ANAESTHESIA FOR TRANSTHORACIC ENDOSCOPIC SYMPATHECTOMY IN THE TREATMENT OF UPPER LIMB HYPERHIDROSIS

• Published in: British journal of anaesthesia : BJA Vol. 69; no. 4; pp. 349 - 351
• Main Authors: JEDEIKIN, R., OLSFANGER, D., SHACHOR, D., MANSOOR, K.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.10.1992; Oxford University Press
• Subjects: Adolescent; Adult; Anaesthesia; Anaesthetic techniques; Anesthesia; Anesthesia depending on patient's condition; Anesthesia, General - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arm; Biological and medical sciences; Child; Electrocoagulation - methods; endobronchial; Endoscopy; Female; Humans; Hyperhidrosis - surgery; Male; Medical sciences; Middle Aged; Postoperative Complications; Prospective Studies; Surgery; Sympathectomy - methods; thoracic; Thorax; transthoracic endoscopic sympathectomy; Anaesthesia; Anaesthetic techniques; endobronchial; thoracic; transthoracic endoscopic sympathectomy; Surgery; Human; Skin disease; Hyperhidrosis; Treatment; Sympathectomy; General anesthesia; Upper limb; Endoscopy; Thoracoscopy; Sweat gland disease
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/69.4.349

Renewed interest has been shown in transthoracic endoscopic sympathectomy (TES) for the treatment of upper limb hyperhidrosis. We review our experience and discuss the anaesthetic technique and perioperative problems encountered in 58 patients undergoing TES for hyperhidrosis. Patients were monitored for arterial pressure, heart rate, ECG, pulse oximetry (Spo, end-tidal carbon dioxide concentration, peak inspired airway pressure and skin temperature. General anaesthesia, with a double-lumen endobronchial tube, enabled the lungs to be collapsed alternately, thereby ensuring easy and clear access to the sympathetic chain. Controlled ventilation with 100% inspired oxygen was necessary to obviate hypoxaemia. In two patients, severe hypotension and bradycardia occurred during insufflation of carbon dioxide into the chest cavity. Four patients required underwater drainage of the pleural cavity for treatment of pneumothorax or haemothorax. The success and safety of the procedure depends on a scrupulous anaesthetic technique.