Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “SYMPATHECTOMY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 883 records · Page 49Linked to original sources
PubMed1992

Anaesthesia for transthoracic endoscopic sympathectomy in the treatment of upper limb hyperhidrosis.

Renewed interest has been shown in transthoracic endoscopic sympathectomy (TES) for the treatment of upper limb hyperhidrosis. We review our experience and discuss the anaesthetic technique and perioperative problems encountered in 58 patients undergoing TES for hyperhidrosis. Patients were monitored for arterial pressure, heart rate, ECG, pulse oximetry (SpO2), end-tidal carbon dioxide concentration, peak inspired airway pressure and skin temperature. General anaesthesia, with a double-lumen endobronchial tube, enabled the lungs to be collapsed alternately, thereby ensuring easy and clear access to the sympathetic chain. Controlled ventilation with 100% inspired oxygen was necessary to obviate hypoxaemia. In two patients, severe hypotension and bradycardia occurred during insufflation of carbon dioxide into the chest cavity. Four patients required underwater drainage of the pleural cavity for treatment of pneumothorax or haemothorax. The success and safety of the procedure depends on a scrupulous anaesthetic technique.

Adolescent↗
PubMed1995

Tracheal anaesthesia for transthoracic endoscopic sympathectomy: an alternative to endobronchial anaesthesia.

When using endobronchial anaesthesia for the management of transthoracic endoscopic sympathectomy (TES), excessive insufflation of carbon dioxide into the pleural space may cause haemodynamic instability, hypoxaemia and tension pneumothorax. We prospectively studied an alternative technique using a tracheal tube, i.v. fentanyl, propofol, atracurium and nitrous oxide in 82 consecutive healthy patients (31 male, 51 female; mean age 26.48 (range 14-50) yr, weight 61.26 (33-100)kg.) They were suffering from severe palmar hyperhidrosis and they underwent bilateral TES (mean duration of operation 34.57 (15-90) min). After being placed in a 30-40 degree head-up position, three patients required ephedrine to treat arterial hypotension. A capnograph was used to confirm correct placement of the Verres needle in the pleural space. In two groups of 13 patients undergoing ventilation with an FlO2 of either 0.3 or 0.4, during partial collapse of the operative lung, PaO2 and the PaO2:FlO2 ratio decreased significantly (P < 0.001). TES was unsuccessful in three patients because of pleural adhesions. After operation five patients required chest drains; two for haemothorax and three for pneumothorax. Seventy-seven patients without complications were discharged from hospital within 24 h.

Adolescent↗
PubMed1997

Transdiscal lumbar sympathetic block: a new technique for a chemical sympathectomy.

UNLABELLED: Genitofemoral neuritis, which occurs when the neurolytic solution spreads into the psoas muscle, is the most common complication after neurolytic lumbar sympathetic block. We developed a transdiscal approach for neurolytic lumbar sympathetic block to reduce the danger of genitofemoral neuritis by making a sympathectomy without penetration of the psoas muscle, through which the genitofemoral nerve passes. We attempted transdiscal lumbar sympathetic block in 14 patients for whom the last previous lumbar sympathetic block performed by using the conventional paravertebral method was unsuccessful. Under fluoroscopic guidance, the needle was inserted transdiscally at L2-3 and/or L3-4 and was advanced until its tip pierced the anterior longitudinal ligament. Radiography and computed tomography revealed that the injected contrast media spread along the anterolateral surface of the vertebral column without any flow into the psoas muscle. Alcohol was injected successfully in all patients. During the 1-mo follow-up period, no patients had any symptom of genitofemoral neuritis. Thirteen patients who had been suffering from lower extremity pain achieved partial or complete pain relief. One patient with plantar hyperhidrosis achieved persistent anhidrosis. These results suggest that the transdiscal approach can be a technical option for neurolytic lumbar sympathetic block. IMPLICATIONS: Neurolytic lumbar sympathetic block was performed with the needle advanced through the intervertebral disc. With this technique, the risk of genitofemoral neuritis, the most common complication after neurolytic lumbar sympathetic block, was reduced because the needle does not penetrate the psoas muscle, through which the genitofemoral nerve passes.

