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PubMed1992

Effects of sympathetic stimulation on use dependence of lidocaine, mexiletine, and quinidine in an intact canine model.

The use- or rate-dependent effects of a continuous infusion of lidocaine (n = 6, serum level 3.1 +/- 0.34 micrograms/mL), mexiletine (n = 8, serum level 7.08 +/- 0.90 micrograms/mL), and quinidine (n = 6, serum level 6.8 +/- 1.22 micrograms/mL) were studied in an open chest canine preparation. A use-dependent effect on conduction was assessed by measuring the change in the His to surface ventricular activation (HV) time at differing atrial paced rates during drug infusion. Global sympathetic activation was achieved by nondecentralized left stellate ganglion stimulation (4-10 Hz, 6-12 V, 2 ms) and use dependence at the same cycle lengths was compared. Repolarization times were measured from epicardial monophasic action potentials recorded from the anterior left ventricle throughout the study. There was no significant change in the HV time during control studies with or without left stellate stimulation. Use-dependent slowing of conduction was seen in all studies during drug infusion. This was evident at cycle lengths of 300-190 ms for quinidine and at cycle lengths less than 250 ms for lidocaine and mexiletine. Stellate stimulation attenuated use dependence in all studies. This effect was significant from cycle lengths of 300-190 ms for lidocaine and quinidine and at cycle lengths shorter than 230 ms for mexiletine (p less than 0.05). Stellate stimulation significantly reduced use-dependent prolongation of the HV interval by an average of 60%. During stellate stimulation there was a nonsignificant trend towards cycle length independent shortening of action potential duration both at baseline and in the presence of drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Action Potentials↗
PubMed1999

Organization of the sympathetic innervation of the forelimb resistance vessels in the cat.

UNLABELLED: Detailed information on the outflow pathway of sympathetic vasoconstrictor fibers to the upper extremity is lacking. We studied the organization of the sympathetic innervation of the forelimb resistance vessels and of the sinoatrial (SA) node in the decerebrated, artificially respirated cat. The distal portion of sectioned individual rami T1-8 and the sympathetic chain immediately caudal to T8 on the right side were electrically stimulated while the right forelimb perfusion pressure (forelimb perfused at constant flow) and heart rate were recorded. Increases in perfusion pressure were evoked by stimulation of T2-8 (maximal response T7: 55 +/- 2.3 mm Hg). Responses were still evoked by stimulation of the sympathetic chain immediately caudal to T8 (44 +/- 15 mm Hg). Increases in heart rate were evoked by the stimulation of more rostral rami (T1-5; maximal response T3: 55.2 +/- 8 bpm). These vasoconstrictor and cardioacceleratory responses were blocked by the cholinergic antagonists hexamethonium and scopolamine. Sectioning of the vertebral nerve and the T1 ramus abolished the vasoconstrictor response. Stimulation of the vertebral nerve and of the proximal portion of the sectioned T1 ramus increased perfusion pressure (69 +/- 9 and 34 +/- 14 mm Hg, respectively), which was unaffected by ganglionic cholinergic block. These data suggest that forelimb resistance vessel control is subserved by sympathetic preganglionic neurons located mainly in the middle to caudal thoracic spinal segments. Some of the postganglionic axons subserving vasomotor function course through the T1 ramus, in addition to the vertebral nerve. IMPLICATIONS: Forelimb vasculature is controlled by sympathetic preganglionic neurons located in middle to caudal thoracic spinal segments and by postganglionic axons carried in the T1 ramus and vertebral nerve. This helps to provide the anatomical substrate of interruption of sympathetic outflow to the upper extremity produced by major conduction anesthesia of the stellate ganglion or spinal cord.

Anesthesia, Conduction↗
PubMed1975

Calcium dependent action potentials produced in leech Retzius cells by tetraethylammonium chloride.

