Use of a single lumen endotracheal tube and continuous CO2 insufflation in transthoracic endoscopic sympathectomy.
BACKGROUND
Transthoracic endoscopic sympathectomy (TES) is an accepted standard surgical treatment for palmar hyperhidrosis. For anesthetic management, a double lumen endobronchial tube is usually used to deflate the lung on the operative side. Recently we have applied continuous insufflation of carbon dioxide (CO2) into the pleural cavity to merely compress one lung while ventilating both lungs with a conventional single lumen endotracheal tube.


METHODS
We have studied 45 patients (ASA I and II) who underwent bilateral TES, Thirty-three were ventilated by single lumen tube and the other 12 by double lumen endobronchial tube with one lung ventilation. In both groups I and II, CO2 was insufflated slowly through the scope to a intrapleural pressure of 20 cm H2O. Both lungs were ventilated with peak pressure of less than 20 cmH2O at tidal volume of 5-12 ml/kg at 10-16 beats/min.


RESULTS
In these patients, no CO2 retention was noted. Oxygenation and cardiovascular stability were maintained and there were no complications. In the double lumen series, we found that oxygen saturation was less uniform and less stable than those in the single lumen series.


CONCLUSIONS
It is concluded that the use of single lumen endotracheal tube with continuous insufflation of CO2 in TES is easy, simple and safe.
Wong
R Y
RY
Department of Anesthesiology, Chang-Gung Memorial Hospital, Taiwan, R.O.C.
Fung
S T
ST
Jawan
B
B
Chen
H J
HJ
Lee
J H
JH
D000293:Adolescent; D000328:Adult; D002245:Carbon Dioxide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D011031:Pneumothorax, Artificial; D013562:Sympathectomy / Q000379:methods*; D013906:Thoracoscopy
D002245:Carbon Dioxide