change in sympathetic nervous system activity after thoracic sympathectomy

The photoplethysmographic (PPG) signal, which measures cardiac-induced changes in tissue blood volume by light transmission measurements, shows spontaneous fluctuations. In this study, PPG was simultaneously measured in the right and left index fingers of 16 patients undergoing thoracic sympathectomy, and, from each PPG pulse, the amplitude of the pulse (AM) and its maximum (BL) were determined. The parameter AM/BL is proportional to the cardiac-induced blood volume increase, which depends on the arterial wall compliance. AM/BL increased after the thoracic sympathectomy treatment (for male patients, from 2.60±1.49% to 4.81±1.21%), as sympathetic denervation decreases arterial tonus in skin. The very low-frequency (VLF) fluctuations of BL or AM showed high correlation (0.90±0.11 and 0.92±0.07, respectively) between the right and left hands before the thoracic sympathectomy, and a significant decrease in the right-left correlation coefficient (to 0.54±0.22 and 0.76±0.20, respectively) after the operation. The standard deviation of the BL or AM VLF fluctuations also reduced after the treatment, indicating sympathetic mediation of the VLF PPG fluctuations. The study also shows that the analysis of the PPG signal and the VLF fluctuations of the PPG parameters enable the assessment of the change in sympathetic nervous system activity after thoracic sympathectomy.

Medical and Biological Engineering and Computing

2001, Volume 39, Issue 5, pp 579-583
http://link.springer.com/article/10.1007%2FBF0234514

after sympathectomy "He becomes more quiet, less impressionable, less agitated, tremor diminishes..."

Everyone seems to agree that when sympathectomy is successful the subjective symptoms of the patient show a considerable improvement. He becomes more quiet, less impressionable, less agitated, tremor diminishes, tachycardia, however, is little influenced or not at all, and the same is true for goiter.
   In conclusion it may be said that the results obtained from sympathectomy when present are very immediate. The ocular symptoms are the ones most happily influenced by the operation; the others such as nervousness, tachycardia, and goiter are problematical.
   Remote Results.- In going over the cases operated by Jaboulay as far back as twelve and fourteen years, A. Charlier was able to find that a number of his patients had been cured completely. He was able to retrace 18 out of the 31 cases operated by Jaboulay from four to fourteen years before. Three of them were completely cured, 9 of them were so ameliorated that the subjective cure was a complete one, the objective cure, however, being incomplete; the 6 remaining cases were doubtful. All these patients experienced considerable benefit to their nervous symptoms; improved and no trophic disturbances of any sort followed as the result of sympathectomy.

Title	Thyroid and Thymus
Author	André Crotti
Publisher	Lea & Febiger, 1918
Original from	Harvard University
Digitized	17 Dec 2007
Length	567 pages

ELECTRICAL STIMULATION OF THE SYMPATHETIC NERVE CHAIN for a vast array of conditions

The present invention provides a method of affecting physiological disorders by stimulating a specific location along the sympathetic nerve chain. Preferably, the present invention provides a method of affecting a variety of physiological disorders or pathological conditions by placing an electrode adjacent to or in communication with at least one ganglion along the sympathetic nerve chain and stimulating the at least one ganglion until the physiological disorder or pathological condition has been affected.

[0009] A number of treatment regiments utilizing electrical stimulation can be employed for a vast array of physiological disorders or pathological conditions associated with the sympathetic and parasympathetic nervous system. Physiological disorders that may be treated include, but are not limited to, hyperhydrosis, complex regional pain syndrome and other pain syndromes such as headaches, cluster headaches, abnormal cardiac sympathetic output, cardiac contractility, excessive blushing condition, hypertension, renal disease, heart failure, angina, hypertension, and intestinal motility disorders, dry eye or mouth disorders, sexual dysfunction, asthma, liver disorders, pancreas disorders, and heart disorders, pulmonary disorders, gastrointestinal disorders, and biliary disorders. The number of disorders to be treated is limited only by the number, variety, and placement of electrodes (or combinations of multiple electrodes) along the sympathetic nervous system. 

http://www.faqs.org/patents/app/20110098762

depression that may occur as part of stress system dysfunction

Stress precipitates depression and alters its natural history. Major depression and the stress response share similar phenomena, mediators and circuitries. Thus, many of the features of major depression potentially reflect dysregulations of the stress response. The stress response itself consists of alterations in levels of anxiety, a loss of cognitive and affective flexibility, activation of the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system, and inhibition of vegetative processes that are likely to impede survival during a life-threatening situation (eg sleep, sexual activity, and endocrine programs for growth and reproduction).

http://www.nature.com/mp/journal/v7/n3/full/4001032a.html

Limbic-cortical dysregulation: a proposed model of depression

cognition and reward processing

Recent functional magnetic resonance imaging (fMRI) investigations of the interaction between cognition and reward processing have found that the lateral prefrontal cortex (PFC) areas are preferentially activated to both increasing cognitive demand and reward level. Conversely, ventromedial PFC (VMPFC) areas show decreased activation to the same conditions, indicating a possible reciprocal relationship between cognitive and emotional processing regions. We report an fMRI study of a rewarded working memory task, in which we further explore how the relationship between reward and cognitive processing is mediated. We not only assess the integrity of reciprocal neural connections between the lateral PFC and VMPFC brain regions in different experimental contexts but also test whether additional cortical and subcortical regions influence this relationship. Psychophysiological interaction analyses were used as a measure of functional connectivity in order to characterize the influence of both cognitive and motivational variables on connectivity between the lateral PFC and the VMPFC.

These findings provide evidence for a dynamic interplay between lateral PFC and VMPFC regions and are consistent with an emotional gating role for the VMPFC during cognitively demanding tasks. Our findings also support neuropsychological theories of mood disorders, which have long emphasized a dysfunctional relationship between emotion/motivational and cognitive processes in depression.
http://dl.acm.org/citation.cfm?id=1480468

Sympathectomy disrupts feedback from the viscera

Researchers have examined the role of autonomic feedback in emotional experience using the heartbeat detection paradigm. Katkin et al. (1982) found that some normal subjects can accurately detect their heartbeats, and it was those individuals who had a stronger emotional response to negative slides as determined by self-report (hantas et al. 1982)

Experiments in animals demonstrate that sympathectomy may retard aversive conditioning (DiGusto and King, 1972) most likely because sympathectomy reduces fear. 
In order for feedback to occur, there must be a means for the viscera and autonomic nervous system to become activated.

Clinical Neuropsychology

By Kenneth M. Heilman, Edward Valenstein

Published by Oxford University Press US, 2003

http://books.google.com.au/books?id=VbTKTyn-XK4C&pg=PA458&lpg=PA458&dq=viscera+sympathectomy&source=web&ots=2lCUoqE7Rs&sig=90mBXjr9IGd_Worq34KzsrZRpCc&hl=en&sa=X&oi=book_result&resnum=5&ct=result

central representations of organism physiological homeostasis constitute a critical aspect of the neural basis of feelings

The Embodiment of Emotional Feelings in the Brain: "The Embodiment of Emotional Feelings in the Brain
Neil A. Harrison 1 , 3 , Marcus A. Gray 1 , Peter J. Gianaros 4 , and Hugo D. Critchley 1 , 2 , 3
+Show Affiliations
The Journal of Neuroscience, 22 September 2010, 30(38): 12878-12884; doi: 10.1523/JNEUROSCI.1725-10.2010



Central to Walter Cannon's challenge to peripheral theories of emotion was that bodily arousal responses are too undifferentiated to account for the wealth of emotional feelings. Despite considerable evidence to the contrary, this remains widely accepted and for nearly a century has left the issue of whether visceral afferent signals are essential for emotional experience unresolved. Here we combine functional magnetic resonance imaging and multiorgan physiological recording to dissect experience of two distinct disgust forms and their relationship to peripheral and central physiological activity. We show that experience of core and body–boundary–violation disgust are dissociable in both peripheral autonomic and central neural responses and also that emotional experience specific to anterior insular activity encodes these different underlying patterns of peripheral physiological responses. These findings demonstrate that organ-specific physiological responses differentiate emotional feeling states and support the hypothesis that central representations of organism physiological homeostasis constitute a critical aspect of the neural basis of feelings."

An absence of afferent feedback concerning autonomically generated bodily states was associated with subtle impairments of emotional responses

nature neuroscience • volume 4 no 2 • february 2001 

Neuroanatomical basis for first- and second-order representations of bodily states
H. D. Critchley1,2, C. J. Mathias2,3 and R. J. Dolan1

The Effects of Thoracic Sympathotomy on Heart Rate Variability in Patients with Palmar Hyperhidrosis

Compared with preoperative variables, there was a significant increase in the number of adjacent normal R wave to R wave (R- R) intervals that differed by more than 50 ms, as percent of the total number of normal RR intervals (pNN50); root mean square difference, the square root of the mean of the sum of squared differences between adjacent normal RR intervals over the entire 24-hour recording; standard deviation of the average normal RR in- terval for all 5-minute segments of a 24-hour recording (SDANN) after thoracic sympathotomy. Low frequencies (LF, 0.04 to 0.15 Hz) decreased significantly.
Yonsei Med J 53(6):1081-1084, 2012

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481380/pdf/ymj-53-1081.pdf 

"synaptic reorganization in the sympathetic chain or spinal cord after sympathotomy" - MAYO Clinic

"synaptic reorganization in the sympathetic chain or spinal cord after sympathotomy" - MAYO Clinic
http://www.mayoclinic.org/documents/mc5520-06pdf/DOC-20077566"

Alteration in 'fight-or-flight response following sympathectomy

Mental arithmetic produces a psychophysiological arousal similar to the so-called defence-alarm reaction elicited by stimulation ofthe hypothalamic defence area in experimental animals (Folkow, 1982). This reaction pattern is characterized by increased heart rate, cardiac output and blood pressure, whereas total peripheral resistance is unchanged or decreased (Brod, 1970).

The increase of platelet concentration during psychological arousal is also in accordance with what has been observed in response to other stressors, i.e. physical exercise and adrenaline infusion (Sarajas et al, 1961; Gjerloff Schmidt & Waever Rasmussen, 1984; Dawson & Ogston, 1969; Vilen et al, 1980).

The emotional leucocytosis observed in dogs has been claimed to be neurogenic in origin, since sympathectomy abolished the rise in leucocyte count (Garrey & Bryan, 193 5).
Both alpha- and beta-receptors seem to be of importance in the mobilization of lymphocytes (Gader & Cash, 1975).

British Journal of Haematology. 1989. 71, 153-1 56

pituitary secretions of ACTH and TSH after sympathectomy

The present results suggest that cervical sympathectomy in the rat increases ACTH secretion and decreases TSH secretion in the pituitary. These effects seem to be due to a mildly increased secretion of melatonin in the pineal body that probably in turn increases corticotropin-releasing factor (CRF) secretion and decreases thyrotropin-releasing hormone (TRH) secretion in the hypothalamus. Extrapolation of these findings to humans suggests that longterm and repeated stellate ganglion block would affect the pituitary secretions of ACTH and TSH.

