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.