Jedeikin R, Olsfanger D, Shachor D, Mansoor K
Department of Anaesthesiology and Intensive Care, Sackler School of Medicine, University of Tel Aviv, Meir Hospital, Kfar Saba, Israel.
Br J Anaesth. 1992 Oct;69(4):349-51. doi: 10.1093/bja/69.4.349.
Renewed interest has been shown in transthoracic endoscopic sympathectomy (TES) for the treatment of upper limb hyperhidrosis. We review our experience and discuss the anaesthetic technique and perioperative problems encountered in 58 patients undergoing TES for hyperhidrosis. Patients were monitored for arterial pressure, heart rate, ECG, pulse oximetry (SpO2), end-tidal carbon dioxide concentration, peak inspired airway pressure and skin temperature. General anaesthesia, with a double-lumen endobronchial tube, enabled the lungs to be collapsed alternately, thereby ensuring easy and clear access to the sympathetic chain. Controlled ventilation with 100% inspired oxygen was necessary to obviate hypoxaemia. In two patients, severe hypotension and bradycardia occurred during insufflation of carbon dioxide into the chest cavity. Four patients required underwater drainage of the pleural cavity for treatment of pneumothorax or haemothorax. The success and safety of the procedure depends on a scrupulous anaesthetic technique.
经胸交感神经内镜切除术（TES）治疗上肢多汗症已重新引起人们的关注。我们回顾了我们的经验，并讨论了58例接受TES治疗多汗症患者的麻醉技术及围手术期遇到的问题。对患者进行动脉压、心率、心电图、脉搏血氧饱和度（SpO2）、呼气末二氧化碳浓度、吸气峰气道压及皮肤温度监测。采用双腔支气管导管全身麻醉可使双肺交替萎陷，从而确保易于清晰地显露交感神经链。为避免低氧血症，需用100%的吸氧浓度进行控制通气。2例患者在向胸腔内注入二氧化碳期间出现严重低血压和心动过缓。4例患者因气胸或血胸需要胸腔闭式引流治疗。该手术的成功与安全取决于严谨的麻醉技术。
