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PubMed1981

Effect of sympathectomy with 6-hydroxydopamine on the renal excretion of water and electrolytes in developing rats.

The influence of sympathectomy (SE) by s.c. administration of 6-hydroxydopamine (10 mg/100 g b.m. daily from the 1st up to the 4th day of life) on the age dependent development of the renal excretion of water and electrolytes was tested by means of diuresis experiments in conscious rats. Immediately after SE natriuresis occurs as a consequence of denervation. Already on the 10th day of life this denervation diuresis disappears due to several compensatory mechanisms and 10 to 55 day old rats excrete less sodium than control animals of the same age. The potassium excretion is also diminished in 20 to 55 day old rats. The results show -- that the typical age course of water and electrolyte excretion is not altered by SE, -- that adrenergic influences are of importance for the renal function in rats, and -- that the consequences of the sympathectomy can be fully compensated in the kidney too.

Animals↗
PubMed1980

[The role of lumbar sympathectomy in the treatment of diabetic arterial disease (author's transl)].

220 lumbar sympathectomies were performed in 206 patients. Postoperative mortality morbidity were essentially related to the cardiovascular past history of the patients and indications for surgery must be very carefully weighed, in particular after the age of 70 years. Sympathectomy markedly increases the chances of healing of patients with ischaemic trophic disturbances. It shortens the time required for healing, whatever the type of gangrene.

Aged↗
PubMed1994

Intraoperative anaesthetic management of hypoxaemia during transthoracic endoscopic sympathectomy.

OBJECTIVE: To present our experience and evaluate intraoperative arterial oxygen desaturation during anaesthesia for transthoracic endoscopic sympathectomy (TES). DESIGN: Prospective open study. SETTING: University Hospital in Israel. SUBJECTS: Consecutive series of patients (n = 210), suffering from upper limb hyperhidrosis, anaesthetised for TES. MAIN OUTCOME MEASURES: Peripheral oxygen saturation (SpO2), haemodynamic status, complications, postoperative pain (n = 210) and arterial blood gases (n = 10). RESULTS: 407 TES; 195 bilateral, 17 unilateral. Surgical time range 20-75 minutes. SpO2 decreased below 98% in 58 patients. Sudden hypotension and bradycardia in two patients. The mean PaO2 was significantly (p = 0.03) decreased during two-lung ventilation (TLV), after reinflation of the right lung, compared with TLV after endobronchial intubation. There was no significant difference in mean PaO2 during one-lung ventilation of both lungs. Lowest PaO2 observed during one-lung ventilation was less than 13.3 kPa in three sympathectomies. Postoperative pain, severe on awakening and mainly retrosternal, was relieved with i.v. opiates. CONCLUSION: Controlled ventilation with 100% inspired O2, SpO2 monitoring and one to two gentle manual ventilations when it decreases is the cornerstone of the management of hypoxaemia, a potentially serious complication of TES.

Adolescent↗
PubMed1994

Total intravenous anaesthesia with single-lumen endotracheal intubation for thoracoscopic sympathectomy.

The aim of this paper was to discuss the stress applied to the circulatory and respiratory systems by the combination of general anaesthesia and thoracoscopic sympathectomy and to show the benefits of an intravenous anaesthetic technique together with a single-lumen endotracheal tube as a safe method of anaesthesia for this procedure. In a retrospective study, 125 cases of thoracoscopic sympathectomy were reviewed. The anaesthesia was a totally intravenous technique with propofol, alfentanil, and atracurium and a gas mixture of 40% oxygen in air. The degree of hypoxaemia during inflation of carbon dioxide into the thorax was assessed. The results showed that hypoxaemia caused no problems in any of the patients. Three patients with severe angina pectoris were also studied using the same anaesthetic technique and they showed marked haemodynamic instability throughout the procedure requiring inotropic support. Haemodynamic values obtained through a Swan-Ganz catheter in one patient showed marked changes during the procedure, but values returned to normal after the operation. Although these patients were haemodynamically unstable there was no problem with hypoxaemia.

Alfentanil↗
PubMed1994

[Experimental retroperitoneoscopic lumbar sympathectomy].

