ANESTHETIC IMPLICATIONS FOR TRANSTHORACIC ENDOSCOPIC SYMPATHECTOMY

Transthoracic endoscopic sympathectomy is now considered the treatment of choice for patients with upper limb hyperhidrosis requiring sympat hetic ablation. This procedure requires the use of an endobronchial do uble lumen tube and subsequent one-lung anaesthesia, a technique that is associated with a number of potential problems. Full patient monito ring is thus required and includes pulse, ECG, non-invasive blood pres sure measurement, pulse oximetry, end-tidal carbon dioxide concentrati on and peak inspiratory airway pressure. We reviewed our anaesthetic t echnique and peri-operative complications in 26 patients, to assess pa tient safety. In our study hypoxaemia occurred commonly but was transi ent in all bar one case where reexpansion of the lung was required. Hy potension occurred at two stages of the procedure, but active interven tion was not required, and two patients required underwater drainage o f the pleural cavity for treatment of pneumothorax. With skilled anaes thetic personnel and adequate monitoring this procedure may be carried out safely.