Right vs left side thoracoscopic sympathectomy: Effects of CO2 insufflation on haemodynamics

Background and Aims: Currently, few reports of the haemodynamic impact of i ntrapleural CO, insufflation in the clinical setting are available. Therefo re, we conducted the present study to compare the haemodynamic changes betw een right and left side thoracoscopic sympathectomy (TS) for treatment of p almar hyperhidrosis (PH) under general anaesthesia. Materials and Methods: 20 adult patients (17 males) undergoing TS were rand omly allocated to two groups (each 10); group A, right side and group B, le ft side TS procedures were performed under general anaesthesia with single- lumen endotracheal tube. Besides the routine monitoring of vital signs, non -invasive cardiac output monitor (NICO) was used to record the stroke volum e (SV), cardiac output (CO) and cardiac index (CI). Intrapleural CO2 insuff lation was used. Anaesthesia was maintained with 1 MAC sevoflurane in 50 % nitrous oxide in oxygen with incremental doses of sufentanil and atracurium when required. Haemodynamic parameters were obtained every 3 min then aver aged over the time of surgery at phases; 1) after tracheal intubation, II) after CO2 insufflation and III) after CO2 deflation. Results: The CO, CI and SV showed decreased trend in both groups during pha se II compared to phase I with significant differences (P < 0.05). Comparin g the CO and Cl variables revealed lower values in group A compared to grou p B but with non-significant differences (P > 0.05). While the SV variable showed significant low value in group A compared to group B (P < 0.05). Conclusions: Compared to left side TS, direct compression by CO2 against th e venae cava and right atrium and ventricle during right side TS caused red uction of the venous return and hence low CO, Cl and SV.