title: Multimodal approach to rapid discharge after endoscopic thoracic sympathectomy.
abstract: BACKGROUND
  After a large experience (more than 10 years) with bilateral endoscopic thoracic sympathectomy (ETS) surgery on an outpatient basis, we studied prospectively a multimodal approach to rapid discharge patients undergoing this procedure.
  
  
  METHODS
  One hundred and seventeen consecutive patients, aged 13-60 years, ASA physical status I or II, undergoing outpatient ETS under general anaesthesia were enrolled in this study. All patients were managed using a predefined multimodal clinical care protocol consisting of a general balanced anaesthesia. Basic demographic information was collected from each patient. Duration of surgery and anaesthesia and times to PACU and home discharge were recorded as well as intraoperative and postoperative complications like nausea and vomiting.
  
  
  RESULTS
  Surgery took 41.4 +/- 22.1 min and anaesthesia lasted 63 +/- 21.5 min. Time between induction of anaesthesia and beginning of surgery and end of surgery to extubation was 15.0 +/- 2.0 and 7.2 +/- 3.1 min, respectively. It took 4.9 +/- 1.5 min from extubation to OR discharge. Time from PACU arrival to discharge was 12.8 +/- 6.3 min. Time of hospital stay was 132 +/- 18 min. No patient experienced vomiting and two had nausea, representing an incidence of 1.7%. The only anaesthetic cause for hospital admission was a severe allergic reaction.
  
  
  CONCLUSIONS
  Multimodal management to rapid discharge after ETS surgery did result in a short time to patient discharge. We confirm that endoscopic thoracic sympathectomy can be performed safely on an outpatient basis with brief postoperative hospital care and a low rate of complications.
authors.affiliation: Department of Anesthesiology, Mater Dei Hospital, Belo Horizonte, Brazil. marcoscruvinel@uai.com.br
authors.forename: M G C
authors.initials: MG
authors.lastname: Cruvinel
authors.forename: J B V
authors.initials: JB
authors.lastname: Duarte
authors.forename: C H V
authors.initials: CH
authors.lastname: Castro
authors.forename: J R R
authors.initials: JR
authors.lastname: Costa
authors.forename: P
authors.initials: P
authors.lastname: Kux
mesh_terms: D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D013562:Sympathectomy / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000932:Antiemetics