Olsfanger D, Jedeikin R, Fredman B, Shachor D
Department of Anaesthesia and Intensive Care, Meir Hospital, Kfar Saba, Israel.
Br J Anaesth. 1995 Feb;74(2):141-4. doi: 10.1093/bja/74.2.141.
When using endobronchial anaesthesia for the management of transthoracic endoscopic sympathectomy (TES), excessive insufflation of carbon dioxide into the pleural space may cause haemodynamic instability, hypoxaemia and tension pneumothorax. We prospectively studied an alternative technique using a tracheal tube, i.v. fentanyl, propofol, atracurium and nitrous oxide in 82 consecutive healthy patients (31 male, 51 female; mean age 26.48 (range 14-50) yr, weight 61.26 (33-100)kg.) They were suffering from severe palmar hyperhidrosis and they underwent bilateral TES (mean duration of operation 34.57 (15-90) min). After being placed in a 30-40 degree head-up position, three patients required ephedrine to treat arterial hypotension. A capnograph was used to confirm correct placement of the Verres needle in the pleural space. In two groups of 13 patients undergoing ventilation with an FlO2 of either 0.3 or 0.4, during partial collapse of the operative lung, PaO2 and the PaO2:FlO2 ratio decreased significantly (P < 0.001). TES was unsuccessful in three patients because of pleural adhesions. After operation five patients required chest drains; two for haemothorax and three for pneumothorax. Seventy-seven patients without complications were discharged from hospital within 24 h.
在使用支气管内麻醉管理经胸内镜交感神经切除术（TES）时，向胸膜腔内过度注入二氧化碳可能会导致血流动力学不稳定、低氧血症和张力性气胸。我们前瞻性地研究了一种替代技术，对82例连续的健康患者（31例男性，51例女性；平均年龄26.48岁（范围14 - 50岁），体重61.26 kg（33 - 100 kg））使用气管导管、静脉注射芬太尼、丙泊酚、阿曲库铵和氧化亚氮。这些患者患有严重的手掌多汗症，均接受了双侧TES（平均手术时间34.57分钟（15 - 90分钟））。将患者置于头高位30 - 40度后，3例患者需要麻黄碱来治疗动脉低血压。使用二氧化碳监测仪确认Verres针在胸膜腔内的正确位置。在两组分别为13例的患者中，当分别使用0.3或0.4的吸入氧分数进行通气时，在手术侧肺部分萎陷期间，动脉血氧分压（PaO2）和PaO2:吸入氧分数比值显著下降（P < 0.001）。3例患者因胸膜粘连导致TES手术失败。术后5例患者需要胸腔引流；2例因血胸，3例因气胸。77例无并发症的患者在24小时内出院。
