Anesthetic Procedure for Left Thoracic Sympathectomy under Thoracoscope in Long QT Syndrome Patients_West China Medical Journal

Authors：

 ZhangHuiying ,  HouGuanghui , HeQiyue

Department of Anaesthesia, Benq Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210019, P. R. China;

Corresponding?author：

HouGuanghui, Email: mike.hou@benqmedicalcenter.com

Keywords：

Long QT syndrome; Left thoracic sympathectomy; Arrhythmia; Anesthetic procedure

DOI：

10.7507/1002-0179.20160070

Video：

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Objective To discuss the anesthetic procedure for left thoracic sympathectomy under thoracoscope for long QT syndrome patients. Methods We selected 8 patients with long QT syndrome classified American Society of Anesthesiologists Ⅱ-Ⅲ who were going to undergo left thoracic sympathectomy under thoracoscope between July 2011 and October 2014 as our study subjects. They were given a moderate amount of beta blockers before operation, inducted with 0.1 mg/kg midazolam, 3-6 μg/kg fentanyl, 2-4 mg/kg propofol, 0.3-0.6 mg/kg cis-atracurium, and maintained with propofol 1-4 mg/(kg·h) combined with 0.025-2.000 μg/(kg·min) fentanyl. We recorded the mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO₂) and airway peak pressure, and end-tidal carbon dioxide before anesthesia induction (T₀), at endotracheal intubation (T₁), during artificial lung-collapse when surgery initiated (T₂), 5 minutes after surgery initiation (T₃), 15 minutes after surgery initiation (T₄), during artificial lung-collapse at the end of surgery (T₅) and during extubation (T₆). Results When compared with T₀, T₂ got a higher MAP, T₃ and T₄ had a slower HR (P<0.05), but all were within a normal range. All the patients showed little change in airway peak pressure and end-tidal carbon dioxide during the surgery with no statistically significant difference (P>0.05). Conclusion Proper anesthetic procedure for left thoracic sympathectomy under thoracoscope for long QT syndrome patients can reduce the incidence of perioperative malignant arrhythmia.

Citation： ZhangHuiying, HouGuanghui, HeQiyue. Anesthetic Procedure for Left Thoracic Sympathectomy under Thoracoscope in Long QT Syndrome Patients. West China Medical Journal, 2016, 31(2): 258-261. doi: 10.7507/1002-0179.20160070 Copy

1.	方俊標, 駱曉攀, 周冰, 等. 先天性QT間期延長綜合征病人左側胸交感神經離斷術的麻醉處理[J]. 中華麻醉學雜志, 2005, 25(10):788.
2.	胡大一, 李翠蘭, 王樂信, 等. 經胸腔鏡行左側心交感神經切除術治療長QT綜合征[J]. 中國心臟起搏與心電生理雜志, 2002, 16(3):174-177.
3.	陳彩霞, 張宏艷. 先天性長Q-T間期綜合征基因診斷的研究進展[J]. 國外醫學:兒科學分冊, 2004, 31(2):57-59.
4.	Juang JJ, Chen CY,Yeh HM, et al. Clinical characteristics of patients with congenital long QT syndrome and bigenic mutations[J]. Chin Med J (Engl), 2014, 127(8):1482-1486.
5.	Liu WL, Hu DY, Li CL, et al. Mutation analysis of Potassium Channel genes KCNQ1 and KCNH2 in patients with long QT syndrome[J]. Chin Med J (Engl), 2003, 116(9):1333-1335.
6.	劉洋, 戴琳, 張遠恒, 等. 維拉帕米減少2型長 QT 綜合征楔形心肌塊模型跨室壁復極離散度并預防尖端扭轉型室速[J]. 中國藥理學與毒理學雜志, 2014(4):503-509.
7.	李翠蘭, 胡大一, 劉文玲, 等. 普萘洛爾對21例長QT綜合征的臨床療效觀察[J]. 中國心臟起搏與心電生理雜志, 2003, 17(6):412-415.
8.	Mandal B, Kaur G, Batra YK, et al. Manifestation of long QT syndrome with normal QTc interval under anesthesia:a case report[J]. Paediatr Anaesth, 2011, 21(12):1265-1267.
9.	王家和, 王惠軍, 成文聰. Q-T間期延長綜合征患者的全身麻醉[J]. 臨床麻醉學雜志, 2009, 25(6):490-492.
10.	謝言虎, 方才, 馬冬春, 等. 單孔電視胸腔鏡下手汗癥患者胸交感神經節切斷術麻醉管理[J]. 安徽醫科大學學報, 2010, 45(3):393-395.
11.	中華醫學會心血管病學分會心律失常學組, 中華心血管病雜志編輯委員會. 中國心臟起搏與心電生理雜志編輯委員會等.獲得性長QT間期綜合征的防治建議[J]. 中華心血管病雜志, 2010, 38(11):961-969.
12.	戴國峰, 田新民, 蔣仲敏, 等. 胸腔鏡胸交感神經切斷術病人舒芬太尼復合異丙酚麻醉的效果[J]. 中華麻醉學雜志, 2008, 28(7):594-596.
13.	趙建英, 林健清, 林財珠, 等. 胸腔鏡下胸交感神經干切斷術治療手汗癥250例的麻醉體會[J]. 中國內鏡雜志, 2007, 13(7):697-699.
14.	李翠蘭, 胡大一, 史旭波, 等. 長QT綜合征患者運動試驗特征及左心交感神經切除術的影響[J]. 中華心血管病雜志, 2004, 32(增刊1):82-84.
15.	歐偉明, 劉洪珍, 王漢兵, 等. 手汗癥患者電視縱隔鏡下胸交感神經切斷術的麻醉處理[J]. 中國內鏡雜志, 2011, 17(11):1187-1189.
16.	李劍鋒, 王俊, 胡大一, 等. 經胸腔鏡切除左胸交感神經治療先天性QT間期延長綜合征[J]. 中華外科雜志, 2003, 41(9):660-661.
17.	Saussine M, Massad I, Raczka F, et al. Torsade de pointes during sevoflurane anesthesia in a child with congenital long QT syndrome[J]. Paediatr Anaesth, 2006, 16(1):63-65.
18.	Wang L, Feng G. Left cardiac sympathetic denervation as the first-line therapy for congenital long QT syndrome[J]. Med Hypotheses, 2004, 63(3):438-441.

