Top Tweets for #SympatheticNervousSystem
💉⚔️ RA & ANS: D. Who Really Controls Surgical Stress? - GA vs RA
#GeneralAnesthesia #RegionalAnesthesia #RAandANS #SurgicalStress #StressResponse #SympatheticNervousSystem #PerioperativeMedicine #AnesthesiaEducation #PainMedicine #NeuroendocrineResponse #AutonomicPhysiology
#TipOfTheDay #MyRATips
Tip of the Day:
🔹 Surgery is not just tissue injury.
🔹It is a neuroendocrine storm.
🔹The real question is not: “Is the patient asleep?”
🔹 It is: “Is the stress response truly controlled?”
Let’s decode 👇
1. 😴 GENERAL ANESTHESIA (GA)
⚠️ Stress is masked, not necessarily blocked
🔹 Patient unconscious
🔹 Awareness abolished
🔹 But nociceptive signals may still reach spinal cord & hypothalamus
Unless:
Deep anesthesia
High-dose opioids
Alpha-2 agonists / beta-blockers
The body may still activate:
🧠 Sympathetic nervous system
🧪 HPA axis
🔥 Adrenal catecholamine surge
📈 Physiological consequences:
➡️ Variable heart rate
➡️ Blood pressure swings
➡️ Elevated catecholamines
➡️ Increased cortisol levels
➡️ Hyperglycemia & inflammatory activation
⚠️ GA silences the MIND,
but does not automatically silence PHYSIOLOGY.
2. 🟢 REGIONAL ANESTHESIA (RA)
✨ Stress is prevented at the source
🔹 Nociceptive input blocked before reaching CNS
🔹 Dorsal horn activation reduced
🔹 Sympathetic efferent output attenuated
🔹 Adrenal catecholamine release blunted
🔹 RA interrupts the pathway before the cascade begins.
📉 Physiological consequences:
➡️ More stable hemodynamics
➡️ Lower stress hormone levels
➡️ Reduced metabolic disturbance
➡️ Improved postoperative recovery
⚠️ RA modifies PHYSIOLOGY,
not just PERCEPTION.
🚨 High spinal / extensive epidural block
If sympathetic tone is excessively suppressed:
➡️ Loss of vascular tone
➡️ Reduced adrenal compensatory response
➡️ Hypotension & bradycardia
Stress response can become too weak, not just controlled.
Balance matters.
3. ⚖️ GA + RA COMBINED
🎯 When combined intelligently, they complement each other.
🔹 RA blocks nociceptive input at the source
🔹 GA ensures unconsciousness and airway control
🔹 Lower anesthetic depth required
🔹 Reduced opioid requirement
🔹 Blunted sympathetic & hormonal surge
🔹 Improved hemodynamic stability
🔹 Enhanced recovery profile
📊 Physiological advantages:
➡️ Reduced catecholamine surge
➡️ Better BP control
➡️ Less endocrine stress activation
➡️ Lower postoperative pain scores
➡️ Decreased opioid-related side effects
⚠️ This is not COMPETITION, its strategic INTEGRATION.
🎯 TAKE HOME:
💉 RA doesn’t just provide analgesia, it rewrites the body’s stress response.
😴 GA mainly hides it.
⚖️ Together, when balanced well, they control it.

🚨🚨 RA & ANS: C. Stress Response - When the Sympathetic System Hits the Panic Button
#StressResponse #RAandANS #SympatheticNervousSystem #FightOrFlight #SympathoadrenalAxis #HPAaxis #Catecholamines #PerioperativeMedicine #AnesthesiaEducation #RegionalAnesthesia #CriticalCare #Neurophysiology #MedEd
#TipOfTheDay #MyRATips
Tip of the Day:
💥 What is the stress response?
It’s the body’s fight-or-flight reaction to pain, fear, hypovolemia, hypoxia, or surgery.
And it has TWO parallel arms 👇
1️⃣ ⚡ FAST ARM: Sympathetic–Adrenal Medulla system (SAM)
🔹 🧠 Trigger : sudden stress (pain, anxiety, laryngoscopy, blood loss)
🔹 🛣️ Pathway :
Spinal cord (T1–L2) ▶️
Thoracic splanchnic nerves ⏩
Adrenal medulla
🔹 🧪 What’s released into blood:
🧬 Epinephrine
🧬 Norepinephrine
🔹 ⏱️ Speed :Seconds (very fast)
🔹 🎯 Effects :
❤️ ↑ Heart rate & contractility
🩸 ↑ Blood pressure
🫁 Bronchodilation
🧠 ↑ alertness
🍬 ↑ Blood glucose
👉 This is the immediate survival response
2️⃣ ⏳ SLOW ARM: HPA axis (Hormonal stress response)
🔹 🧠 Hypothalamus → CRH
🔹 🧠 Pituitary → ACTH
🔹 🧠 Adrenal cortex → Cortisol
🔹 ⏱️ Time: Minutes to hours
🔹 🎯 Effects:
Maintains BP
Sustains glucose supply
Modulates inflammation
Supports prolonged stress
💉 Where RA fits in
🟢 HOW RA does well
✨ Blocks nociceptive input
✨ Reduces sympathetic outflow
✨ Blunts catecholamine surge
✨ ↓ Stress response to surgery
⚠️ But here’s the catch
❌ High spinal / epidural:
May block Peripheral sympathetic tone & Adrenal medulla input
👉 Result:
Hypotension
Bradycardia
Poor stress compensation
🟢 Why peripheral nerve blocks are safer hemodynamically
✔️ They do not block splanchnic nerves
✔️ Adrenal stress response is preserved
✔️ Better cardiovascular stability
🎯 Take Home:
🔹 The stress response has a FAST sympathetic–adrenal component and a SLOWER hormonal component.
🔹 RA modulates this response by reducing afferent pain signals and sympathetic outflow, but excessive Neuraxial blockade may abolish essential compensatory mechanisms.

