RESUMO
Thoracoscopic approach to sympathetic surgery has gained its popularity and emerged as the main stream in the treatment of hyperhidrosis palmaris in Taiwan. Different kinds of anesthesia have been practiced and reported in these surgeries. We made a survey of anesthetic methods in twelve medical centers and regional hospitals of the island. It was found out that the choice of the anesthesia was mainly dependent on the mutual trust and the full communication between the anesthesiologist and the surgeon, both based on their skills and the operative methods chosen by the surgeon. Single-lumen endotracheal tube with general inhalation anesthesia is practiced in most of the hospitals surveyed. Sevoflurane and desflurane are the choices of the inhalational anesthetic agents. In short, the anesthesiologists tend to practice the type of anesthesia that is simple but safe enough to secure the airway of the patient throughout the thoracoscopic sympathetic surgery.
Assuntos
Anestesia/tendências , Mãos/inervação , Hiperidrose/cirurgia , Simpatectomia , Toracoscopia , Anestesia por Inalação , Desflurano , Humanos , Isoflurano/análogos & derivados , Éteres Metílicos , Sevoflurano , Inquéritos e Questionários , TaiwanRESUMO
A patient with angina pectoris who had been successfully treated by thoracoscopic cardiac sympathectomy was scheduled to have scalp debridement under general anaesthesia for a scald burn. There were haemodynamic changes during and after the operation including anaesthetic induction, endotracheal intubation, maintenance, and early recovery period. The sympathetic denervated heart showed little chronotropic response to anaesthetic and surgical stimulation. On the contrary, the parasympathetic response was predominant. An episode of severe bradycardia occurred during endotracheal suctioning prior to extubation. The haemodynamic response to cardiac sympathetic denervation corresponded to the efferent effect of beta-receptor blockade