1. Retzius cells of leech segmental ganglia were exposed to tetraethylammonium chloride (TEA) presented both extracellularly, dissolved in the perfusing fluid, and intracellulary, by iontophoresis from a microelectrode. 2. Extracellular TEA, 10 and 25 mM, greatly prolonged the cells' action potentials, and the higher concentration increased their amplitude as well. At 10 mM the characteristic changes developed gradually over a period of about half an hour, while at 25 mM they appeared much more rapidly. However, at both concentrations the changes were reversible within minutes, even after long soaks in drug-containing solution. It is therefore probable that the drug acted at the outer surface of the membrane. 3. Intracellular TEA also prolonged the action potentials but there were several differences from the response produced by extracellular application. The changes developed gradually, and for a time, each firing of the cell was a complex event consisting of several early, brief depolarizations followed by a single much larger and more prolonged one. The large, late depolarization eventually obliterated the early ones; its gradual development suggested that it was produced only after TEA diffused to some extrasomatic portion of the cell. Intracellular TEA always caused progressive depolarization; this and the changes in the action potential were both irreversible, suggesting that the site of action was on the inner surface of the membrane. 4. Manipulations of external Na and Ca provided evidence that (a) in the absence of TEA, Retzius cell action potentials were exclusively Na-dependent, (b) that the early depolarizations in the complex action potentials produced by intracellular TEA were Na-dependent, while the later, large depolarization was Ca-dependent and (c) that the prolonged action potentials produced by extracellular TEA contained a large Ca-dependent component. 5. We conclude that TEA, acting from either side of the membrane, caused a voltage-sensitive, slowly activated Ca current to become a major contributor to the inward current of the action potential, probably by blocking the outward K current which ordinarily counteracts it. However, we cannot rule out the possibility that TEA enabled a Ca current by some means independent of its presumed action on K conductance. 6. Data resembling ours in some respects have been obtained from studies of the action of TEA on frog dorsal root ganglion cells, frog neuromuscular junction, and squid stellate ganglion. No clear counterpart of our findings has been reported form experiments on squid and amphibian axons, molluscan neurones, or frog skeletal muscle fibres.

Action Potentials↗
PubMedDate not supplied

Axillary sympathectomy for upper extremities.

Among the several various surgical approaches to the cervico-dorsal sympathetic system, the axillary approach seems to us the operation of choice. The operation is simple, gives excellent access to the required sympathetic ganglions, including the lower part of the stellate ganglion, down to the fifth thoracic ganglion. In all cases the sympathectomy was clinically complete. The postoperative course was mostly smooth, and the few cases of transient Horner's Syndrome, pneumothorax and hemothorax could have been avoided.

Adolescent↗
PubMed1993

[Autonomic neurons sending fibers into the canine laryngeal nerves--using a retrograde tracer technique with cholera toxin].

The distribution of the autonomic neurons sending fibers into the canine superior and inferior laryngeal nerves was investigated by an immunohistochemical technique with cholera toxin B subunit as a retrograde tracer. Cholera toxin was applied to the right internal branch of the superior laryngeal nerve (SLNI), external branch of the superior laryngeal nerve (SLNE) or inferior laryngeal nerve (ILN) in 2-month-old dogs. In every case of cholera toxin application, labeled neurons were seen mainly in the caudal portion of the ipsilateral superior cervical ganglion, whereas none were seen in the stellate ganglion. The number of labeled neurons in the superior cervical ganglion after application of cholera toxin to the SLNI was over 20 times that observed after application to the SLNE or ILN. When cholera toxin was applied to the SLNI or SLNE, labeled neurons were found mainly in the ipsilateral dorsal motor nucleus of the vagus (DMNV), and a few labeled neurons were found in the ipsilateral reticular formation. The neurons in the DMNV were localized, on the average, between 2.7 mm and 5.3 mm rostral to the obex. The number of neurons in the DMNV labeled retrogradely from the SLNI was much larger than that from the SLNE. In contrast, no labeled neurons were detected in the DMNV after application to the ILN. These results demonstrate the following: 1) The sympathetic neurons innervating the canine larynx are distributed mainly in the caudal portion of the superior cervical ganglion and they send their fibers mainly into the SLNI. 2) The parasympathetic neurons innervating the canine larynx have a limited distribution in the dorsal motor nucleus of the vagus and their main pathway is also the SLNI.

Animals↗
PubMed1999

Left thoracoscopic sympathectomy and stellate ganglionectomy for treatment of the long QT syndrome.

The long QT syndrome (LQTS) is a rare inherited cardiac disorder that may induce fatal cardiac arrhythmias. Patients diagnosed with this disorder generally have several treatment options, including beta-blockade, cardiac pacing, an implantable automatic defibrillator, or a high thoracic left sympathectomy. We report the case of a 6-year-old girl with the LQTS treated by left thoracoscopic sympathectomy and stellate ganglionectomy. The procedure was performed after an initial thorascopic attempt at another institution failed due to inadequate resection of the sympathetic chain. Operative time was 85 min and blood loss was minimal. There were no intraoperative or postoperative complications. The girl's QT interval decreased and she was discharged on the 4th postoperative day. After 9 months of follow-up, she remains asymptomatic. We conclude that the LQTS patients who fail medical treatment can be treated successfully with left thoracoscopic cervicothoracic sympathectomy. We recommend that the extent of sympathectomy for treating the LQTS be T1-T4 and either the entire stellate ganglion or at least the inferior one-third.

