Department of Anesthesia, Apollo Hospital, E 348, Greater Kailash Part One, New Delhi 110048, India.
Surg Endosc. 2013 Aug;27(8):2868-76. doi: 10.1007/s00464-013-2843-5. Epub 2013 Feb 13.
Endoscopic thoracic sympathectomy (ETS) is now an established surgical technique for treatment of palmar hyperhidrosis that is performed under general anesthesia with positive pressure ventilation via either an endotracheal tube or a double lumen endobronchial tube. This is a bilateral disease that requires the division of the right and left thoracic sympathetic chain. The aim of this study was to compare the hemodynamic changes using a left capnothorax first versus right a capnothorax first surgical approach using a single lumen endotracheal tube in patients undergoing bilateral ETS. Lung collapse was achieved by carbon dioxide insufflation.
Forty patients of both sexes aged 18-30 years and of American Society of Anesthesiologists grade I were randomly assigned to undergo bilateral ETS. Patients were divided into two groups. Group L comprised left capnothorax first, followed by right capnothorax (n = 20). Group R comprised right capnothorax first, followed by left capnothorax (n = 20). The anesthesia technique was standardized for all patients. Cardiovascular variables were determined during the procedure every minute. Statistical analysis was performed by independent-sample t test and Pearson's chi-square test.
There was a significant (P < 0.05) mean percentage decrease in systolic blood pressure in group L compared to group R. Similarly, the mean percentage decrease in diastolic blood pressure in group L was significant compared to group R (P < 0.05). Seven patients in group L developed bradycardia, but this was not found to be statistically significant.
When the left capnothorax first approach was used, there was significant hypotension, compared to a right capnothorax first thoracoscopy. We thus recommend that right capnothorax should be performed first in cases of bilateral ETS.
胸腔镜胸交感神经切除术（ETS）现已成为治疗手掌多汗症的一种既定手术技术，手术在全身麻醉下进行，通过气管内管或双腔支气管内管进行正压通气。这是一种双侧疾病，需要对右侧和左侧胸交感神经链进行分割。本研究的目的是比较在使用单腔气管内管进行双侧 ETS 时，首先进行左侧气胸与首先进行右侧气胸的手术方法对血流动力学变化的影响。通过二氧化碳充气实现肺萎陷。
40 名年龄在 18-30 岁之间的男女患者，美国麻醉医师协会（ASA）分级 I 级，随机分为两组，行双侧 ETS。患者分为两组。L 组为左侧气胸先行，然后进行右侧气胸（n = 20）。R 组为右侧气胸先行，然后进行左侧气胸（n = 20）。所有患者的麻醉技术均标准化。在手术过程中，每 1 分钟测量心血管变量。采用独立样本 t 检验和 Pearson's chi-square 检验进行统计学分析。
与 R 组相比，L 组的收缩压平均百分比下降有显著差异（P < 0.05）。同样，L 组的舒张压平均百分比下降与 R 组相比也有显著差异（P < 0.05）。L 组有 7 名患者出现心动过缓，但无统计学意义。
与首先进行右侧气胸的胸腔镜相比，首先进行左侧气胸时，血压显著降低。因此，我们建议在进行双侧 ETS 时，应首先进行右侧气胸。
