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Pain and Epidural

Treatment of hyperhidrosis by transthoracic endoscopic sympathectomy: 016

Gomar, C.; Roux, C.; Jiménez, M. J.; Callejas, M. A.; Fita, G.; Rovira, I.; Matute, P.

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European Journal of Anaesthesiology: June 2004 - Volume 21 - Issue - p 17-18
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Introduction: Endoscopic transthoracic sympatectomy (SYMP) is a treatment for palmar hyperhidrosis and blush [1]. The aim of our study is to present our experience in the anaesthesic management and surgical outcome.

Method: We studied 315 patients with hyperhidrosis and blush. All patients were undergoing bilateral thoracoscopy with general anaesthesia using a total intravenous technique and one lung ventilation for the first 144 patients and tracheal intubation for the last 171 patients. We do not use CO2. ECG, non-invasive arterial pressure, SpO2 and end-tidal CO2 were monitored. We also monitored the temperature (T°) in both hands to check the efficiency of the SYMP. An increase in palmar T° of more than 1°C was considered evidence of a successful sympathectomy. Temperature of the hands was recorded after anaesthesia induction (Basal); before T2 sympathectomy (Pre); and at 10 and 20 min. post-sympathectomy (10′ and 20′ Post). An intercostal block with 20 mL of bupivacaine 0.5% was made before surgery, to best control postoperative pain.

Results: The average T° increase was about 3°C post-SYMP (see Table 1). All patients were extubated in the operating room. No intraoperative anaesthetic complications were recorded. Two patients (0.6%) required assisted thoracotomy for pleural adhesions. Three patients (0.9%) had a haemothorax and four patients (1.3%) developed chest wall discomfort and needed analgesia treatment for more than one week. Two more patients (0.6%) had a temporary palpebral ptosis. One patient (0.3%) developed a chylothorax, requiring pleural drainage for six days. The mean stay in the hospital was 1.4 days. Only two patients (1.4%) developed compensatory sweating and four patients (1.3%) continued to sweating. Table 2 shows patients' satisfaction regarding surgery results.

Table 1
Table 1:
Temperature changes in both hands.
Table 2
Table 2:
Patients' satisfaction regarding surgery results.

Conclusions: In our study, hand T° monitoring detected SYMP effectiveness. The rate of complications was low but significant. Patient satisfaction was good. The follow-up is still short.

Reference:

1 Nicholson ML, Dennis MJ, Hopkinson BR. Endoscopic transthoracic sympathectomy: successful in hyperhidrosis but can the indications be extended. Ann R Coll Surg Engl 1994; 76; 311-314.
© 2004 European Society of Anaesthesiology