Child↗
PubMed1980

The treatment of Sudeck's atrophy in the upper limb by sympathetic blockade.

The incidence of Sudeck's atrophy as a sequel to injury in the upper limb has been estimated in relation to casualty attendances in a 3-year period. Seventeen patients were treated at varying intervals after the onset of the condition either by stellate ganglion block or by regional intravenous guanethidine. The results are compared and the advantages of each method are discussed.

Adult↗
PubMed1993

Cervicothoracic sympathectomy for Raynaud's syndrome.

Raynaud's syndrome is a clinical entity characterized by episodic vascular spasm and digital ischemia occurring in response to cold or emotional stimuli. Most patients with Raynaud's syndrome are successfully managed with medical therapy. Surgical sympathectomy is rarely performed and its use remains controversial. Of 3,219 patients seen with the diagnosis of Raynaud's disease, phenomenon or syndrome over the last 10 years at Mayo Clinic, 20 cervical or thoracic sympathectomies were performed in 14 (0.4%) patients. Of all patients who underwent cervico thoracic sympathectomy (68) for various reasons during the same time period, 20.5% (14/68) were performed for Raynaud's syndrome. Surgical sympathectomy was reserved for those rare patients with persistent, severe symptoms (pain, ulcer) despite intensive medical treatment. Surgical therapy was also used for those few patients with occupations involving exposure to cold and disabling, refractory symptoms in hopes of allowing them to return to work. Transaxillary (12 limbs) or supraclavicular (8 limbs) exposure and resection of the sympathetic chain with T1-T4 ganglions was usually performed. Initial resolution or improvement of symptoms was achieved in 19/20 (95%) of limbs. Both patients with digital ulceration healed. Although improved in some, persistent or recurrent symptoms were present in all patients after six months postoperatively. Increased sensitivity of digital vessels to circulating catecholamines, nerve fiber regeneration or incomplete sympathectomy have been postulated to lead to recurrence. Five patients developed Horner's syndrome postoperatively. A portion of the stellate ganglion was intentionally resected in 3 of the 5 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Ganglionic local opioid application (GLOA) for treatment of chronic headache and facial pain.

OBJECTIVE: This report describes the effects of ganglionic local opioid application (GLOA) in patients with chronic headache and persistent idiopathic facial pain. CASE REPORT: We present 2 patients with chronic headaches and 1 patient with persistent idiopathic facial pain who were refractory to medical treatment. These patients responded well to a series of ganglionic local opioid applications (GLOAs) by administration of buprenorphine. The beneficial effect of GLOA was manifested by a decrease in pain intensity, reduction of pain medications, and improvement in quality of life. CONCLUSIONS: These results support the theory of sympathetically mediated pain in the head and face, the presence of opioid receptors on the sympathetic ganglia, and a possible beneficial role of opioids in modulation of this process. To our knowledge, this case series is the first case series in the English literature of the use of GLOA at the stellate ganglion for head-and-face pain.

Adult↗
PubMed2003

In vivo extracellular recording of sympathetic ganglion activity in a chronic animal model.

Surgery of the sympathetic system is performed for a variety of indications, hyperhidrosis being a major one. Despite excellent results, sympathectomy for hyperhidrosis bears a number of sequels, some of which may be devastating. Several surgical methods, empirically advocated to alleviate these problems, have only limited success. Chronic in vivo recording of the electrical activity from sympathetic ganglia may assist in understanding and clarifying complex problems of sympathetic surgery; however, no suitable method has been reported. An electrode device developed by our group was implanted on the stellate ganglion, in a chronic animal model (dog). The signals obtained were amplified, filtered, and transmitted via an A/D interface to be acquired and saved on a computer, using special software which we developed. Our method enabled the separate recording of neuroelectrical signals, ECG, and respiration waves. An additional software program, also developed by our group, was used to analyze the data. This chronic animal model allows investigation of surgical and pharmacological manipulations of the sympathetic system.

Animals↗
PubMed1994

Neuronal activity of the stellate ganglia in neonatal swine.

In anesthetized, paralyzed, and artificially ventilated neonatal pigs, neuronal activity was recorded extracellularly from the intact right stellate ganglion. Of 301 investigated neurons, only a few had spontaneous activity: 27 neurons generated activity either during lung inflation or deflation, and 1 neuron generated activity related to the cardiac cycle. The remaining 273 neurons were activated by stroking of body hair or by light pressure applied to various somatic sites. These data suggest that much of the spontaneous activity in the stellate ganglia appear later during development.