⚡ RA & ANS: B. Sympathetic System & Adrenals - The Direct Hotline
#SympatheticNervousSystem #AdrenalMedulla #StressResponse #SympathoadrenalAxis #AnesthesiaEducation #RegionalAnesthesia #Neuroanatomy #PerioperativeMedicine #AutonomicNervousSystem #Catecholamines
#MyRATips #TipOfTheDay
Tip of the Day:
🧠 Key concept
The adrenal medulla is a modified sympathetic ganglion.
🛣️ How sympathetic fibers reach the adrenal gland
➡️ Origin
Preganglionic sympathetic neurons arise mainly from T5–T9 spinal segments
➡️ Exit from spinal cord
Ventral root → spinal nerve → white ramus communicans
➡️ Sympathetic chain
Fibers pass through the chain without synapsing
➡️ Splanchnic pathway
🔹 Greater splanchnic (T5–T9)
🔹Lesser splanchnic (T10–T11)
➡️ Adrenal entry
Preganglionic fibers synapse directly on chromaffin cells
🔥 What makes the adrenal medulla unique
➖ No postganglionic neuron
➖ No gray ramus
➖ No peripheral nerve travel
➡️ Preganglionic fiber → adrenal medulla → bloodstream
🧪 Neurochemical mechanism
🔹 Acetylcholine released from preganglionic fiber
🔹 Acts on nicotinic receptors
🔹 Chromaffin cells release:
➡️ Epinephrine (~80%)
➡️ Norepinephrine (~20%)
📢 Hormones enter circulation, not synapses
💉 Clinical relevance in Regional Anesthesia
➡️ Spinal / epidural anesthesia
↓ Sympathetic tone → ↓ adrenal catecholamine response → hypotension
➡️ High spinal anesthesia
Loss of both: → Peripheral sympathetic tone → Adrenal stress response
➡️ Peripheral nerve blocks
Do not affect adrenals (splanchnic nerves spared)
🎯 Take Home
➡️ Preganglionic sympathetic fibers (T5-T9) bypass the sympathetic chain and directly innervate the adrenal medulla via thoracic splanchnic nerves, making it a modified sympathetic ganglion.

🔥 RA & ANS: A. Knowing the Sympathetic System Before Blocking It
#RegionalAnesthesia #SympatheticNervousSystem #AnesthesiaEducation #NeuraxialAnesthesia #PeripheralNerveBlock #PainMedicine #RAandANS
#PerioperativeMedicine #StressResponse #AdrenalMedulla #AnatomyMatters
#TipOfTheDay #MyRATips
Tip of the Day:
Why regional anesthesia does more than just numb pain?
The sympathetic nervous system quietly travels alongside our nerves and vessels and when we perform RA, we often block it without even trying.
🧠 The Sympathetic Highway
🔹 🚦 Origin: Starts in the spinal cord from T1–L2 (thoracolumbar outflow)
🔹 🛣️ Exit route: Leaves via ventral root → spinal nerve → white ramus
🔹 🔗 Relay station: Enters the sympathetic chain. May synapse at the same level, go up/down, or pass through as splanchnic nerves
🔹 🌿 Final journey: Returns via gray ramus. Travels with peripheral nerves and blood vessels to skin, muscles, joints, and organs
🎯 One-line rule👇
White ramus = exit from spinal nerve (T1–L2 only)
Gray ramus = entry into spinal nerve (all levels)
💉 What Happens During Regional Anesthesia?
🟢 Sympathetic fibers are small, superficial, and highly sensitive to local anesthetics
➡️ They get blocked earlier and more easily than motor fibers
🌡️ Clinical Signs
✨ 🔥 Warm limb after block → sympathetic vasodilation
✨ 💧 Dry skin → sudomotor block
✨ 📉 Drop in BP after spinal/epidural → sympathetic blockade
✨ 👁️ Ptosis, miosis, warm arm → Horner’s syndrome (after stellate spread)
⛔ But Important Reality Check
⚠️ Not all pain is sympathetic pain
❌ Tourniquet pain
❌ Ischemic pain
❌ Compartment syndrome pain
👉 These persist because they involve:
🔹 Deep C-fibers & A-delta fibers 🧬
🔹 Central sensitization🧠
🔹 Multi-segmental spinal input 🔄
🔹 Ischemic chemical mediators 🧪
🔹 Blocking sympathetic efferents ≠ blocking all pain afferents🔹
🎯 Why This Matters to Us (RA Perspective):
🧩 Perfect block ≠ pain-free tourniquet
🧩 Large-volume proximal blocks feel “better”
🧩 Vasodilation happens before sensory loss
🧩 Sympathetic block is a feature, not a complication
🏁 Take-home
RA always blocks the sympathetic system but pain relief depends on much more than just sympathetic blockade.

