Video-assisted Thoracic Surgery Sympathectomy under Monitored Anesthesia Care and Local Analgesia for the Treatment of Palmar Hyperhidrosis without Endotracheal Intubation: A Randomized Controlled Trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIELiang ¹ , CHENGang ¹ , WANGQing ² , CUICan ² , YEXiong ¹ , ZHANGDong-kun ¹ , ZHOUZi-hao ¹ , TANGJi-ming ¹ , BENXiao-song ¹ , WANGGang ² , LINWen-liang ¹ , MAOYu-hong ¹

1. Department of Thoracic Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou 510080, P. R. China;
2. Department of Anesthesiology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou 510080, P. R. China;

Corresponding?author：

Keywords：

Palmar hyperhidrosis; Video-assisted thoracic surgery sympathectomy; Monitored anesthesia care; Local anesthesia; Fast track recovery surgery; Randomized controlled trial

DOI：

10.7507/1007-4848.20140005

Video：

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Objective To investigate the feasibility, safety and effectiveness of video-assisted thoracic surgery (VATS) sympathectomy under monitored anesthesia care (MAC) and local anesthesia (LA) without endotracheal intubation as a new fast track recovery surgical strategy for the treatment of palmar hyperhidrosis. Methods A total of 124 patients with intermediate or severe hyperhidrosis who were admitted to Guangdong General Hospital were enrolled in this study. With SPSS18 random number generator, all the patients were divided into MAC+LA group and general anesthesia (GA) group with 62 patients in each group. There were 43 males and 19 females in MAC+LA group with their age of 22.25±6.22 years, and 42 males and 20 females in GA group with their age of 23.98±6.67 years. During the surgery, MAC+LA group patients received MAC and oxygen via nasal tube or face mask instead of endotracheal intubation, and GA group patients received GA, endotracheal intubation and controlled ventilation. Clinical outcomes were compared between the 2 groups. Results All the patients received their operations safely. None of MAC+LA group patients received conversion to GA and controlled ventilation. There was statistical difference in operation time (47.18±12.06 minutes vs. 39.33±13.21 minutes, P=0.002) and length of theatre stay 84.52±22.56 minutes vs. 134.68±26.12 minutes, P=0.000) between MAC+LA and GA group patients. There was no statistical difference in blood loss, incidence of intraoperative SpO₂ lower than 95% (2 patients vs. 0 patient), postoperative hospital stay, incidence of postoperative compensatory sweating (86.5% vs. 89.0%) and patient satisfaction rate (94.59% vs.95.12%) between the 2 groups. No intraoperative pain, postoperative complication or symptom recurrence was observed in either group. There was statistical difference in anesthetic preparation time (20.52±10.55 minutes vs. 36.47±12.16 minutes), duration between operation finish and returning to ward (11.26±7.09 minutes vs. 59.39±19.89) minutes and hospitalization cost (RMB 6 376.86±746.00 yuan vs. RMB 8 812.04±867.93 yuan) between the 2 groups. The incidence of postoperative sore throat (0% vs. 100%), monitor time (4 hours vs. 12 hours) and time to resume oral intake (2 hours vs. 6 hours) of MAC+LA group were significantly lower or shorter than those of GA group. Conclusion VATS sympathectomy under MAC and LA can avoid complications of GA and endotracheal intubation, and provide a safe, feasible, effective and more minimally invasive fast track alternative for the treatment of palmar hyperhidrosis.

Citation： XIELiang, CHENGang, WANGQing, CUICan, YEXiong, ZHANGDong-kun, ZHOUZi-hao, TANGJi-ming, BENXiao-song, WANGGang, LINWen-liang, MAOYu-hong. Video-assisted Thoracic Surgery Sympathectomy under Monitored Anesthesia Care and Local Analgesia for the Treatment of Palmar Hyperhidrosis without Endotracheal Intubation: A Randomized Controlled Trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(1): 11-16. doi: 10.7507/1007-4848.20140005 Copy