Hiroshi Iwama¹  Mamoru Adachi¹, Choichiro Tase¹ and Yoichi Akama¹

(1)	Department of Anesthesiology, Fukushima Medical College, 1 Hikarigaoka, 960-12 Fukushima, Japan

Received: 26 June 1995 Accepted: 1 March 1996

significant change after sympathectomy: reduced sympathetic and increased vagal tone

The HRV analysis showed a significant change of indices reflecting sympatho-vagal balance indicating significantly reduced sympathetic (LF) and increased vagal (HF, rMSSD) tone. These changes still persisted after 2 years. Global HRV increased over time with significant elevation of SDANN after 2 years. QT dispersion was significantly reduced 1 month after surgery and the dispersion was further diminished 2 years later.

http://www.sciencedirect.com/science/article/pii/S0167527399001011

The Change in Regional Cerebral Oxygen Saturation after Stellate Ganglion Block

The Change in Regional Cerebral Oxygen Saturation after Stellate Ganglion Block: "Korean J Pain. Jun 2010; 23(2): 142–146.
Published online May 31, 2010.



Background

Stellate ganglion block (SGB) is known to increase blood flow to the innervations area of the stellate ganglion. Near infrared spectroscopy reflects an increased blood volume and allows continuous, non-invasive, and bedside monitoring of regional cerebral oxygen saturation (rSO2). We investigated the influence of SGB on bilateral cerebral oxygenation using a near infrared spectroscopy.



Methods

SGB was performed on 30 patients with 1% lidocaine 10 ml using a paratracheal technique at the C6 level and confirmed by the presence of Horner's syndrome. The blood pressure (BP), heart rate (HR) and rSO2 were measured before SGB and 5, 10, 15 and 20 minutes after SGB. Tympanic temperature of each ear was measured prior to SGB and 20 minutes after SGB.



Results

The increments of the rSO2 on the block side from the baseline were statistically significant at 5, 10, 15 and 20 minutes. The rSO2 on the non-block side compared with the baseline, however, decreased at 15 and 20 minutes. The difference between the block and the non-block sides was significant at 15 and 20 minutes. The BP at 10, 15 and 20 minutes was increased and the HR was increased at 10 and 15 minutes.



Conclusions

We observed an increment of the rSO2 on the block side from the baseline; however, the rSO2 on the non-block side decreased."

Local distribution of the effects of sympathetic stimulation on cerebral blood flow in the rat

Local distribution of the effects of sympathetic s... [Brain Res. 1990] - PubMed - NCBI: "Although the density of sympathetic fibres on the cerebral vessels varies regionally, the cerebral circulatory effects of electrical stimulation of these fibres on the cerebral circulation have not been mapped in detail. In the present study the effects of sympathetic stimulation on local cerebral blood flow were examined in urethane anaesthetized rats using autoradiographic techniques. Initial experiments determined that unilateral stimulation of the superior cervical ganglion altered cerebral circulatory dynamics to an extent sufficient to reduce cerebral venous pressure by 1.1 +/- 0.2 mm Hg. Local cerebral blood flow was measured with iodo[14C]antipyrine autoradiography in 4 groups: (1) sham; (2) sham + unilateral sympathetic nerve section; (3) unilateral stimulation of the superior cervical ganglion; and (4) unilateral sympathetic stimulation + contralateral sympathetic nerve section. In the sham animals, local cerebral blood flow was equivalent in the innervated and denervated hemispheres. During stimulation plus contralateral nerve section, a regionally heterogeneous response to sympathetic stimulation was observed. Local cerebral blood flow was reduced 11-19% on the stimulated side in over one half (15/28) of the regions examined (e.g. thalamic nuclei and caudate nucleus). In general, ipsilateral reductions in flow occurred in the territory supplied by the middle cerebral, posterior cerebral and posterior communicating arteries and their branches. Cerebral blood flow was symmetrical in regions supplied by the basilar and anterior cerebral arteries and in some midline structures."



'via Blog this'

Effects of stellate ganglion block on cerebral haemodynamics as assessed by transcranial Doppler ultrasonography

Background. Stellate ganglion block (SGB) causes vasodilatation in the skin of the head and neck

because of regional sympathetic block. Its effects on cerebral haemodynamics, in health or in

disease, are not clear. We evaluated the effects of SGB on ipsilateral middle cerebral artery flow

velocity (MCAFV), estimated cerebral perfusion pressure (eCPP), zero flow pressure (ZFP),

carbon dioxide reactivity (CO2R) and cerebral autoregulation using transcranial Doppler

ultrasonography (TCD).



Methods. Twenty male patients, with pre-existing brachial plexus injury, and undergoing SGB for

the treatment of complex regional pain syndrome of the upper limb, were studied. For SGB, 10 ml

of plain lidocaine 2% was used and the onset of block was confirmed by presence of ipsilateral

Horner’s syndrome. The MCAFV, eCPP, ZFP, CO2R, and cerebral autoregulation were assessed

before and after SGB using established TCD methods. The changes in these variables were

analysed using Wilcoxon’s signed rank test.



Results. The block caused a significant decrease in MCAFV from median (inter-quartile range)

value of 61 (53, 67) to 55 (46, 60) cm s 1, a significant increase in eCPP from 59 (51, 67) to

70 (60, 78) mm Hg, and a significant decrease in ZFP from 32 (26, 39) to 25 (16, 30) mm Hg. There

were no significant changes in CO2R or cerebral autoregulation.

http://bja.oxfordjournals.org/content/95/5/669.full.pdf

The role of norepinephrine in spatial reference and spatial working memory

The adrenergic system (utilizing norepinephrine, NE, as a neurotransmitter) is implicated in hippocampus-based learning and memory, in addition to its well known peripheral actions mediated by the sympathetic nervous system.