Adult↗
PubMed1998

Heart rate variability during chemical thoracic sympathectomy.

BACKGROUND: Chemical thoracic sympathectomy (CTS) resulted in profound bradycardia in a patient with severe post-therapeutic neuralgia. To clarify the cause of this bradycardia, the authors evaluated heart rate variability using a Poincaré plot, which is a scatter diagram of the current R-R interval plotted against the R-R interval immediately preceding it, in this patient and in others scheduled for CTS or mandibular block (MB). METHODS: Twenty-three patients were scheduled for CTS (n = 13, CTS group) and for MB (n = 10, MB group). Heart rate and the SD of the R-R interval variabilities spreading along the x axis (SDRR) and perpendicularly along the diagonal line of the Poincaré plot (SDdeltaRR) were evaluated before, just after, and 1 h after the block. RESULTS: Neither group had significant changes in heart rate. The MB group showed no significant change in the SD(RR):SDdeltaRR ratio. In the CTS group, however, the SD(RR):SDdeltaRR ratio decreased significantly from 1.72+/-0.20 to 1.23+/-0.11 just after CTS. The previous patient, who had a high SD(RR):SDdeltaRR ratio of 3.45 before CTS, exhibited severe bradycardia (22 beats/min). CONCLUSIONS: The SD(RR):SDdeltaRR ratio decreased after CTS without any significant concomitant change in heart rate. The decrease in the SD(RR):SDdeltaRR. ratio indicates a reduction of cardiac sympathetic activity. However, CTS in patients having high SD(RR):SDdeltaRR ratios can result in profound bradycardia.

Adult↗
PubMed1976

Lumbar sympathectomy in end stage arterial occlusive disease.

Sixty-one patients had lumbar sympathectomies performed for end stage occlusive vascular disease manifested by gangrene of less than one-half of the foot, ulcerating ischemic lesions, rest pain or rapidly progressive markedly limiting intermittent claudication. The operative procedure was standardized to permit removal of the lowermost preganglionic fiber at the level of the crus of the diaphragm and the ganglionated chain to the crossing of the iliac vessels. The immediate postoperative mortality was 6.5% from cardiac causes. Over all improvement rate was 60% while early amputation rate was 40% for the entire group. Those patients with rest pain had the poorest prognosis with an amputation rate of 53%. The results are compared to other groups and factors of patient selection, anatomy of the sympathetic chain in relation to operative technique, physiology of decentralization versus devervation are discussed. The procedure is worthwhile in patients who are not candidates for arterial reconstruction who are faced with the prospect of early amputation.

Amputation, Surgical↗
PubMed1986

Cardiovascular changes after bilateral upper dorsal sympathectomy. Short- and long-term effects.

The effect of bilateral upper dorsal sympathectomy (UDS) on cardiac function was investigated in two groups of young healthy patients who underwent bilateral excision of T2 and T3 ganglia for palmar hyperhidrosis. In ten patients echocardiography of left ventricular function (LVF) was performed before operation and 2 weeks after operation. Electrocardiograms (ECG) were done before operation, during operation immediately after sectioning each sympathetic chain, and at 2 weeks after operation. The mean pulse rate decreased significantly in patients after they underwent bilateral UDS. There were no clinical arrhythmias or changes in LVF in any patient. Submaximal exercise testing and ECG tracings done at rest and after effort were obtained for 29 patients before undergoing bilateral UDS, 30 days after operation, and 1-3 more times within a 2-year postoperative period. Pulse rates taken at rest and after effort were significantly lower than those taken after operation, and the blood pressure response to exercise was blunted. ECG tracings showed a significant change in the electrical frontal plane axis and shortening of the QTc interval. These changes were evident 30 days after operation and persisted for 2 years. In conclusion, bilateral UDS has no overt arrhythmogenic effect in the young, healthy heart and its beta-blocker-like effect persists for at least 2 years.

