Differential effects of surgical sympathetic block on sudomotor and vasoconstrictor function

Schick, Christoph; Fronek, Kerstin S.; Held, A.Christian; Birklein, Frank; Hohenberger, Werner; Schmelz, Martin

doi:10.1212/01.wnl.0000067995.13410.47

Cited by 27 publications

(18 citation statements)

References 35 publications

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“…Rewarming kinetics of the hands has been successfully used to assess the effects of surgical sympathetic block previously [19].We confirmed that the main effect of the ESB is observed in the fingertips, as would be expected according to the rich vasoconstrictory innervation of the arterio-venous shunts in the fingertips [6,12]. ESB at the level of T4 was by far less effective in suppressing vasoconstrictor outflow and also in reducing palmar sweating as compared to ESB at T2.…”

Section: Discussionsupporting

confidence: 81%

Differential effects of surgical sympathetic block at the T2 and T4 level on vasoconstrictor function

Krüger

Fronek

Schmelz

et al. 2003

Clinical Autonomic Research

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Endoscopic sympathetic block (ESB) is used as a treatment of excessive palmar sweating. In a prospective study we compared the effect of ESB at the level of the second (T2) and fourth thoracic ganglion (T4) on vasoconstriction and sweating of the hands. Sympathetic vasoconstriction was measured by computerassisted infrared thermography following ice water immersion of the hands in 22 hyperhidrosis patients before, two days and 3 months post op. In addition, palmar sweating before and 3 months post op was assessed by sudometry. After ESB the rewarming was accelerated in both T2 and T4 patients, but was significantly slower in the T4 group. Three months postoperatively rewarming had returned to the preoperative pattern in T4 patients but was still significantly faster in the T2 group. These effects were more pronounced in the fingertips than the hand dorsum. Sudomotor function was blocked in all T2 patients but had relapsed in 2 patients in the T4 group. Two T4 patients had not shown an effect on sudomotor function postoperatively. The normalization of rewarming kinetics may be explained by remaining fibers, denervation hypersensitivity or stimulation of catecholamine receptors, or neuronal reorganization. The effect of ESB T4 on sudomotor function has to be proven.

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Section: Discussionsupporting

confidence: 81%

Differential effects of surgical sympathetic block at the T2 and T4 level on vasoconstrictor function

Krüger

Fronek

Schmelz

et al. 2003

Clinical Autonomic Research

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“…Rewarming kinetics of the hands have been successfully used to assess the effects of surgical sympathetic block in the past [20]. In our study we observed that the inhibition of vasoconstriction was more pronounced following ESB at level T2 as compared to T3.…”

Section: Discussionmentioning

confidence: 53%

“…Rewarming was recorded for another 9 minutes. Time course of rewarming was analyzed offline separately for six circular areas (diameter 5 mm) spaced by 1.5 cm from the fingertip of the middle finger to the center of the palm [20] for both hands by dedicated software [11]. In all patients, the test was performed one to two days before, two days after and three months after ESB.…”

Section: Methods S Patientsmentioning

confidence: 99%

“…The most frequently used technique involves interruption of the sympathetic chain at the level of the second thoracic ganglion (T2), resulting in a success rate of nearly 100 % and excellent long-term results [10,15]. We have shown earlier that impaired vasoconstriction following surgical sympathetic block can be assessed by rewarming kinetics following ice water immersion with infrared thermography [20]. In this study we compared the inhibition of vasoconstriction between different levels of the sympathetic block (T2 vs. T3).…”

Section: Introductionmentioning

confidence: 99%

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Effects of gender and level of surgical sympathetic block on vasoconstrictor function