Using a more standard variation of the above protocol on the radial arm maze, we used this apparatus to test the role of NE in spatial working memory. We found significant, robust differences between Dbh-/- and Dbh+/- mice after a training period of approximately 14 days. To test whether this difference was due to a potential deficit in acquisition or performance, we restored NE in Dbh-/- mice by administering the synthetic precursor L-DOPS after four days of stable behavioral differences between genotypes. In a separate trial, we also restored NE signaling with dexmedetomidine, a selective alpha-2 receptor agonist. A gradual improvement by Dbh-/- mice to levels comparable to Dbh+/- mice indicated that NE is critical for the acquisition of spatial working memory, and suggested a role for the alpha-2 adrenergic receptor in the processing of spatial working memory.

Suggested Citation

Gertner, Michael J. and Thomas, Steven A., "The role of norepinephrine in spatial reference and spatial working memory" 08 June 2006. CUREJ: College Undergraduate Research Electronic Journal, University of Pennsylvania, http://repository.upenn.edu/curej/18.

Date Posted: 08 June 2006

This document has been peer reviewed.

Michael J. Gertner, University of Pennsylvania
Steven A. Thomas, University of Pennsylvania
http://repository.upenn.edu/curej/18/

Inflammation in dorsal root ganglia after peripheral nerve injury: Effects of the sympathetic innervation

Following a peripheral nerve injury, a sterile inflammation develops in sympathetic and dorsal root ganglia (DRGs) with axons that project in the damaged nerve trunk. Macrophages and T-lymphocytes invade these gan- glia where they are believed to release cytokines that lead to hyperexcitability and ectopic discharge, possibly contributing to neuropathic pain. Here, we examined the role of the sympathetic innervation in the inflammation of L5 DRGs of Wistar rats following transection of the sciatic nerve, comparing the effects of specific surgical in- terventions 10–14 days prior to the nerve lesion with those of chronic administration of adrenoceptor antago- nists. Immunohistochemistry was used to define the invading immune cell populations 7 days after sciatic transection. Removal of sympathetic activity in the hind limb by transecting the preganglionic input to the rele- vant lumbar sympathetic ganglia (ipsi- or bilateral decentralization) or by ipsilateral removal of these ganglia with degeneration of postganglionic axons (denervation), caused less DRG inflammation than occurred after a sham sympathectomy. By contrast, denervation of the lymph node draining the lesion site potentiated T-cell in- flux. Systemic treatment with antagonists of α1-adrenoceptors (prazosin) or β-adrenoceptors (propranolol) led to opposite but unexpected effects on infiltration of DRGs after sciatic transection. Prazosin potentiated the influx of macrophages and CD4+ T-lymphocytes whereas propranolol tended to reduce immune cell invasion. These data are hard to reconcile with many in vitro studies in which catecholamines acting mainly via β2-adrenoceptors have inhibited the activation and proliferation of immune cells following an inflamma- tory challenge. 

Autonomic Neuroscience: Basic and Clinical 182 (2014) 108–117 

Neuroscience Research Australia, Randwick, NSW 2031, and the University of New South Wales, Sydney, NSW 2052, Australia

electric stimulation of the sympathetic cord in the upper thoracic level on the middle cerebral artery blood flow velocity

The effect of electric stimulation of the sympathetic cord in the upper thoracic level on the middle cerebral artery blood flow velocity (V(MCA)) in humans was examined using transcranial Doppler sonography monitoring during surgery for palmar hyperhidrosis. Sympathetic stimulation resulted in marked and rapid increases Of V(MCA). The responses were preceded by prompt increases of mean arterial blood pressure (MABP) and heart rate (HR). Division of the sympathetic cord cranially or caudally to the stimulation site partially reduced the V(MCA), MABP and HR responses. Both these operations reduced sympathetic pathways to the heart as reflected by a decrease in HR and MABP. The integrity of the sympathetic pathway from the stimulation site through the superior cervical ganglion and the carotid plexus was not a prerequisite for a V(MCA) response. Our data suggest that the V(MCA) increase mainly results from stimulation of the heart and the cardiovascular system, resulting in marked increases of blood pressure and heart rate.

CEREBROVASCULAR DISEASES Volume: 2 Issue: 6 Pages: 359-364 Published: NOV-DEC 1992

NE levels and Posttraumatic Stress Disorder

CSF Norepinephrine Concentrations in Posttraumatic Stress Disorder

Thomas D. Geracioti, Jr., M.D.
Dewleen G. Baker, M.D.
Nosakhare N. Ekhator, M.S.
Scott A. West, M.D.
Kelly K. Hill, M.D.
Ann B. Bruce, M.D.
Dennis Schmidt, Ph.D.
Barbara Rounds-Kugler, R.N.
Rachel Yehuda, Ph.D.
Paul E. Keck, Jr., M.D.
John W. Kasckow, M.D., Ph.D.
Objective: Despite evidence of hyperresponsive peripheral and central nervous system (CNS) noradrenergic activity in posttraumatic stress disorder (PTSD), direct measures of CNS norepinephrine in PTSD have been lacking. The goal of this study was to determine serial CSF norepinephrine levels in patients with PTSD.
Method: CSF samples were obtained serially over a 6-hour period in 11 male combat veterans with chronic PTSD and eight healthy men through an indwelling subarachnoid catheter. Thus the authors were able to determine hourly CSF norepinephrine concentrations under base-
line (unstressed) conditions. Severity of the patients’ PTSD symptoms was assessed with the Clinician-Administered PTSD Scale.
Results: CSF norepinephrine concentrations were significantly higher in the men
with PTSD than in the healthy men. Moreover, CSF norepinephrine levels strongly and
positively correlated with the severity of PTSD symptoms. Plasma norepinephrine concentrations showed no significant relationship with the severity of PTSD symptoms.
Conclusions: These findings reveal the presence of greater CNS noradrenergic activity under baseline conditions in patients with chronic PTSD than in healthy subjects and directly link this pathophysiologic observation with the severity of the clinical posttraumatic stress syndrome.
(Am J Psychiatry 2001; 158:1227–1230)

Treatment of social phobia by endoscopic thoracic sympathicotomy

Eur J Surg Suppl. 1998;(580):27-32.

