Intraoperative anaesthetic management of hypoxaemia during transthoracic endoscopic sympathectomy.

Objective: To present our experience and evaluate intraoperative arterial oxygen desaturation during anaesthesia for transthoracic endoscopic sympathectomy (TES).

Design: Prospective open study.

Setting: University Hospital in Israel.

Subjects: Consecutive series of patients (n = 210), suffering from upper limb hyperhidrosis, anaesthetised for TES.

Main Outcome Measures: Peripheral oxygen saturation (SpO2), haemodynamic status, complications, postoperative pain (n = 210) and arterial blood gases (n = 10).

Results: 407 TES; 195 bilateral, 17 unilateral. Surgical time range 20-75 minutes. SpO2 decreased below 98% in 58 patients. Sudden hypotension and bradycardia in two patients. The mean PaO2 was significantly (p = 0.03) decreased during two-lung ventilation (TLV), after reinflation of the right lung, compared with TLV after endobronchial intubation. There was no significant difference in mean PaO2 during one-lung ventilation of both lungs. Lowest PaO2 observed during one-lung ventilation was less than 13.3 kPa in three sympathectomies. Postoperative pain, severe on awakening and mainly retrosternal, was relieved with i.v. opiates.

Conclusion: Controlled ventilation with 100% inspired O2, SpO2 monitoring and one to two gentle manual ventilations when it decreases is the cornerstone of the management of hypoxaemia, a potentially serious complication of TES.