Adolescent↗
PubMed1992

Endoscopic transthoracic sympathectomy in the treatment of hyperhidrosis.

A 5-year experience of 50 endoscopic transaxillary dorsal sympathectomies is presented. The procedure was successful in either curing or improving the symptoms of hyperhidrosis in the great majority of patients. The commonest side effects were compensatory sweating (75%) and gustatory sweating (48%); despite this, there was an extremely high level of patient satisfaction. Permanent Horner's syndrome did not occur. The procedure is effective, simple, cheap, and requires only an overnight stay; and is recommended as the method of choice for the surgical treatment of upper limb hyperhidrosis.

Adolescent↗
PubMed2001

Cholecystokinin-8 promotes recovery of sympathectomy induced by 6-hydroxydopamine in adult mice.

We used an experimental model of sympathetic neuropathy to investigate the effects of intraperitoneal cholecystokinin-8 (CCK-8) administration on the recovery of injured peripheral neurones. After treatment of adult mice with 6-hydroxydopamine (6-OHDA), which known to induce peripheral sympathectomy, nerve growth factor (NGF) in peripheral tissue first increased and then rapidly decreased to baseline levels. Following this observation, sympathectomised mice were treated with CCK-8 starting when the NGF levels lowered toward the control value. Our results show that injections with 8 nmol/kg of CCK-8 promote not only recovery of noradrenergic innervation but also NGF and neuropeptide Y (NPY) synthesis in peripheral tissue. This latter observation suggests that the effect of CCK-8 might be mediated through the stimulation of NGF synthesis.

Animals↗
PubMed1991

Positron emission imaging of cardiac sympathetic innervation and function using 18F-6-fluorodopamine: effects of chemical sympathectomy by 6-hydroxydopamine.

Hypotheses concerning the pathophysiology of hypertension, cardiac failure and other cardiovascular disorders have imputed abnormal cardiac sympathoneural activity. Here we describe a technique to examine cardiac sympathetic innervation and function using positron emission tomographic (PET) scanning after systemic intravenous injection of 18F-6-fluorodopamine, and the effects of chemical sympathectomy by the neurotoxin, 6-hydroxydopamine (6-OHDA). Uptake of 18F-6-fluorodopamine by the heart of anesthetized dogs resulted in striking delineation of the left ventricular myocardium. Myocardial radioactivity declined bi-exponentially, with a half-life of approximately 2 h during the longer phase. In 6-OHDA-treated animals, the ventricular myocardium was barely distinguishable from the chamber; myocardial radioactivity declined rapidly and was virtually absent within 30 min after injection of 18F-6-fluorodopamine. The rates of decline in myocardial radioactivity in dogs treated with 6-OHDA were similar to those in dogs treated with reserpine, but the mechanisms of sympatholysis by these drugs were distinguished by arterial plasma levels of 6-fluorodihydroxyphenylacetic acid (6-FDOPAC). Plasma 6-FDOPAC levels were diminished in 6-OHDA-treated dogs and elevated in reserpinized dogs. The results confirm that, after injection of 18F-6-fluorodopamine, cardiac sympathetic nerve endings are radiolabeled, allowing visualization of sites of sympathetic innervation. Combined assessments of PET time-activity curves and plasma levels of metabolites of 18F-6-fluorodopamine constitute a new, potentially clinically applicable means by which to examine cardiac sympathetic function.

Animals↗
PubMedDate not supplied

Effect of prostaglandin synthesis inhibition and sympathectomy on ouabain-induced arrhythmia in cats.