Treatment of social phobia by endoscopic thoracic sympathicotomy.

Telaranta T.

The pathognomonic symptoms of social phobia: hyperhidrosis, palpitation, blushing, tremor, and anxiety, were all highly significantly (p < 0.001) alleviated by ETS. 88% of the patients were satisfied with the result. There were no complications.

CONCLUSION:

ETS seems a promising alternative to conservative therapy for social phobia.

Can J Anaesth. 2002 Aug-Sep;49(7):758-9.

Unexpected beneficial effect of stellate ganglion block in a schizophrenic patient.

Takano M, Takano Y, Sato I.

http://www.ncbi.nlm.nih.gov/pubmed/12193502

Jpn J Ophthalmol. 2006 Nov-Dec;50(6):567-9.

Visual hallucinations following stellate ganglion block in a patient with central retinal artery occlusion.

Kurimoto T, Takata M, Nishimura M, Tagami Y, Okamoto N, Mimura O.

http://www.ncbi.nlm.nih.gov/pubmed/17180540

Masui. 1993 Nov;42(11):1696-8.

[Three case reports of the use of stellate ganglion block for the climacteric psychosis].

Ikeda K1, Isshiki A, Yoshimatsu N, Oumi A, Ito S, Ikeda T.

Author information

Abstract

There are many reports of the use of stellate ganglion block (SGB) for the climacteric psychosis, which is considered to be sympathicotonic response to stress. We experienced three cases of the SGB therapy for the climacteric psychosis. We performed SGB three times per week by 1% lidocaine 5 ml, and observed improvements of the symptoms after doing SGB for five times. The patients reported psychological relaxation after receiving SGB therapy. We examined the changes of the serum concentrations of ACTH, LH, FSH, and catecholamines (epinephrine, norepinephrine) before and after SGB in 8 patients who were suffering from climacteric psychosis, because we wanted to know the endocrinological response to SGB. We observed a significant decrease in norepinephrine concentration after SGB, which is reasonable considering the sympathetic blockage. There were no significant changes of ACTH, LH, FSH, and epinephrine. We conclude that SGB therapy must be effective for the climacteric psychosis because of sympathetic blockade. But we could not clarify the influence of endocrinological response to SGB.

Stellate Ganglion Block for the Treatment of Posttraumatic Stress Disorder

"Nerve blocks have long been used to treat both acute and chronic pain. When performing regional anesthesia procedures, clinicians realized that pain relief could be achieved not only by blocking the afferent somatic nerves but also by anesthetizing the efferent nerves of the sympathetic nervous system at sites containing regional collections of autonomic ganglia.1
The sympathetic nervous system (SNS) is a key mediator of the “fight or flight” response. During periods of stress, pre-ganglionic, cholinergic nerves in the spinal cord fire, releasing the neurotransmitter acetycholine. Some of these pre-ganglionic neurons transmit directly to the adrenal medulla, causing bulk release of adrenalin and other stress-hormones. However, most pre-ganglionic SNS neurons synapse with peripheral neurons and release noradrenalin at nerve terminals, which induce stress-appropriate responses specific to the tissue involved.2 Masses of postganglionic, adrenergic neurons can be found in a chain of ganglia that lay along the spinal cord.
The stellate ganglion (SG) is the result of the fusion of the inferior cervical ganglion (C7) and the first thoracic ganglion into a single, star-shaped mass measuring about 1.5 cm3. It is normally situated lateral and posterior to the lateral edge of the longus colli muscle anterior to the first rib and posterior to the subclavian artery. About 80% of individuals will have fused anatomy, with the remaining 20% having unfused ganglia that lay in a similar area anterior to the transverse process of the C7 vertebra.3,4 All pre-ganglionic sympathetic nerves innervating the head and neck, as well as many to the upper extremity, either synapse here or pass through to more distal sites."

"Pharmacological complications are related to the dose, volume, type of local anesthetic and site of deposition of the solution. This includes hoarseness of voice due to paralysis of the recurrent laryngeal nerve. Additionally, phrenic nerve paralysis may lead to respiratory distress, especially if there is contralateral dysfunction of the phrenic nerve. Other adverse events may include seizures, loss of consciousness, profound hypotension due to a high spinal anesthetic blockade, air embolism, and loss of cardioaccelerator activity that may lead to various bradyarrhythmias and hypotension.

Therapeutic Utility of SGB
NONPSYCHIATRIC CONDITIONS
SGB has been shown to have utility for diagnostic, therapeutic, and prognostic purposes for a variety of conditions, including: chronic regional pain syndrome types I and II to the upper extremities (CRPS I and II);; chronic and acute vascular insufficiency/occlusive vascular disorders of the upper extremities, such as Raynaud’s disease, intra-arterial embolization and vasospasm. SGB has also been found an effective treatment for poor lymphatic drainage and local edema of the upper extremity following breast surgery;; postherpetic neuralgia;; and phantom limb pain or amputation stump pain. Patients with quinine poisoning;; sudden hearing loss and tinnitus;; hyperhidrosis of the upper extremity;; cardiac arrhythmias and ischemic cardiac pain;; Bell’s palsy and a variety of orofacial pain syndromes, including neuropathic orofacial pain and trigeminal neuralgia;; vascular headache such as cluster and migraine headaches;; and neuropathic pain syndromes among cancer patients are all also candidates for SGB.

