TOTAL INTRAVENOUS ANESTHESIA AND HIGH-FREQUENCY JET VENTILATION DURING TRANSTHORACIC ENDOSCOPIC SYMPATHECTOMY FOR TREATMENT OF ESSENTIAL HYPERHIDROSIS PALMARIS - A NEW APPROACH

Objective: To evaluate the effects of high-frequency jet ventilation ( HFJV) applied to both lungs on hemodynamic parameters, oxygenation, an d operating conditions during bilateral videothoracoscopic sympathecto my. Design: A prospective, unblinded study. Setting: An ambulatory sur gical unit at a university medical center. Participants: 80 patients ( 11 men, 19 women), ASA status I. Intervention: Bilateral videothoracos copic sympathectomies were performed using total intravenous anesthesi a with propofol, alfentanil, and atracurium, and the patients were ven tilated with an oxygen-air mixture using HFJV delivered to both lungs with a Hi-Lo Jet tracheal tube (Mallinckrodt). Measurements and Main R esults: Mean total anesthesia time was 55 +/- 13 minutes. Hemodynamic parameters remained stable during surgery, although ablation of the sy mpathetic ganglia induced three incidences of bradycardia (10% of the patients), which were responsive to atropine. Four patients developed oxygen desaturation (Sa O-2 <90%) after the creation of the pneumothor ax. Surgical conditions were considered excellent by the surgeons. Con cerning postoperative complications, a temporary Horner's syndrome was observed in one patient. Another patient had a mild residual pneumoth orax on the first postoperative day that resolved without insertion of a chest tube. Conclusions: It was concluded that HFJV applied to both lungs is an easy and safe anesthetic technique that provides excellen t surgical conditions and causes a minor incidence of morbidity. Copyr ight (C) 1996 by W.B. Saunders Company