#Axolotls regenerate limbs by activating #StemCells body-wide through the #SympatheticNervousSystem, suggesting regeneration is a coordinated, whole-body response rather than a local event. @HarvardResearch @CellCellPress https://t.co/qaT5RmprQC https://t.co/EejI0kzEgs
#Axolotls regenerate limbs by activating #StemCells body-wide through the #SympatheticNervousSystem, suggesting whole-body coordination is key to vertebrate tissue regeneration. @HarvardResearch @CellCellPress https://t.co/qaT5RmprQC https://t.co/EejI0kzEgs
Research Article by EM Gloger et al. (@Penn_State @UDelaware) Greater negative affective responsivity to #dailystressors is positively related to #urinary #norepinephrine excretion in middle-aged adults | #sympatheticnervoussystem
https://t.co/0QbW2PDRSg

New in @AJPRegu "Adrenal epinephrine facilitates erythropoietin gene activation by hypoxia through β2 adrenergic receptor interaction with Hif-2α" by Xiaoyu Su et al.
https://t.co/gpNElm5Edp
#Catecholamines #SympatheticNervousSystem #ProteinKinaseA

The sympathetic nervous system activates in response to stress or danger, but overactivation can lead to insomnia and fatigue. Relaxation techniques and deep breathing help stimulate the parasympathetic system to restore balance. #SympatheticNervousSystem

New Editorial Focus👉Does electroacupuncture reducing heart rate rebalance autonomic nervous system? by Stephanie C. Tjen-A-Looi et al.
🖱️https://t.co/aZRM2OQvqj
#Tachycardia #SympatheticNervousSystem #electroacupuncture #ChronicStress #cardiomyopathy

*️⃣FREE Article of the Week*️⃣
#Aging and sympathetic transduction to #BloodPressure in humans: methodological and physiological considerations
@BigalkeJeremy @CarterPhysiol and co-authors
🔓 https://t.co/jRVQIp9gsg
#SympatheticNervousSystem @RobbinsCollege @utarlington

A drawing of the sympathetic nervous system activating a panic attack reaction (ironic) in my Strathmore 5.5 x 8.5 Sketch sketchbook. I made this drawing while having a panic attack and feeling nauseous
#Strathmore #panicattack #nervoussystem #sympatheticnervoussystem #medicalart

#ArticlesInPress: Aging and Sympathetic Transduction to Blood Pressure in Humans: Methodological and Physiological Considerations
Bigalke ET AL
https://t.co/oibgPeWajz
@CarterPhysiol @BigalkeJeremy @EmilyLCleveland @RobbinsCollege
#Aging #SympatheticNervousSystem

#ArticlesInPress: Evidence of Impaired Functional #Sympatholysis in Patients with Heart Failure with Preserved Ejection Fraction
(Alpenglow et al.)
https://t.co/SDXpfGUkPL
@UVRLphysiology @craig_jesse @K_Bunsawat @UofUMedicine
#SympatheticNervousSystem #Exercise #HeartFailure

One of the results of #trauma & prolonged patterns of #ToxicStress is an #oversensitized #amygdala– triggering the #fight, #flight, & #freeze #response. The #SympatheticNervousSystem (SNS) runs the show when faced with a perceived #threat, physical &/or emotional.

Find out a little about anxiety and dysregulation in this blog:
https://t.co/kcm3jdI299
#anxiety #sympatheticnervoussystem #parasympatheticnervoussystem #dysregulation #dysregulatednervoussystem #safeandsoundprotocol #therapy #counselling #therapistsconnect

I believe this advert has been rescinded because of the negative response but it’s indicative of the culture and expectations of senior leaders in too many schools.
#burnout #edutwitter #stress #sympatheticnervoussystem https://t.co/cFUBJqbsaJ
How to work with Shutdown vs. Freeze – with Ruth Lanius, MD, PhD https://t.co/QFudd9P4jg via @YouTube #trauma #collapse #shutdown #arousal #fight #flight #sympatheticnervoussystem #parasympathetic #thebody #sensoryprocessing
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