Fronek

Schmelz

Krüger

et al. 2003

Clinical Autonomic Research

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Interruption of sympathetic outflow by surgical sympathetic block has been used to treat hyperhidrosis for decades. In this study the effect of gender and the level of sympathetic block (T2 vs. T3) on the rewarming kinetics following ice water immersion were assessed in a prospective study on 60 hyperhidrosis patients before, 2 days, and 3 months postoperatively. Rewarming kinetics following endoscopic sympathetic block (ESB) was massively enhanced 2 days post-operatively, but had returned to pre-operative conditions at the 3 month follow-up for ESB at level T3. ESB at level T2 provoked significantly faster rewarming as compared to T3 at the 2 day and 3 month follow-up. Independent of the level of ESB, there was a slower rewarming in women already pre-operatively. This gender difference was clearly reduced at the 2 day follow-up, but had increased again at the 3 month follow-up. There was no correlation between the rewarming kinetics of the fingertips and palmar sweating. We conclude that for the sympathetic vasoconstriction of the fingertips the sympathetic ganglion T2 is crucial. Gender differences have to be taken into account when assessing effect of ESB by cold induced vasoconstriction. It remains to be established whether the quantification of vasoconstriction has some predictive value for the long-term prognosis of sudomotor blockade.

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“…Interestingly, Freedman et al (2005) showed that despite an B21C difference in skin temperature across 18-301C T A conditions in humans, (7)MDMA induced changes in the temperature of skin and core of approximately the same magnitude. Human peripheral thermoregulation by vasodilation/vasoconstriction and sweating appears to be independently mediated (Inoue et al, 1998;Schick et al, 2003). Freedman and colleagues found that sweating onset in humans is at a core temperature of 35.51C and a skin temperature of 371C.…”

Section: Discussionmentioning

confidence: 99%

Impact of Ambient Temperature on Hyperthermia Induced by (±)3,4-Methylenedioxymethamphetamine in Rhesus Macaques

Huben

Lay

Crean

et al. 2006

Neuropsychopharmacol

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The ambient temperature (T A ) under which rodents are exposed to (7)3,4-methylenedioxymethamphetamine (MDMA) affects the direction and magnitude of the body temperature response, and the degree of hypo/hyperthermia generated in subjects can modify the severity of lasting brain changes in 'neurotoxicity' models. The thermoregulatory effects of MDMA have not been well described in nonhuman primates and it is unknown if T A has the potential to affect acute hyperthermia and therefore other lasting consequences of MDMA. The objective of this study was to determine if the temperature alteration produced by MDMA in nonhuman primates depends on T A as it does in rats and mice. Body temperature and spontaneous home cage activity were monitored continuously in six male rhesus monkeys via radiotelemetry. The subjects were challenged intramuscularly with 0.56-2.4 mg/kg (7)MDMA under each of three T A conditions (18, 24, and 301C) in a randomized order. The temperature was significantly elevated following injection with all doses of MDMA under each ambient temperature. The magnitude of mean temperature change was B11C in most conditions suggesting a closely controlled thermoregulatory response in monkeys across a range of doses and ambient temperatures. Activity levels were generally suppressed by MDMA; however, a 50% increase over vehicle was observed after 0.56 MDMA under the 301C condition. It is concluded that MDMA produces a similar degree of hyperthermia in rhesus monkeys across a range of T A conditions that result in hypothermia or exaggerated hyperthermia in rodents. Monkey temperature responses to MDMA appear to be more similar to humans than to rodents and therefore the monkey may offer an improved model of effects related to MDMA-induced hyperthermia.

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Differential effects of surgical sympathetic block on sudomotor and vasoconstrictor function

Abstract: T2 sympathectomy leads to long-lasting inhibition of palmar sweating, which does not correlate to loss of vasoconstriction. Recurrent and enhanced vasoconstrictor function 3 months following endoscopic sympathetic block has major implications for its use to treat enhanced vasoconstriction.

Cited by 27 publications

References 35 publications

Differential effects of surgical sympathetic block at the T2 and T4 level on vasoconstrictor function

Differential effects of surgical sympathetic block at the T2 and T4 level on vasoconstrictor function

Effects of gender and level of surgical sympathetic block on vasoconstrictor function

Impact of Ambient Temperature on Hyperthermia Induced by (±)3,4-Methylenedioxymethamphetamine in Rhesus Macaques

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