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British Journal of Anaesthesia, 1992, Vol. 69, No. 4 349-351
© 1992 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

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

R. JEDEIKIN, B.SC., M.B. CH.B., F.F.A.(S.A.), D. OLSFANGER, M.B., CH.B.,, D. SHACHOR, M.D. and K. MANSOOR, M.D.

Department of Anaesthesiology and Intensive Care Kfar Saba, Israel
Department of Surgery A Kfar Saba, Israel
Sackler School of Medicine, University of Tel Aviv, Meir Hospital Kfar Saba, Israel

Address for correspondence: Department of Anaesthesia and Intensive Care, Meir Hospital, Kfar Saba, Israel.

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.


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