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Continuing Education in Anaesthesia, Critical Care & Pain Advance Access originally published online on March 4, 2009
Continuing Education in Anaesthesia, Critical Care & Pain 2009 9(2):52-55; doi:10.1093/bjaceaccp/mkp003
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Anaesthesia for endoscopic thoracic sympathectomy

Alastair Martin, MB ChB FRCA
Specialist Registrar
Department of Anaesthesia
Plymouth Hospitals NHS Trust
Crownhill
Plymouth
Devon PL6 8DH
UK

Richard Telford, BSc (Hons) MB BS FRCA
Consultant Anaesthetist
Royal Devon and Exeter Hospital
Barrack Road
Exeter
Devon EX2 5DW
UK
Tel: +44 1392 402475 Fax: +44 1392 402472 E-mail: richard.telford@rdeft.nhs.uk

The first 150 words of the full text of this article appear below.


   History and indications
 

Key points

Endoscopic thoracic sympathectomy (ETS) involves division of the thoracic sympathetic chain between T2 and T4.
The main indication for ETS is the treatment of palmar hyperhidrosis.
The most common method of anaesthesia for ETS uses intermittent positive pressure ventilation via a standard tracheal tube.
Perioperative risks are low, but complications can be devastating.
Postoperative compensatory sweating occurs in almost 50% of patients.

 

Open cervicothoracic cord ganglionectomy was originally performed for Raynaud’s disease and acrocyanosis. Surgical approaches (transthoracic, transaxillary, supraclavicular, and dorsal) were gross and mutilating and associated with a stormy convalescence. Open sympathectomy was almost invariably associated with postoperative Horner’s syndrome.

In 1942, Hughes1 reported the first endoscopic thoracic sympathectomy (ETS). In 1954, Kux2 reported his experience of more than 1400 procedures. However, ETS remained a rare operation until the introduction of video endoscopic techniques into surgery in the 1980s.

The main indication for ETS is palmar hyperhidrosis. . . . [Full Text of this Article]


   Anatomical and surgical considerations
 

   Surgical procedure
 

   Anaesthetic considerations
 
Preoperative assessment

Monitoring

Anaesthetic technique

Intraoperative period

Postoperative period


   Mortality, morbidity, and outcomes
 
Anaesthetic complications

Immediate surgical complications

Postoperative complications


   Conclusions
 

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