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

Abstract

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.

An Epidemiological Study of Hyperhidrosis

“…9 Further work has elucidated sex differences in these autonomic responses between men and women, with women showing slower baseline rewarming responses than men. 10 Although we did not find that more women presented with palmar hyperhidrosis in our population, there may be further sex differences in autonomic responses that predispose each sex to have a higher propensity to develop focal hyperhidrosis in certain sites, such as the facial hyperhidrosis more prevalent in men.…”

New epidemiological aspects of patients with severe hyperhidrosis presenting for sympathetic surgery

“…Fronek et al . demonstrated that autonomic responses between women and men differ 22 . Nevertheless, a hormonal impact on severe primary hyperhidrosis is unlikely, as more than one third of the female patients using the pill and other hormones did not recognize any alteration in sweating pattern and intensity.…”

Thoracoscopic Sympathectomy at the T2 or T3 Level Facilitates Bradykinin-Induced Protein Extravasation in Human Forearm Skin

“…Therefore, the objective of our study was to test the contribution of the sympathetic nervous system on BK‐induced vasodilation and protein extravasation in a human model. The study was conducted in patients who underwent surgical interruption of sympathetic outflow at the T2 or T3 level to treat primary regional hyperhidrosis [19–21]. This means that most of the postganglionic sympathetic fibers remain intact.…”