GKD Anest Yoð Bak Dern Derg. 2015; 21(3): 142-146 | DOI: 10.5222/GKDAD.2015.142

Anesthetic Management Of Thoracic Sympathectomy Surgery: Retrospective Clinical Trial

Ahmet Selim Özkan¹, