Lumbar Sympathetic Block: Paramedian Approach

1. The changes of peripheral venous plasma renin concentration (PRC) induced by head-up tilting were studied in four patients with orthostatic hypotension. 2. Two of the patients had the Holmes—Adie syndrome and tests of autonomic function suggested that they had an afferent block from baroreceptors with intact efferent pathways; the others had no evidence of the Holmes—Adie syndrome and investigations suggested that they had interruption of efferent sympathetic pathways. 3. In the two patients in whom lesions of the afferent side of baroreceptor reflexes were suspected, a marked increase in PRC occurred with upright tilting, whereas no change in PRC occurred in the two patients thought to have an efferent sympathetic block. 4. During repeated tilting, supine blood pressure and PRC increased progressively in the two patients with suspected afferent block, but not in the two patients with suspected efferent block. 5. It is suggested that an increase in plasma renin may contribute to the supine hypertension sometimes observed in patients with orthostatic hypotension. 6. It is also suggested that renin release does not require intact autonomic reflexes although certain components of efferent sympathetic pathways, not dependent on baroreceptor reflexes, may be important.

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Chemical Lumbar Sympathetic Block in the Treatment of Plantar Hyperhidrosis: A Study of 69 Patients

Dermatologic Surgery ◽

10.1111/j.1524-4725.2008.34286.x ◽

2008 ◽

Vol 34 (10) ◽

pp. 1340-1345 ◽

Cited By ~ 4

Author(s):

WON OAK KIM ◽

KYUNG BONG YOON ◽

HAE KEUM KIL ◽

DUCK ME YOON

Keyword(s):

Sympathetic Block

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Thoracic sympathetic block reduces respiratory system compliance

Sao Paulo Medical Journal ◽

10.1590/s1516-31802007000100003 ◽

2007 ◽

Vol 125 (1) ◽

pp. 9-14 ◽

Cited By ~ 5

Author(s):

Fábio Ely Martins Benseñor ◽

Joaquim Edson Vieira ◽

José Otávio Costa Auler Júnior

Keyword(s):

Chest Wall ◽

Respiratory System ◽

Lung Resection ◽

Lung Compliance ◽

Airway Hyperreactivity ◽

Sympathetic Block ◽

Respiratory System Compliance ◽

Double Blind ◽

Thoracic Epidural ◽

Student’S T

CONTEXT AND OBJECTIVE: Thoracic epidural anesthesia (TEA) following thoracic surgery presents known analgesic and respiratory benefits. However, intraoperative thoracic sympathetic block may trigger airway hyperreactivity. This study weighed up these beneficial and undesirable effects on intraoperative respiratory mechanics. DESIGN AND SETTING: Randomized, double-blind clinical study at a tertiary public hospital. METHODS: Nineteen patients scheduled for partial lung resection were distributed using a random number table into groups receiving active TEA (15 ml 0.5% bupivacaine, n = 9) or placebo (15 ml 0.9% saline, n = 10) solutions that also contained 1:200,000 epinephrine and 2 mg morphine. Under general anesthesia, flows and airway and esophageal pressures were recorded. Pressure-volume curves, lower inflection points (LIP), resistance and compliance at 10 ml/kg tidal volume were established for respiratory system, chest wall and lungs. Student’s t test was performed, including confidence intervals (CI). RESULTS: Bupivacaine rose 5 ± 1 dermatomes upwards and 6 ± 1 downwards. LIP was higher in the bupivacaine group (6.2 ± 2.3 versus 3.6 ± 0.6 cmH2O, p = 0.016, CI = -3.4 to -1.8). Respiratory system and lung compliance were higher in the placebo group (respectively 73.3 ± 10.6 versus 51.9 ± 15.5, p = 0.003, CI = 19.1 to 23.7; 127.2 ± 31.7 versus 70.2 ± 23.1 ml/cmH2O, p < 0.001, CI = 61 to 53). Resistance and chest wall compliance showed no difference. CONCLUSION: TEA decreased respiratory system compliance by reducing its lung component. Resistance was unaffected. Under TEA, positive end-expiratory pressure and recruitment maneuvers are advisable.

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