The present study was designed to support the hypothesis that lumbar sympathectomy could be performed by minimal invasive surgery. In a porcine experiment, under laparoscopic vision control, a pneumoretroperitoneum was established through a direct retroperitoneal access for dissecting the retroperitoneal tissue layers and resecting the lumbar sympathetic trunc. The connective tissue septae were separated without any problems by blunt dissection under vision through the retroperitoneally inserted laparoscope. After exposure of the retroperitoneal organs and identification of specific landmarks, the resection of the lumbar sympathetic trunk was performed. We conclude that lumbar sympathectomy can be easily performed by minimal invasive surgery.

Animals↗
PubMed1994

Video thoracoscopic laser sympathectomy for palmar hyperhidrosis.

Palmar hyperhidrosis (PH) is common in Orientals from subtropical areas. Many therapeutic modalities are used in practice, but none has proved to be entirely satisfactory. We have developed a new therapeutic technique by combining a video thoracoscopic system with a surgical laser unit (both waveguide CO2 laser and fibre-optic Nd:YAG laser). The operation was performed under general anaesthesia with alternative one-lung ventilation. With this technique, we are able to identify the sympathetic trunk on the TV screen and confirm its proper level with accurate ablation by intraoperative vasomotor monitoring. Consequently, an adequate sympathectomy can be definitely achieved through laser extirpation. We have successfully treated 300 PH patients with this technique from 1990 to 1992. The ages ranged from six to 63 years with a mean of 26.6. There were 125 males and 175 females. Most patients underwent en bloc ablation of the T2 segment which includes a major part of the T2 ganglion with its adjacent trunk which overlays the T2 rib head. All of them obtained a satisfactory relief of PH except 13 patients. The procedure did not result in a change of vital signs. There was neither obvious injury to lung nor bleeding. No Horner's syndrome was produced. The commonest complication was compensatory hyperhidrosis in various degrees encountered in about half of the cases. Two-thirds of the patients were followed up for more than 12 months and only three had recurrence. Based on our experience, the technique is considered to be a minor and safe procedure and able to achieve a definite and long-lasting therapeutic effect. It causes minimal discomfort and scarring. Particularly, the operation time and hospital stay were markedly shortened in comparison with other conventional open sympathectomy procedures.

Adolescent↗
PubMed1994

[Comparison of double-lumen endobnonchial versus single-lumen endotracheal tube anesthesia in bilateral thoracoscopic sympathectomy].

Since the development of video endoscopic surgery, the number of transthoracic endoscopic sympathectomy has been increasing. The use of double-lumen endobronchial tube or single-lumen endobronchial tube during anesthesia for these surgeries has been a controversial. 385 palmar hyperhidrosis patients divided into three groups: group I, under alterative one lung ventilation anesthesia with double-lumen endobronchial tube; group II, under alterative one lung ventilation anesthesia with single-lumen endobronchial tube; group III, under two lung ventilation anesthesia with single-lumen endobronchial tube were studied. All had received bilateral thoracoscopic sympathectomy. The age of patients ranged from 8 to 64 years old. There were 154 male and 231 female. The average anesthesia durations for group I, II and III were 38.56 +/- 10.28, 34.14 +/- 5.21, 31.83 +/- 3.34 min respectively. The variables considered in the study were: physique of the patients; duration of anesthesia; airway pressure changes; SaO2 changes during the operation and post-anesthesia complaints. We found that upon using double-lumen endobronchial tube, SaO2 levels was better maintained especially in the obese patients and the patients who had received a traditional surgical operation before.

Adolescent↗
PubMed1993

Thoracoscopic sympathectomy.

With the advent of advanced video and laparoscopic techniques, new applications have been found for thoracoscopy's expanding role in thoracic surgery. Described herein are three cases of thoracoscopic sympathectomy for three different indications. The evaluation and surgical technique are described in detail. Thoracoscopic sympathectomy is an excellent alternative to open transthoracic approach.

Adult↗
PubMed1993

[Total intravenous anesthesia with O2 mask in transthoracic endoscopic sympathectomy for palmar hyperhidrosis].

