A number of different anesthetic techniques have been described to facilitate surgical access for patients undergoing bilateral thoracoscopic sympathectomy (BTS). Most common are general anesthesia with a double-lumen tube (DLT) or a single-lumen tube (SLT) with insufflation of CO2. The goal of this study was to compare clinical advantages and hemodynamic and respiratory changes during two different techniques of ventilation: one lung-collapsed ventilation (OLCV) using a double-lumen tube (DLT) or a single-lumen tube (SLT) with apneic oxygenation, by applying 3 – 5 cm H2O continuous positive airways pressure (CPAP).
Key words: Thoracoscopic sympathectomy, Anesthetic techniques, Endo-tracheal intubation, Apneic oxygenation, Endobronchial
One thousand four hundred and twenty-six patients underwent BTS for the treatment of palmar hyperhidrosis (PH) at the Clinic for Thoracic surgery, the Institute for pulmonary diseases of Vojvodina, Sremska Kamenica, between 2008 and 2016. Out of all operated patients, study included 698 patients. Patients were divided into two groups: group A (n=133) underwent thoracoscopic sympathectomy using DLT, and group B (n=565) underwent thoracoscopic sympathectomy through Semi-Fowler supine position (semi sitting with arm abducted) using SLT with CPAP. Each patient was premedicated with IM midazolam and Atropine 30 min before entering the operating room. Anesthesia was induced with IV propofol. Muscle relaxation was achieved with rocuronium, and the trachea was intubated with a double-lumen tracheal tube in group A and single lumen tube in group B. Anesthesia was maintained with Propofol and incremental doses of fentanyl when required and 100% oxygen. In both groups, we have monitored the following parameters: continuous monitoring of electrocardiogram (ECG), noninvasive arterial blood pressure, arterial oxygen saturation (SpO2) determined by pulse oximeter; and end-tidal CO2, depth of anesthesia (BIS method), operation and apneic time.
There were no significant differences in hemodynamic and respiratory parameters between the two groups during the study phases, except for the arterial oxygen saturation (SpO2). The time required for anesthesia and surgery were significantly shorter in the SLT group than in the DLT group. For group A average operation time for both sides was 31.2±3.87 min and for group B average time was 14.19±4.98 min. In group B apnea period per one lung lasted 2.86±1.15 min. SpO2 during OLCV was 95±1% with DLT and 92.65%±2% with SLT.
General anesthesia with SLT and CPAP for BTS without insufflation of CO2 provides optimal operating conditions, adequate oxygenation, and perfect hemodynamic stability during BTS.
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