The purpose of this study was to examine the importance of endogenous prostaglandins (PGs) and sympathectomy on the arrhythmogenic action of ouabain. Cats, anesthetized with dial-urethane, were infused intravenously with ouabain continuously. The dose of ouabain necessary to produce arrhythmia (AR), ventricular tachycardia (VT), and death was determined. Pretreatment with sulfinpyrazone at 100 mg kg-1 i.v. 1 h before glycoside infusion was used to inhibit PG synthesis. Removal of endogenous PGs with sulfinpyrazone reduced the cardiotoxic dose of ouabain. Sympathetic influences were removed by: (a) destroying sympathetic nerve terminals with 6-hydroxydopamine (6-OHDA); (b) depleting nerve terminal catecholamines with reserpine; or (c) preventing catecholamine release from the nerve terminal with bretylium. Reduction of sympathetic influences with reserpine or bretylium increased the cardiotoxic dose of ouabain; whereas removal of nerve terminals with 6-OHDA did not alter the toxic dose of ouabain from that found in control animals. When endogenous PG synthesis was inhibited with sulfinpyrazone the protective effects of reserpine and bretylium were eliminated. These results suggest that endogenous PGs protect against the arrhythmogenic action of ouabain, not only by interfering with catecholamine influences at the sympathetic nerve terminal, but also by a mechanism independent of sympathetic inhibition. Furthermore, the protective action of agents which diminishes the cardiotoxic action of ouabain by interfering with sympathetic influences is lost when endogenous PGs are removed. Finally, 6-OHDA, which destroys the sympathetic nerve terminals, removes both the arrhythmic influence of the catecholamine as well as the protective influence of the PG, resulting in no net change in the cardiotoxic dose of this glycoside.

Animals↗
PubMed1985

Antiarrhythmic effect of regional myocardial chemical sympathectomy in the early phase of coronary artery occlusion in dogs.

To investigate the importance of local noradrenaline (NA) release in initiating early ventricular extrasystoles (VES) and primary ventricular fibrillation (VF) after acute myocardial ischemia, a special form of regional myocardial chemical sympathectomy (RMCS) has been performed in dogs. After RMCS the tissue content of NA within the denervated region was reduced below 1.5% of normal, whereas the residual myocardium retained its functional state almost unchanged. After acute left circumflex coronary artery (LCX) occlusion (30 min), all control animals with normal circumflex circulation and without functionally effective collaterals died of VF. In contrast, after RMCS none of the dogs had VF and very few had VES. After RMCS the rise in myocardial extracellular K+ activity ([K+]e) during coronary occlusion is slightly slower, but the same [K+]e are reached at 8 min of occlusion. Therefore, the effect of RMCS cannot be explained by changes in myocardial K+ liberation. These results, obtained from RMCS experiments, are supported by the preliminary results of experiments using a special perfusion technique to wash out blood from the acutely occluded myocardial region, and show an ischemia-induced raise of the locally released NA in the early arrhythmic phase 1a with a further increase in phase 1b.

Animals↗
PubMed1994

Chronic sympathectomy of canine cardiac ventricles affects Gs-adenylyl cyclase coupling and muscarinic receptor density.

The effect of chronic ventricular sympathectomy on sarcolemmal muscarinic receptor (MR) and beta-adrenoceptor densities and coupling of these receptors to adenylyl cyclase was examined. Microsomal membranes were isolated from right and left ventricles of control dogs (sham- and nonoperated) and dogs with ventricles sympathectomized 4 weeks earlier. Relative to control membranes, MR density was decreased in left but not right ventricular (LV, RV) membranes from sympathectomized hearts. Relative carbachol inhibition of adenylyl cyclase was similar in RV and LV membranes from both heart groups, however, Although beta-adrenoceptor densities and ratio of beta 1- and beta 2-adrenoceptor subtypes did not change, basal adenylyl cyclase activity was 40% less in sympathectomized membranes as compared with control membranes. Furthermore, relative stimulation of adenylyl cyclase by isoproterenol was twofold greater in sympathectomized heart membranes. Because maximally stimulated adenylyl cyclase activity by NaF or MnCl2 was identical in sympathectomized and control membranes, the reduction in basal activity may not be related to a decrease in Gs and adenylyl cyclase. In support of this hypothesis, Gs alpha content as estimated from optimal cholera toxin-catalyzed ADP-ribosylation was similar in control and sympathectomized membranes. Therefore, an alteration in Gs interaction with adenylyl cyclase may account for the reduction in basal adenylyl cyclase activity and the increased relative responsiveness of adenylyl cyclase to isoproterenol in chronically sympathectomized ventricular membranes.