Using non-invasive monitors (such as blood pressure, O2 saturation, end-tidal CO2 pressure monitors and electrocardiograms), the application of total intravenous anesthesia with O2 mask in transthoracic endoscopic sympathectomy was evaluated. A total of 198 palmar hyperhidrosis patients were studied. In the study, the durations of surgery were 5-15 min (mean 8 min) with anesthesia duration of 8-20 min (mean 12 min), respectively. The cardiovascular system was quite stable during operation, with systolic blood pressures of 90-165 mmHg (mean 132 mmHg), diastolic blood pressures of 50-106 mmHg (mean 92 mmHg) and heart rates of 56-130 beats/min (mean 104 beats/min). The respiratory function was maintained within a safety range with O2 saturation of 95-100% (mean 99%) and end-tidal CO2 pressure of 32-40 mmHg (mean 36 mmHg). After surgery, the major discomfort was chest pain (132/198), but this could be improved with intravenous analgesics. Patients' consciousness returned within 1-3 min. After ensuring their general condition was stable, patients were discharged within 24 hr. Preliminary study showed that total intravenous anesthesia plus muscle relaxant, with O2 mask and assisted ventilation, could serve as a safe and simple anesthesia for palmar hyperhidrosis patients who received transthoracic endoscopic sympathectomy.

Adolescent↗
PubMed1993

[Chylothorax: a rare complication of transaxillary thoracic sympathectomy].

Transaxillary upper thoracic sympathectomy is a safe surgical procedure for the treatment of palmar hyperhidrosis. Although thoracic complications such as hemothorax and pneumothorax occasionally occur following this procedure chylothorax is an extremely rare complication. From 1978 to 1991, 215 consecutive patients underwent upper thoracic sympathectomy for the treatment of palmar hyperhidrosis in our institution. We report the surgical management of one patient who developed an intractable chylous fistula which did not respond to non-surgical treatment. Attempts at non-surgical management of the disease, with aspiration therapy, tube thoracostomy and the administration of medium chain triglyceride diet, should be tried first. If, however, this is not successful within two weeks, one should not wait for further metabolic and nutritional impairment before instituting surgical treatment. We believe that proximal thoracic duct ligation is a relatively simple and effective means of controlling chylothorax.

Adolescent↗
PubMed1977

[The role of lumbar sympathectomy. Review of the cases performed between 1950 and 1955 (author's transl)].

This reviews 839 isolated lumbar sympathectomy performed between 1950 and 1975. The patients are stratified by decades and grouped in 3 periods : 1950 to 1959, 1960 to 1969 and 1970 to 1975. In the first period most patients were between 50 and 59 years old; in the last period most were between 60 and 69 years old. At this time direct vascular reconstruction had become more frequent. The approach described by Pearls was used exclusively in the last period. Isolated lumbar sympathectomy yields a symptomatic improvement. Best results are obtined in peripheral and isolated lesions.

Adult↗
PubMed1977

[Forecasting of the effects of lumbar sympathectomy by the radiothermometry with pentothal (author's transl)].

This test has been previously described and is used routinely by the authors since 1960. The method is based on the alternate arterial blood distribution between skin and muscle of a limb, depending on modifications in the vasomotor tone. Skin temperature, arteriography and progression speed of the contrast medium are measured simultaneously. The test shows the morphology of the arterial lesion. It measures vasomotor reserve by these parameters, especially the skin temperature, before and after administration of pentothal. Results are rated as good, average and poor. The authors have compared this test, performed before surgery, to the results of lumbar sympathectomy and found an excellent correlation. Late result of lumbar sympathectomy can thus be foreseen by means of this test provided no new organic lesion interferes with the hemodynamics of the limb.

Angiography↗
PubMed1996

Endoscopic transthoracoscopic sympathectomy--the Durban experience.

Advances in optics, illumination and video-technology together with refinements in operative technique have made endoscopic transthoracoscopic sympathectomy (ETS) the method of choice for upper thoracic sympathectomy. Palmar hyperhidrosis is by far the main indication for ETS. The procedure is technically easy and well tolerated by patients, and complications are few and minor.

Adolescent↗
PubMedDate not supplied

Altered endothelium-mediated relaxation by sympathectomy in isolated rabbit carotid artery rings.

The influence of cervical and periarterial sympathectomy on endothelium-dependent and endothelium-independent relaxations of the mature rabbit carotid artery was studied in vitro. The responses to adenosine, vasoactive intestinal polypeptide and substance P in sympathectomized and control rabbit carotid artery rings were recorded and analyzed. The effects of endothelium removal were also investigated. The maximal relaxation achieved by substance P, which produces endothelium-dependent relaxation, was significantly inhibited in 3 weeks in postsympathectomy arterial preparations as compared to controls. Adenosine and vasoactive intestinal polypeptide, which produce endothelium-independent relaxation, elicited similar relaxation in all tissues. These results demonstrated that the response to substance P was impaired by cervical and periarterial sympathectomy. The decreased maximum response to substance P may be the result of a decreased NK-1 receptor subtype density or excitation/response coupling, or it may be due to an impaired production and/or liberation of endothelium-derived relaxing factor (EDRF).