1. 方俊標, 駱曉攀, 周冰, 等. 先天性QT間期延長綜合征病人左側胸交感神經離斷術的麻醉處理[J]. 中華麻醉學雜志, 2005, 25(10):788.
2. 胡大一, 李翠蘭, 王樂信, 等. 經胸腔鏡行左側心交感神經切除術治療長QT綜合征[J]. 中國心臟起搏與心電生理雜志, 2002, 16(3):174-177.
3. 陳彩霞, 張宏艷. 先天性長Q-T間期綜合征基因診斷的研究進展[J]. 國外醫學:兒科學分冊, 2004, 31(2):57-59.
4. Juang JJ, Chen CY,Yeh HM, et al. Clinical characteristics of patients with congenital long QT syndrome and bigenic mutations[J]. Chin Med J (Engl), 2014, 127(8):1482-1486.
5. Liu WL, Hu DY, Li CL, et al. Mutation analysis of Potassium Channel genes KCNQ1 and KCNH2 in patients with long QT syndrome[J]. Chin Med J (Engl), 2003, 116(9):1333-1335.
6. 劉洋, 戴琳, 張遠恒, 等. 維拉帕米減少2型長 QT 綜合征楔形心肌塊模型跨室壁復極離散度并預防尖端扭轉型室速[J]. 中國藥理學與毒理學雜志, 2014(4):503-509.
7. 李翠蘭, 胡大一, 劉文玲, 等. 普萘洛爾對21例長QT綜合征的臨床療效觀察[J]. 中國心臟起搏與心電生理雜志, 2003, 17(6):412-415.
8. Mandal B, Kaur G, Batra YK, et al. Manifestation of long QT syndrome with normal QTc interval under anesthesia:a case report[J]. Paediatr Anaesth, 2011, 21(12):1265-1267.
9. 王家和, 王惠軍, 成文聰. Q-T間期延長綜合征患者的全身麻醉[J]. 臨床麻醉學雜志, 2009, 25(6):490-492.
10. 謝言虎, 方才, 馬冬春, 等. 單孔電視胸腔鏡下手汗癥患者胸交感神經節切斷術麻醉管理[J]. 安徽醫科大學學報, 2010, 45(3):393-395.
11. 中華醫學會心血管病學分會心律失常學組, 中華心血管病雜志編輯委員會. 中國心臟起搏與心電生理雜志編輯委員會等.獲得性長QT間期綜合征的防治建議[J]. 中華心血管病雜志, 2010, 38(11):961-969.
12. 戴國峰, 田新民, 蔣仲敏, 等. 胸腔鏡胸交感神經切斷術病人舒芬太尼復合異丙酚麻醉的效果[J]. 中華麻醉學雜志, 2008, 28(7):594-596.
13. 趙建英, 林健清, 林財珠, 等. 胸腔鏡下胸交感神經干切斷術治療手汗癥250例的麻醉體會[J]. 中國內鏡雜志, 2007, 13(7):697-699.
14. 李翠蘭, 胡大一, 史旭波, 等. 長QT綜合征患者運動試驗特征及左心交感神經切除術的影響[J]. 中華心血管病雜志, 2004, 32(增刊1):82-84.
15. 歐偉明, 劉洪珍, 王漢兵, 等. 手汗癥患者電視縱隔鏡下胸交感神經切斷術的麻醉處理[J]. 中國內鏡雜志, 2011, 17(11):1187-1189.
16. 李劍鋒, 王俊, 胡大一, 等. 經胸腔鏡切除左胸交感神經治療先天性QT間期延長綜合征[J]. 中華外科雜志, 2003, 41(9):660-661.
17. Saussine M, Massad I, Raczka F, et al. Torsade de pointes during sevoflurane anesthesia in a child with congenital long QT syndrome[J]. Paediatr Anaesth, 2006, 16(1):63-65.
18. Wang L, Feng G. Left cardiac sympathetic denervation as the first-line therapy for congenital long QT syndrome[J]. Med Hypotheses, 2004, 63(3):438-441.

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Anesthetic Procedure for Left Thoracic Sympathectomy under Thoracoscope in Long QT Syndrome Patients

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