Hemodynamics following endoscopic thoracic sympathotomy for palmar hyperhidrosis.
OBJECTIVE
We studied patients with palmar hyperhidrosis before and after endoscopic thoracic sympathotomy (ETS) to determine the effect of chronic sympathetic denervation on (1) forearm blood flow (FBF) response to mental stress and (2) exercise tolerance.


RESULTS
Twenty-two healthy patients were evaluated before ETS, and 17 returned after surgery (11 F; 19-32 years). We measured heart rate (HR; 12 lead), blood pressure, and FBF (plethysmography, ml dl(-1) min(-1)). Supine HR tended to decrease after ETS (69 ± 10 vs. 66 ± 6, p = 0.2). Mental stress FBF was recorded during baseline, 3-min Stroop color word test, and 2-min recovery. Mental stress responses were unaffected by ETS. However, during post-mental stress recovery period, ETS resulted in a significant elevation in FBF (2 ± 1 vs. 3 ± 1), FVC (3 ± 1 vs. 4 ± 2), and a decrease in FVR (52 ± 22 vs. 32 ± 16, p < 0.01 for all). ETS resulted in a reduction in pre-exercise seated baseline HR (94 ± 2.5 beats/min preoperatively vs. 84 ± 4.3 beats/min postoperatively, p < 0.05), maximal HR response to cycle exercise, and exercise systolic blood pressure (172 ± 5.2 mmHg pre-op vs. 158 ± 5.9 mmHg post-op, p < 0.05) but not mean or diastolic pressure. VO(2)max and exercise duration determined by cycle ergometry was unchanged.


CONCLUSIONS
Functional evidence of upper limb denervation is observed during the FBF recovery period from mental stress and hemodynamic alterations associated with upright cycle exercise. However, the sustained exercise capacity suggests modest clinical consequences.
Wehrwein
Erica A
EA
Department of Anesthesia Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Schmidt
John E
JE
Elvebak
Rachel L
RL
Pike
Tasha L
TL
Atkinson
John L D
JL
Fealey
Robert D
RD
Eisenach
John H
JH
D000293:Adolescent; D000328:Adult; D017704:Baroreflex / Q000502:physiology; D004724:Endoscopy; D005080:Exercise Test; D005260:Female; D005542:Forearm / Q000098:blood supply; D006225:Hand / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006945:Hyperhidrosis / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D011184:Postoperative Period; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D013315:Stress, Psychological / Q000503:physiopathology; D057190:Stroop Test; D013562:Sympathectomy; D014664:Vasodilation / Q000502:physiology; D055815:Young Adult