Action Potentials↗
PubMed2002

Complex regional pain syndrome in the head and neck: a review of the literature.

This article reviews the features of complex regional pain syndrome (CRPS), including its pathophysiology, diagnosis, and treatment. CRPS is a pathology that has been described as occurring almost always in a limb, but this review provides a focus on the literature reporting cases in which the face, head, and neck were affected. Very few cases were found that seemed to meet the International Association for the Study of Pain criteria for the disease. The clinical characteristics were similar to those of CRPS elsewhere in the body, with the main features being burning pain, hyperalgesia, and hyperesthesia starting after a trauma to the craniofacial region. Physical signs were reported less frequently. The treatment of choice was seen to be a series of stellate ganglion anesthetic blocks, which resulted in a good outcome in all the cases reviewed.

Autonomic Nerve Block↗
PubMed1976

Regional shortening patterns in canine right ventricle.

The right ventricular outflow tract (OT) is a functionally distinct area of the right ventricle. However, there is little information on the contrdingly, inflow tract (IT) and OT chords and right ventricular free wall segmental changes were measured with implanted ultrasound crystals. The timing and extent of shortening of IT and OT chords and free wall segments were determined both at rest and after stellate ganglion stimulation. At rest, IT chord shortening began 51 ms before OT shortening. OT expansion occurred during this period. IT chord shortening began 51 ms before OT shortening. OT expansion occurred during this period. IT chord shortening was 38% while OT shortening was 34%. In contrast, OT segments did not show systolic expansion. IT segment shortening was 13% while OT shortening was 21%. With stellate stimulation, IT-OT gradients of 15-25 mmHg developed. The lag between IT and OT shortening decreased to 30 ms and segmental shortening increased. We conclude that the OT is a physiologically distinct region which contracts later and remains contracted longer than the IT. Both septal and free wall movements contribute to these changes.

Animals↗
PubMed1979

Anaesthetic considerations in the prolonged Q-T interval (LQTS): a case report.

A case of prolonged Q-T interval syndrome (LQTS) with ventricular dysrhythmias is presented. The patient was unresponsive to medical treatment. Left stellate ganglion block, followed by surgical excision of the ganglion, resulted in reversion to normal sinus rhythm. The causes of LQTS, its treatment and the effects of anaesthetic agents are discussed.

Adult↗
PubMed1978

Left stellectomy in the long QT syndrome.

Recent investigations have reaffirmed the role of autonomic innervation of the heart in the genesis of certain cardiac arrhythmias. The long QT syndrome (LQTS) has been described for years, but only recently has evidence of its link to autonomic imbalance been established. A case of LQTS is presented with intraoperative evidence at the time of left stellectomy of life-threatening arrhythmias triggered by stimulation of this neural body. Removal of the left stellate ganglion normalized the electrocardiographic (ECG) abnormalities and has rendered the patient asymptomatic since surgery. Left stellectomy may become definitive therapy for selected patients with the LQTS.

Adult↗
PubMed1987

Comparison of autonomic responses in the trachea isolated from normal and albumin-sensitive guinea-pigs.

1 Mechanical and electrical responses to stimulation of the parasympathetic and sympathetic nerves were compared in the trachea isolated from normal guinea-pigs and from guinea-pigs sensitized to albumin and exposed repeatedly to inhaled albumin (a model of bronchial asthma). 2 Sensitized trachealis exhibited mechanical hyper-responsiveness to vagal stimulation characterized by a shift to the left of the frequency-response relationship and a 71% increase in the maximum response. 3 Transmembrane potential was significantly less negative in sensitized trachealis cells. 4 The amplitude of the depolarization evoked by vagal stimulation (4 or more pulses) was significantly greater in sensitized tissues. Vagally-mediated depolarization was associated with the appearance of regenerative electrical activity (spikes) in sensitized but not in control tissues. 5 Spontaneous discharge of slow waves occurred in cells from both control and sensitized trachea but the proportion of spontaneously active cells was higher in sensitized tissues. Spontaneous depolarization, like nerve-mediated depolarization, gave rise to abortive spikes only in sensitized trachealis. 6 Inhibitory responses to stimulation of the sympathetic stellate ganglion, mediated by beta-adrenoceptors, were unaltered in sensitized trachealis. 7 Possible explanations for the hyper-responsiveness to vagal input in sensitized trachealis are discussed.

Albumins↗