Adenosine↗
PubMed1996

[Thoracic sympathectomy in palmar hyperhidrosis: comparison of open with thorascopic procedure].

Between 1976 and 1994 we performed 26 thoracic sympathectomies for treatment of therapy-resistant palmar hyperhidrosis. Until the end of 1992 the operation was performed using an open transaxillary approach, since 1993 sympathectomy was done by video-assisted thoracoscopy. Both procedures consisted in excision of the thoracic ganglia T2 to T5. The only complication was a pneumothorax in the open surgery group (successfully treated by drainage). Compensatory sweating occurred in 70% of our patients, compared to results in the literature of 60-90%. We did not note further complications, e.g. no Horner's syndrome. All of our patients were satisfied with the result of the operation. Comparison of the two collectives shows significant advantages for video-assisted thoracoscopic surgery. the procedure is easier to perform, exposure is better, cosmetic results are favourable, operation-time and hospital stay are reduced.

Adult↗
PubMed1977

[Plastic surgery of the arteries of the lower limbs with autologous vein and its association with lumbar sympathectomy].

In surgical treatment of patients with arterial occulsion of the lower limbs an autovein was employed as a transplant in 66 patients. In 22 patients reconstructive operation was performed after preliminary lumbar sympathectomy. Restored patency of the operated segment with restoration of foot artery pulsation was noted in 53 patients. Late results were followed up for 1--6 years in 32 patients. Major blood flow was maintained in 24 patients (75%). Other conditions being equal, reconstructive operations yield better results, if lumbar sympathectomy was preliminary performed.

Adult↗
PubMedDate not supplied

[Thoracoscopic bilateral sympathectomy in Raynaud's syndrome. Anesthesiology problems].

The objective of this paper was to examine the major anaesthetic problems during transthoracic endoscopic sympathectomy without artificial pneumothorax and to present our experience of 16 cases suffering from Raynaud's disease. For the perioperative management we used a double lumen endo-bronchial tube and balanced anaesthesia (intravenous agents plus isoflurane). Arterial pressure, heart rate, ECG, end-tidal carbon dioxide concentration, SatO2, blood gases and peak inspiratory pressures were monitored. The results showed that no significant changes in these parameters occurred during surgery. Since hypoxaemia is the main problem of the thoracoscopic sympathectomy the A.A. emphasize the necessity to ensure a correct ventilation as well as a haemodynamic stability throughout the procedure. The combination of balanced anaesthesia and double lumen endobronchial intubation seems an advisable method when no artificial pnx is instituted. A close monitoring of the circulatory and respiratory systems is imperative.

Adolescent↗
PubMed1997

Transthoracic endoscopic sympathectomy for treatment of hyperhidrosis palmaris.

The objective of this study was to determine the effectiveness of modified transthoracic endoscopic sympathectomy (TES) being used in our institute for treatment of hyperhidrosis palmaris (HP). One hundred and eight cases of HP were treated using TES from June 1991 to June 1992. All underwent TES bilaterally. Palmar temperature was monitored during the operation as an indicator of a successful lesioning of the sympathetic trunk at the T2-level. The ages of the patients ranged from 10 to 61 years. Fifty-one percent of these patients had a positive family history. Seventy-three percent had onset during childhood. Eighty-nine percent had excessive plantar sweating in addition to hyperhidrosis palmaris. The increase in palmar temperature after lesioning the sympathetic trunk was inversely related to the preoperative temperature of the palms (r = 0.81, p < 0.005). Our treatment resulted in improvement of palmar sweating in all of the patients. Decrease of plantar sweating was also noted in 68% of the patients at follow up. No neurological deficits were found. Transient post-operative chest discomfort and compensatory hyperhidrosis (87%) were the most common complications. TES is an effective method for treating patients with HP, with a shorter operation time, fewer hospital days, and a better cosmetic result, as compared with the dorsal approach for thoracic sympathectomy.

Adolescent↗