SGB has also been recommended for improving blood flow to the cranium for angiography and following stroke/cerebrovascular accident and hyperhidrosis to the upper extremities.13,14 Additionally, SGB’s use has been reported in the treatment of Ménière’s syndrome3 and hot flashes.17–19
PSYCHIATRIC CONDITIONS
It might seem counterintuitive that treating the peripheral nervous system could affect psychiatric conditions presumably mediated in the brain. Most psychiatrists, however, are probably familiar with the observation that vagal nerve stimulation improves depression.20 As early as 1947, reported cases of improvements in depression subsequent to SGB treatment began emerging in the literature.21 More recently, unexpected benefits of SGB have been reported for hallucinations in schizophrenia,22 and in “climacteric psychosis” (a term for mental illness associated with menopause).23

Although not specifically SGB, similar techniques of lesioning the sympathetic chain has been reported widely as a potential treatment for social phobia.24–26

In the case of social phobia, the mechanism is presumably because the techniques prevent blushing. For patients with both blushing and social phobia, sympathectomy proved as good as or better than sertraline in improving anxiety.27 Taken together, the evidence suggests that techniques that influence the peripheral sympathetic nervous system could potentially be used to treat psychiatric conditions."

"Cumulatively, the growing body of preliminary evidence about the potential therapeutic benefits of SGB for PTSD is compelling. Starting in 2008, a series of case reports were published in which SGB relieved symptoms of PTSD, even when co-occurring pain was not present among patients in a private clinic practice.29–31 The effect was usually immediate and often dramatic. SGB appeared to produce some form of a “calming effect” that primarily impacted symptoms associated with avoidance and hyperarousal. However, to experience sustained symptom relief, patients often required at least two SGB injections over a short follow-up period (< 30 days).31 In some cases, radiofrequency ablation of the SG was needed to prolong the duration of benefit.30 "

 

Anita H. Hickey, MD;; Maryam Navaie, DrPH;; Eric T. Stedje-Larsen, MD;; Eugene G. Lipov, MD;; Robert N. McLay, MD, PhD
Psychiatric Annals
February 2013 - Volume 43 · Issue 2: 87-92 

The effect of dysfunction of the autonomic nervous system on experienced feelings and emotions - literature

Hohmann, G.W. : The effect of dysfunction of the autonomic nervous system on experienced feelings and emotions

Paper read at Conference on Emotions and Feelings at New School for Social Research, New York, Oct 1962.

Sherrington, C.S.: Experiments on the value of vascular and visceral factors for the genesis of emotion 

Proc. Roy.Soc., 1900, 66, 390-403

Wenger, M.A.: Emotion as visceral action: an extension of Lange's theory. In Reymert, M.L., Feelings and emotions: the Moosehart ymposium, New York: McGraw-Hill, 1950. Pp.3-10.

Wynne, L.C., and Solomon, R.L.: Traumatic avoidance learning: acquisition and extinction in dogs deprived of normal peripheral autonomic function. 

Genet. psychol. Monogr., 1955, 52, 241-84

Landis, C., and Hunt, W. A. Adrenalin and emotion. 

Psychol. Rev., 1932, 39, 467-85.

Schachter, S., and Wheeler, L.: Epinephrine, chlorpromazine, and amusement. 

J. of abnorm. soc. Psychol., 1962, 65, 121-28.

sympathectomy and parasympathectomy lead to hyperfunction of the serotoninergic system and pathology.

Bulletin of Experimental Biology and Medicine, Vol. 140, No. 5, 2005 PHYSIOLOGY

decrease in basal heart rate, norepinephrine, level after sympathectomy

Endoscopic thoracic sympathectomy – its effect in the treatment of refractory angina pectoris

Interact CardioVasc Thorac Surg (2006) 5 (4): 464-468. 

Martin Striteskya, Milos Dobiasa, Rudolf Demesb, Michal Semradc,*, Eva Poliachovaa, Tomas Cermaka, Jiri Charvatd and Ivan Maleke
Author Affiliations*Corresponding author. Tel.: +420224962781; fax: +420224922695. E-‐‑mail address:

+

↵

semradvfn@hotmail.com (M. Semrad).
Abstract

Received September 16, 2005. Revision received February 12, 2006. Accepted March 13, 2006.

Objective: To document an improvement in the quality of life in a group of patients with refractory angina and videothoracoscopic sympathectomy (VTSY) during the early postoperative period and a six-‐‑month follow-‐‑up. Methods: Ten patients with angina CCS IV refractory to a conventional therapy underwent VTSY between the years 1998 and 2002 at our institution. All patients underwent a complex preoperative evaluation, including pain assessment using a visual analog scale (VAS). Proximal thoracic sympathetic blockage was performed in all patients as a diagnostic test. The resection of bilateral Th2-‐‑Th4 ganglions was performed under general anesthesia and selective lung ventilation. All patients were monitored 6 months after the VTSY. Results: No deaths occurred in our group of patients, with an average hospital stay of
4.1 days. Nine of the ten operated patients referred an important subjective relief of pain. There was a drop from 10 to 4 according to VAS (P<0.05), and from 4 to 2.4 according to CCS (P<0.05). Decreases in basal heart rate, norepinephrine level, and an occurrence of ventricular premature beats reached the level of statistical significance. Conclusions: The increasing number of patients with refractory angina prompted a search for an effective and safe therapy to improve the quality of their life. New evidence in the pathophysiology of an ischemic myocardium and investigation of the impact of thoracic sympathectomy suggests sympathetic denervation seems to be a possible alternative method for the treatment of refractory angina pectoris.

