Intraoperative anaesthetic management of hypoxaemia during transthoracic endoscopic sympathectomy.
OBJECTIVE
To present our experience and evaluate intraoperative arterial oxygen desaturation during anaesthesia for transthoracic endoscopic sympathectomy (TES).


METHODS
Prospective open study.


METHODS
University Hospital in Israel.


METHODS
Consecutive series of patients (n = 210), suffering from upper limb hyperhidrosis, anaesthetised for TES.


METHODS
Peripheral oxygen saturation (SpO2), haemodynamic status, complications, postoperative pain (n = 210) and arterial blood gases (n = 10).


RESULTS
407 TES; 195 bilateral, 17 unilateral. Surgical time range 20-75 minutes. SpO2 decreased below 98% in 58 patients. Sudden hypotension and bradycardia in two patients. The mean PaO2 was significantly (p = 0.03) decreased during two-lung ventilation (TLV), after reinflation of the right lung, compared with TLV after endobronchial intubation. There was no significant difference in mean PaO2 during one-lung ventilation of both lungs. Lowest PaO2 observed during one-lung ventilation was less than 13.3 kPa in three sympathectomies. Postoperative pain, severe on awakening and mainly retrosternal, was relieved with i.v. opiates.


CONCLUSIONS
Controlled ventilation with 100% inspired O2, SpO2 monitoring and one to two gentle manual ventilations when it decreases is the cornerstone of the management of hypoxaemia, a potentially serious complication of TES.
Jedeikin
R
R
Department of Anaesthesia and Intensive Care, Sackler School of Medicine, University of Tel Aviv, Meir Hospital, Kfar Saba, Israel.
Olsfanger
D
D
Shachor
D
D
D000293:Adolescent; D000328:Adult; D000758:Anesthesia / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D000860:Hypoxia / Q000209:etiology / Q000628:therapy*; D007431:Intraoperative Complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial; D013562:Sympathectomy; D013906:Thoracoscopy