THORACIC SYMPATHECTOMY: SEDATION EXPERIENCE
DOI:
https://doi.org/10.48729/pjctvs.11Abstract
Introduction/Study Goals: Thoracic sympathectomy is considered to be the most effective treatment for hyperhidrosis, a procedure traditionally performed under general anesthesia. Nowadays it’s a minimally invasive procedure, which makes it possible to perform under sedation with local anesthesia. The goal in this study was to assess the efficacy and safety of this anesthetic technique in video-assisted thoracic sympathectomy.
Material and Methods: The study took place in Centro Hospitalar Universitário Lisboa Norte, between June 2017 and September 2019. The anesthetic technique consisted in a propofol infusion titrated to achieve a moderate to deep sedation, in addition to local anesthesia with lidocaine 2% and ropivacaine 0,75% on surgical incisions. All patients were assessed subsequently for pain and anesthetic or surgical complications, with a 30-day follow-up.
Results: From a final sample of 63 patients, most were female (70%), with age ranging between 15 and 57 years old. There were no intra-operative complications. On the immediate postoperative period there were only two cases of poorly controlled pain.
Conclusion: Results showed efficiency and safety with sedation associated with local anaesthesia as an anaesthetic technique for video-assisted thoracic sympathectomy. This anaesthetic approach avoids possible complications associated with general anaesthesia and one lung ventilation, with good analgesic efficacy. However, there is still the need for a bigger sample to confirm the obtained results and to strengthen sedation as an anesthetic approach in thoracic sympathectomy.
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References
Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results. Vannucci F, Araújo JA. 2017, J Thorac Dis, Vol. 9 (Suppl 3), pp. S178-S192. doi: 10.21037/jtd.2017.04.04 .
Single-port endoscopic thoracic sympathectomy with monitored anesthesia care: a more promising procedure for palmar hyperhidrois. Ning Y, Wang Y, Tao X, et al. 2015, World J Surg, Vol. 39 (9), pp. 2269-2273.
One stage bilateral endoscopic sympathectomy under local anesthesia: Is a valid procedure for treatment of palmar hyperhidrosis? Awad MS, Elzeftawy A, Mansour S, Elshelfa W. 2010, Vol. 6, pp. 11-5.
The pathophysiology of cervical and upper thoracic sympathectic surgery. Hasmonai M, Kopelman D. 2003, Clin Auton Res, Vol. 13, pp. 140-4.
Video-assisted thoracic surgery utilizing local anesthesia and sedation: 384 consecutive cases. Katlic MR, Factor MA. 2010, Ann Thorac Surg, Vol. 90(1), pp. 240-245. DOI: 10.1016/j.athoracsur.2010.02.113.
State of the art and perspectives in non-intubated thoracic surgery. E., Pompeo. 2014, Ann Transl Med, Vol. 2(11), p.106. doi: 10.3978/j.issn.2305-5839.2014.10.01 .
Simpatectomía torácica bilateral R3 - R4 en um paciente sedado non intubado. JM., Mier-Odriozola. 2016, Gac Med Mex, Vol. 152, pp. 228-230.
Recomendações Portuguesas para a profilaxia e tratamento das nauseas e vómitos no pós-operatório em cirurgia de ambulatório. Vieira V, Marcos A, Patuleia D, Pinto J e Lança F. 2011, Revista Portuguesa de Anestesiologia, Vol. 20(2), pp.11-17.