Reduced heart rate variability and vagal tone in anxiety: Trait versus state, and the effects of autogenic training

This study investigated heart rate variability (HRV) in healthy volunteers that were selected for extreme scores of trait anxiety (TA), during two opposite psychophysiological conditions of mental stress, and relaxation induced by autogenic training. R–R intervals, HF and LF powers, and LF/HF ratios were derived from short-term electrocardiographic recordings made during mental stress and relaxation by autogenic training, with respiratory rate and skin conductance being controlled for in all the analyses. The main finding was that high TA was associated with reduced R–R intervals and HF power across conditions. In comparison to mental stress, autogenic training increased HRV and facilitated the vagal control of the heart. There were no significant effects of TA or the psychophysiological conditions on LF power, or LF/HF ratio. These results support the view that TA, which is an important risk factor for anxiety disorders and predictor of cardiovascular morbidity and mortality, is associated with autonomic dysfunction that seems likely to play a pathogenetic role in the long term.
Autonomic Neuroscience: Basic and Clinical
Volume 145, Issue 1 , Pages 99-103, 28 January 2009

The sympathetic system is responsible for the physiological responses to emotional states

The common epithet of “fight or flight” is being enlarged to be “fight, flight, or fright” or even “fight, flight, fright, or freeze.” Cannon’s original contribution was a catchy phrase to express some of what the nervous system does in response to a threat, but it is incomplete. The sympathetic system is responsible for the physiological responses to emotional states. The name “sympathetic” can be said to mean that (sym- = “together”; -pathos = “pain,” “suffering,” or “emotion”).



http://cnx.org/content/m46582/latest/?collection=col11496/latest"

the autonomic nervous system varies in a unique, autonomous manner, and it is therefore difficult to assess changes in patients in a uniform manner

There are several reasons that stellate ganglion block affects the cardiovascular system. Stellate ganglion block will initially affect both the sympathetic and parasympathetic nervous systems based on the degree of block. The intensity of right stellate ganglion blockage of the sympathetic and parasympathetic nervous system will result in heart rate changes and altered activity of the sympathetic and parasympathetic nervous system. Efferent sympathetic innervation from the right stellate ganglion is primarily distributed over the sinus node of the heart, and the influence of the autonomic nervous system and left stellate ganglion block should be assessed. Further, results will be affected by the health status of participants.

Although efferent sympathetic nerves from the stellate ganglion are primarily distributed over the heart, efferent sympathetic fibers from the 2nd to 5th thoracic ganglia affect the heart as well. Accordingly, the autonomic nervous system of the heart is not completely dependent on the stellate ganglia. The influence of the autonomic nervous system cannot be excluded as well. It is worth noting that the mepivacaine in the present study was a lower dosage than those used in other studies. Finally, the autonomic nervous system varies in a unique, autonomous manner, and it is therefore difficult to assess changes in patients in a uniform manner or just through the application of one or two indicators. Future studies should examine diverse methods for the assessment of autonomic nervous system function.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872892/

a strong association of autonomic dysfunction and impaired cerebral autoregulation

Furthermore, we found a strong association of autonomic dysfunction and impaired autoregulation indicated by a correlation between the LF/HF ratio and Sx (p <>

Influences of autonomic dysbalance and mental state during withdrawal are suggested. The finding of an affected autoregulation during acute withdrawal might indicate an increased risk for cerebro-vascular disease.Drug and Alcohol Dependence
Volume 110, Issue 3, 1 August 2010, Pages 240-246

lowering of heart rate and blood pressure, decreased responsiveness of the cardiocirculatory system to emotional stimuli

"lowering of heart rate and blood pressure, decreased responsiveness of the cardiocirculatory system to emotional stimuli: it is an effect that is especially noticeable in patients operated on for erythrophobia and less evident in those operated for hyperhidrosis. It is almost always a welcome phenomenon, which contributes considerably to the feeling of tranquility and serenity that generally supersedes anxiety. Excessive reduction in blood pressure or heart rate may lead to a state of weakness and fatigue that may require removal of the clips in approx. 2%. This rare state of asthenia contrasts with the increased energy and vigor that most patients experience when they feel freed from overwhelming anxiety."


"The neurovegetative nervous system is, however, very dynamic and tends to adapt continuously during lifetime to all environmental or organic changes and conditions. Therefore, it reacts very individually when a reflex circuit has been blocked. The resulting side effects cannot be predicted in detail, and though they in most patients are relatively mild or even absent, there is a small group of patients developing heavy side effects. Therefore, surgery should only be considered in carefully selected cases in whom non-invasive treatment has failed and in whom the detrimental consequences of erythrophobia regarding the psychosocial situation and the quality of life is such to justify more adverse side effects. It should also always be kept in mind that therapy can be ineffective and that, in the long term, 10-15% of patients do not consider themselves satisfied with the result of surgery."

http://www.chir.it/en_erythrophobia.php

Use of stellate ganglion block for the treatment of psychiatric and behavioral disorders

Feb 05, 2007

The present invention is directed to a method for the treatment of a patient suffering from psychiatric and behavioral disorders, including post partum depression, post traumatic stress disorder, compulsive smoking, attention deficit hyperactivity disorder, gambling addiction, comprising the step of administering a stellate ganglion block to the patient to alleviate the symptoms. The stellate ganglion block may be followed by a sympathectomy to provide permanent relief.

http://patents.justia.com/patent/20070135871

The sympathetic nervous system is responsible for the physiological responses to emotional states

The common epithet of “fight or flight” is being enlarged to be “fight, flight, or fright” or even “fight, flight, fright, or freeze.” Cannon’s original contribution was a catchy phrase to express some of what the nervous system does in response to a threat, but it is incomplete. The sympathetic system is responsible for the physiological responses to emotional states. The name “sympathetic” can be said to mean that (sym- = “together”; -pathos = “pain,” “suffering,” or “emotion”). http://cnx.org/content/m46582/latest/?collection=col11496/latest

significant associations between heart rate and regional cerebral blood flow

Neurosci Biobehav Rev. 2012 Feb;36(2):747-56. doi: 10.1016/j.neubiorev.2011.11.009. Epub 2011 Dec 8.

