Continuous ganglionic blockade is being used increasingly to help manage ventricular tachydysrhythmias. The purpose of this chapter is to discuss the physiologic and anatomic basis of ventricular tachydysrhythmias in detail that are mediated by the sympathetic nervous system and to discuss appropriate indications for the use of sympathetic ganglion blocks. These blocks can be instituted as both destination and bridging therapeutic options to control these dysrhythmias. These blocks therefore have value in the heart failure patient population since they offer a means of controlling the dysrhythmias that can be devastating to an already compromised myocardium.
Peripheral neuropathic pain presents one of the greatest on going challenges to both acute and chronic pain management yet our understanding of the origins and pathogenesis of this complex disease state are severely lacking. The purpose of this chapter is to review the current literature regarding neuropathic pain as impacted by hemodynamic alterations. Because of the varied origins of neuropathy, this cannot be discussed as a single entity but we can seek to identify a final common pathway. We will for this reason examine each known pathogenetic category of neuropathy separately then discuss the effect of hemodynamic alterations through changes in blood pressure to determine any correlations between these alterations and specific effects upon neural structure and function. We have divided this chapter into sections which describe the more commonly known and encountered neuropathies. These are diabetes mellitus, neurotoxic medications, alcohol-related neuropathy, Vitamin B12 deficiency, end-stage renal disease, inflammatory bowel disease, and rheumatoid arthritis.
Part of the book: Blood Pressure