Each of these sites develops spontaneous activity and sensitivity for catecholamines and sympathetic activation (8, 53).

The clearest evidence that immune activation partic- ipates in sympathetic sprouting comes from studies of the DRG. DRG cells receive signals that peripheral nerve injury has occurred via retrograde axonal transport from the trauma site. These retrogradely transported signals trigger sympathetic nerve sprouting into DRG (205, 308). As a result of nerve damage-induced retrogradely trans- ported signals, glial cells within the DRG (called satellite cells) proliferate (248) and become activated (343); mac- rophages are recruited to the DRG as well (63, 176). In turn, the activated satellite glial cells (and, presumably, the macrophages) release proinflammatory cytokines and a variety of growth factors into the extracellular fluid of the DRG (206, 246–248, 258, 277, 308, 358). These sub- stances stimulate and direct the growth of sympathetic fibers, which form basket-like terminals around the satel- lite cells that, in turn, surround neuronal cell bodies (247, 248, 343). For discussion of satellite cell functions, see section IIIA.

LINDA R. WATKINS AND STEVEN F. MAIER

Department of Psychology and the Center for Neuroscience, University of Colorado at Boulder, Boulder, Colorado

Physiol Rev

82: 981–1011, 2002; 10.1152/physrev.00011.2002.

A randomized placebo-controlled trial of oxybuty... [J Vasc Surg. 2012] - PubMed - NCBI

A randomized placebo-controlled trial of oxybuty... [J Vasc Surg. 2012] - PubMed - NCBI: "Palmar and axillary hyperhidrosis improved in >70% of the patients, and 47.8% of those presented great improvement. Plantar hyperhidrosis improved in >90% of the patients. Most patients (65.2%) showed improvements in their quality of life. The side effects were minor, with dry mouth being the most frequent (47.8%).
CONCLUSIONS:
Treatment of palmar and axillary hyperhidrosis with oxybutynin is a good initial alternative for treatment given that it presents good results and improves quality of life."

bilateral sympathectomy may cause bowel, bladder, or sexual dysfunction

If regional sympathetic blockade provides relief, surgical sympathectomy can be considered. Initial pain relief may be significant, but symptoms tend to recur over the next 2 to 5 years.^[53] This is believed to occur owing to incomplete surgical removal of all sympathetic innervation to the extremity. Collateral reinnervation can occur, but bilateral sympathectomy may cause bowel, bladder, or sexual dysfunction.^[14]

It is possible to disrupt the sympathetic chain ganglion by treatments other than surgery. Ablation with radiofrequency devices and caustic chemicals (such as alcohol) have been described, but the region of necrosis may expand beyond the ganglion and long-term results are unknown.[59,][69] As such, surgical sympathectomy is considered strictly as a last resort.  

Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes By Frank R. Noyes, MD

Research indicates that a highly variable heart rate increases your capacity to respond and adapt to life’s challenges

Research has shown that reductions in heart rate variability are a predictor of sudden cardiac death, even in individuals without a prior history of cardiovascular disease.

http://theconversation.edu.au/depression-can-break-your-heart-literally-1102

Effects of unilateral stellate ganglion block on the spectral characteristics of heart rate variability

Effects of unilateral stellate ganglion block on ... [Jpn Circ J. 1999] - PubMed - NCBI: "Effects of unilateral stellate ganglion block on the spectral characteristics of heart rate variability"

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Stellate ganglion block may relieve hot flashes by interrupting the sympathetic nervous system

Stellate ganglion block may relieve hot flash... [Med Hypotheses. 2007] - PubMed - NCBI: "the wide range of conditions that have been reported to respond favorably to stellate ganglion block suggest that its effectiveness may not be solely the result of increased blood flow nor restricted just to its sphere of innervation. We have found that stellate ganglion block is effective in the treatment of hot flashes in postmenopausal women, as well as those with estrogen depletion resulting from breast cancer treatment. Based on evidence that hot flashes may be centrally mediated and that the stellate ganglion has links with the central nervous system nuclei that modulate body temperature, we hypothesize that the stellate ganglion block provides relief of hot flashes by interrupting the central nervous system connections with the sympathetic nervous system, allowing the body's temperature-regulating mechanisms to reset. If this mechanism can be confirmed, this would provide women with intractable hot flashes with an effective, potentially long-lasting means of relieving their symptoms, and potentially widen the range of indications for stellate ganglion block to include other centrally mediated syndromes."

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patients with palmar hyperhidrosis have no overactivity of the sympathetic nerve

HR and BP at rest and cardiovascular response to exercise were similar in patients with palmar hyperhidrosis before ETS and in the normal control population. Therefore, we consider that patients with palmar hyperhidrosis have no overactivity of the sympathetic nerve. However, because bilateral ETS causes the suppression of cardiovascular response to exercise, patients that has been treated with ETS need to be observed during high-level exercise.

http://iars.org/abstracts/browsefile/browse.asp?command=N&absnum=45&dir=S190