1.	涂遠榮, 楊劼, 劉彥國.中國手汗癥微創治療專家共識.中華胸心血管外科雜志, 2011, 27 (8):449-451.
2.	Chen JS, Hsu HH, Kuo SW, et al.Needlescopic versus conventional video-assisted thoracic surgery for primary spontaneous pneumothorax:a comparative study.Ann Thorac Surg, 2003, 75 (4):1080-1085.
3.	Smith I, Taylor E.Monitored anesthesia care.Int Anesthesiol Clin, 1994, 32 (3):99-112.
4.	Wilmore DW, Kehlet H.Recent advances:Management of patients in fast track surgery.BMJ, 2001, 322 (7284):473-476.
5.	Cerfolio RJ, De Campos JR, Bryant AS, et al.The society of thoracic surgeons expert consensus for the surgical treatment of hyperhidrosis.Ann Thorac Surg, 2011, 91 (5):1642-1648.
6.	Freixinet J L, Rodríguez P M.Fast track in thoracic surgery.Asian Cardiovasc Thorac Ann, 2008, 16 (3):187-188.
7.	許勝水, 段明科, 吳藝根, 等.二孔法胸腔鏡下T3胸交感神經鏈切斷術治療手汗癥(附52例報告).中國微創外科雜志, 2010, 10 (6):499-500.
8.	Bouma W, Klinkenberg TJ, Mariani MA.Bilateral single-port thoracoscopic sympathectomy with the VasoView device in the treatment of palmar and axillary hyperhidrosis.Interact Cardiovasc Thorac Surg, 2011, 12 (2):106-109.
9.	Scognamillo F, Serventi F, Attene F, et al.T2-T4 sympathectomy versus T3-T4 sympathicotomy for palmar and axillary hyperhidrosis.Clinical Autonomic Research, 2011, 21 (2):97-102.
10.	Kim WO, Kil HK, Yoon KB, et al.Influence of T3 or T4 sympathicotomy for palmar hyperhidrosis.Am J Surg, 2010, 199 (2):166-169.
11.	張文斌, 林高翔, 杜振宗, 等.不同氣管插管在電視胸腔鏡胸交感神經切斷術中的應用.中國內鏡雜志, 2009, 15 (6):604-606, 609.
12.	郭濤, 韓哲, 蘇莉, 等.喉罩通氣在胸腔鏡胸交感神經鏈切斷術中的臨床研究.心肺血管病雜志, 2012, 31 (3):315-317.
13.	Al-Abdullatief M, Wahood A, Al-Shirawi N, et al.Awake anaesthesia for major thoracic surgical procedures:an observational study.Eur J Cardiothorac Surg, 2007, 32 (2):346-350.
14.	Elia S, Guggino G, Mineo D, et al.Awake one stage bilateral thoracoscopic sympathectomy for palmar hyperhidrosis:a safe outpatient procedure.Eur J Cardiothorac Surg, 2005, 28 (2):312-317.
15.	郭紹紅, 王晶晶.麻醉學監護下的局部麻醉胸腔鏡胸交感神經阻斷術114例.中國內鏡雜志, 2012, 18 (1):21-25.
16.	賈向波, 錢如林, 李向陽, 等.局部麻醉下電視胸腔鏡手術治療手汗癥.中國胸心血管外科臨床雜志, 2010, 17 (5):35.
17.	Jeong JY, Park HJ.Sympathicotomy under local anesthesia:a simple way to treat primary hyperhidrosis.Ann Thorac Surg, 2010, 90 (5):1730-1731.
18.	李增玉, 耿清勝, 賀聿國, 等.腰硬聯合麻醉下婦科腹腔鏡手術中呼吸末二氧化碳濃度監測.實用醫學雜志, 2007, 23 (18):2871-2872.
19.	李簡, 王曉新, 賀鋼楓, 等.局麻下經電視胸腔鏡肺腫物切除術.中國腫瘤臨床, 2001, 28 (6):428-430.
20.	Tejedor A, Anglada MT, Pons M, et al.Outpatient or short-stay videothoracoscopy-assisted thoracic sympathectomy:anesthesia in 445 cases.Rev Esp Anestesiol Reanim, 2010, 57 (9):553-558.