Adenylyl Cyclases↗
PubMed1977

The effect of 6-hydroxydopamine-induced hepatic sympathectomy on the early hyperglycemic response to surgical trauma under anesthesia.

A single intraportal injection of 6-OH-DA (50mg/kg) in rats results in a functional hepatic sympathectomy 6 days following the injection. Laparotomy and mild abdominal exploration under pentobarbital anesthesia resulted in elevated plasma glucose levels within 15 minutes as a result of activation of the sympathetic nerves to the liver and adrenal gland discharge. The hyperglycemic response to trauma was reduced by fasting. The hyperglycemic response was examined in untreated rats, 6-OH-DA pretreated rats, bilaterally adrenalectomized rats, and a group which had received 6-OH-DA pretreatment as well as bilateral adrenalectomy. In non-fasted rats the presence of intact sympathetic nerves or intact adrenals was sufficient to produce the hyperglycemia. To prevent the response both nerves and adrenals must be deactivated. The hepatic nerves are primarily responsible for the early hyperglycemic response to trauma in fasted rats while in fed animals the adrenals and hepatic nerves play a more equal role.

Adrenalectomy↗
PubMed1998

Endoscopic transthoracic dorsal sympathectomy for the treatment of upper extremity hyperhidrosis: a new minimally invasive approach.

Palmar and axillary hyperhidrosis are best treated surgically by endoscopic transthoracic upper dorsal sympathectomy. At present, this methodology relies on (at least) double trocar insertion (per side), carbon dioxide insufflation, or both. We present a new minimally invasive endoscopic transthoracic technique, performed by a single-entry specifically modified thoracoscope and without the need for carbon dioxide insufflation, with the aim to reduce the drawbacks associated with the above-mentioned, currently adopted endoscopic technique. In our opinion, this "single-entry" technique, compared with the other reported approaches, should theoretically minimize any damage to the intercostal neurovascular bundle, while avoiding the complications related to carbon dioxide insufflation.

Adolescent↗
PubMed1999

Modulatory role of adrenergic nerves on dexamethasone-induced islet cell NPY expression in the rat: evidence from chemical sympathectomy.

We previously demonstrated induction of neuropeptide Y (NPY) in rat islet beta-cells by the glucocorticoid dexamethasone (DEX). Because noradrenergic nerves appear to regulate NPY expression in the central nervous system (CNS), we investigated whether DEX-induced islet cell expression of NPY could be modulated by catecholaminergic nerves. Therefore rats were treated with DEX (2 mg/kg, i.p., for 12 days) and received injections of 6-hydroxydopamine (6-OHDA; 80 mg/kg, i.v., at day 1 or 10). 6-OHDA treatment eliminated islet adrenergic nerves. The frequency of NPY-immunoreactive islet cells and the levels of islet cell NPY messenger RNA (mRNA) were markedly lower in rats given 6-OHDA at day 1 of the DEX-treatment period. In contrast, the frequency of NPY-immunoreactive cells and levels of islet cell NPY mRNA in DEX-treated rats receiving 6-OHDA at day 10 did not differ from those treated with DEX alone. The findings suggest that DEX-induced islet cell expression of NPY is partially dependent on adrenergic nerves and that the effect of sympathectomy is exerted at an early stage of the NPY induction.

Adrenergic Agents↗
PubMedDate not supplied

The hypophyseal-testicular axis and sex accessory glands following chemical sympathectomy with guanethidine of pre-pubertal to mature rats.

Selective chemical sympathectomy of the internal sex organs of prepubertal to mature male Wistar rats was performed by chronic treatment with low doses of guanethidine. Plasma testosterone and luteinizing hormone and the intratesticular level of testosterone were determined. The weight and fructose content of seminal vesicle and ventral prostate were also investigated. The results showed that sympathetic innervation is related to the control of the hypophyseal-testicular axis as well as to the growth and potential secretory activity of the male sex accessory glands.

Animals↗