A meta-analysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health.

The intimate connection between the brain and the heart was enunciated by Claude Bernard over 150 years ago. In our neurovisceral integration model we have tried to build on this pioneering work. In the present paper we further elaborate our model and update it with recent results. Specifically, we performed a meta-analysis of recent neuroimaging studies on the relationship between heart rate variability and regional cerebral blood flow. We identified a number of regions, including the amygdala and ventromedial prefrontal cortex, in which significant associations across studies were found. We further propose that the default response to uncertainty is the threat response and may be related to the well known negativity bias. Heart rate variability may provide an index of how strongly 'top-down' appraisals, mediated by cortical-subcortical pathways, shape brainstem activity and autonomic responses in the body. If the default response to uncertainty is the threat response, as we propose here, contextual information represented in 'appraisal' systems may be necessary to overcome this bias during daily life. Thus, HRV may serve as a proxy for 'vertical integration' of the brain mechanisms that guide flexible control over behavior with peripheral physiology, and as such provides an important window into understanding stress and health.

http://www.ncbi.nlm.nih.gov/pubmed/22178086

Other causes of autonomic dysfunction: sympathectomy

Patients with progressive autonomic dysfunction (including diabetes) have little or no increase in plasma noradrenaline and this correlates with their orthostatic intolerance (Bannister, Sever and Gross, 1977). In patients with pure autonomic failure, basal levels of noradrenaline are lower than in normal subjects (Polinsky, 1988). Similar low values are observed in patients with sympathectomy and in patients with tetraplegia. (p.51)

The finger wrinkling response is abolished by upper thoracic sympathectomy. The test is also abnormal in some patients with diabetic autonomic dysfunction, the Guillan-Barre syndrome and other peripheral sympathetic dysfunction in limbs. (p.46)
Other causes of autonomic dysfunction without neurological signs include medications, acute autonomic failure, endocrine disease, surgical sympathectomy . (p.100)

Anhidrosis is the usual effect of destruction of sympathetic supply to the face. However about 35% of patients with sympathetic devervation of the face, acessory fibres (reaching the face through the trigeminal system) become hyperactive and hyperhidrosis occurs, occasionally causing the interesting phenomenon of alternating hyperhidrosis and Horner's Syndrome (Ottomo and Heimburger, 1980). (p.159)

Disorders of the Autonomic Nervous System

By David Robertson, Italo Biaggioni

Edition: illustrated

Published by Informa Health Care, 1995

ISBN 3718651467, 9783718651467

sympathectomy led to significant decrements in escape and avoidance responding

PsycNET - Option to Buy: "Chemical sympathectomy and avoidance learning in the rat.

By Di Giusto, E. L.; King, M. G.
Journal of Comparative and Physiological Psychology, Vol 81(3), Dec 1972, 491-500.
Abstract
Reports results of 5 experiments with male Wistar rats (N = 108). Depletion of peripheral sympathetic noradrenaline induced by administration of 6-hydroxydopamine, ip, led to significant decrements in escape and avoidance responding when the required response was difficult, but not when it was relatively easy to acquire. Results are similar to previous findings obtained with adrenal-demedullated Ss. Findings clarify the role of the sympathetic nervous system in the motivation of behavior elicited by aversive stimulation. Implications for 2-process theory and the "Kamin effect," or "learned helplessness," are discussed. (40 ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)"

Heart Rate Variability before and after the Endoscopic Transthoracic Sympathectomy in Hyperhidrosis

The etiology of primary hyperhidrosis has been speculated as "unknown" hyperactivity of the sympathetic nervous system. In our clinic, we performed endoscopic transthoracic sympathectomy(ETS) for the treatment of hyperhidrosis. In this study, we studied the cardiac autonomic nervous function using heart rate variability(HRV) before and after ETS in 70 patients with hyperhidrosis, and compared with normal control. Before ETS, high frequency(HF) power was lower in hyperhidrosis than control group, however, there was no significant difference in LF/HF. After ETS, LF/HF decreased by 31%, and lower than control. No Severe cpomplications were occurred by ETS. In conclusion, on the cardiac autonomic nervous tone, hyperhidrosis patients had the relative dominance of the sympathetic nervous tone by suppression of the parasympathetic nervous tone. 

http://sciencelinks.jp/j-east/article/200002/000020000299A0930354.php

Heart Rate Variability before and after the Endoscopic Transthoracic Sympathectomy in Hyperhidrosis.
Accession number;99A0930354
Title;Heart Rate Variability before and after the Endoscopic Transthoracic Sympathectomy in Hyperhidrosis.
Author; YOSHIDA K (Saga Medical School) UTSUNOMIYA T (Saga Medical School) HIRATA M (Saga Medical School) MOROOKA T (Saga Medical School) MATSUO A (Saga Medical School) SHIRAHAMA K (Saga Medical School) TANAKA M (Saga Medical School) HARANO K (Saga Medical School) MATSUO S (Saga Medical School)
Journal Title;Ther Res
Journal Code:Y0681A
ISSN:0289-8020 VOL.20;NO.9;PAGE.2630-2634(1999) Figure&Table&Reference;FIG.2, REF.19 Pub. Country;Japan
Language;English