1. 涂遠榮, 楊劼, 劉彥國.中國手汗癥微創治療專家共識.中華胸心血管外科雜志, 2011, 27 (8):449-451.
2. Chen JS, Hsu HH, Kuo SW, et al.Needlescopic versus conventional video-assisted thoracic surgery for primary spontaneous pneumothorax:a comparative study.Ann Thorac Surg, 2003, 75 (4):1080-1085.
3. Smith I, Taylor E.Monitored anesthesia care.Int Anesthesiol Clin, 1994, 32 (3):99-112.
4. Wilmore DW, Kehlet H.Recent advances:Management of patients in fast track surgery.BMJ, 2001, 322 (7284):473-476.
5. Cerfolio RJ, De Campos JR, Bryant AS, et al.The society of thoracic surgeons expert consensus for the surgical treatment of hyperhidrosis.Ann Thorac Surg, 2011, 91 (5):1642-1648.
6. Freixinet J L, Rodríguez P M.Fast track in thoracic surgery.Asian Cardiovasc Thorac Ann, 2008, 16 (3):187-188.
7. 許勝水, 段明科, 吳藝根, 等.二孔法胸腔鏡下T3胸交感神經鏈切斷術治療手汗癥(附52例報告).中國微創外科雜志, 2010, 10 (6):499-500.
8. Bouma W, Klinkenberg TJ, Mariani MA.Bilateral single-port thoracoscopic sympathectomy with the VasoView device in the treatment of palmar and axillary hyperhidrosis.Interact Cardiovasc Thorac Surg, 2011, 12 (2):106-109.
9. Scognamillo F, Serventi F, Attene F, et al.T2-T4 sympathectomy versus T3-T4 sympathicotomy for palmar and axillary hyperhidrosis.Clinical Autonomic Research, 2011, 21 (2):97-102.
10. Kim WO, Kil HK, Yoon KB, et al.Influence of T3 or T4 sympathicotomy for palmar hyperhidrosis.Am J Surg, 2010, 199 (2):166-169.
11. 張文斌, 林高翔, 杜振宗, 等.不同氣管插管在電視胸腔鏡胸交感神經切斷術中的應用.中國內鏡雜志, 2009, 15 (6):604-606, 609.
12. 郭濤, 韓哲, 蘇莉, 等.喉罩通氣在胸腔鏡胸交感神經鏈切斷術中的臨床研究.心肺血管病雜志, 2012, 31 (3):315-317.
13. Al-Abdullatief M, Wahood A, Al-Shirawi N, et al.Awake anaesthesia for major thoracic surgical procedures:an observational study.Eur J Cardiothorac Surg, 2007, 32 (2):346-350.
14. Elia S, Guggino G, Mineo D, et al.Awake one stage bilateral thoracoscopic sympathectomy for palmar hyperhidrosis:a safe outpatient procedure.Eur J Cardiothorac Surg, 2005, 28 (2):312-317.
15. 郭紹紅, 王晶晶.麻醉學監護下的局部麻醉胸腔鏡胸交感神經阻斷術114例.中國內鏡雜志, 2012, 18 (1):21-25.
16. 賈向波, 錢如林, 李向陽, 等.局部麻醉下電視胸腔鏡手術治療手汗癥.中國胸心血管外科臨床雜志, 2010, 17 (5):35.
17. Jeong JY, Park HJ.Sympathicotomy under local anesthesia:a simple way to treat primary hyperhidrosis.Ann Thorac Surg, 2010, 90 (5):1730-1731.
18. 李增玉, 耿清勝, 賀聿國, 等.腰硬聯合麻醉下婦科腹腔鏡手術中呼吸末二氧化碳濃度監測.實用醫學雜志, 2007, 23 (18):2871-2872.
19. 李簡, 王曉新, 賀鋼楓, 等.局麻下經電視胸腔鏡肺腫物切除術.中國腫瘤臨床, 2001, 28 (6):428-430.
20. Tejedor A, Anglada MT, Pons M, et al.Outpatient or short-stay videothoracoscopy-assisted thoracic sympathectomy:anesthesia in 445 cases.Rev Esp Anestesiol Reanim, 2010, 57 (9):553-558.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Video-assisted Thoracic Surgery Sympathectomy under Monitored Anesthesia Care and Local Analgesia for the Treatment of Palmar Hyperhidrosis without Endotracheal Intubation: A Randomized Controlled Trial

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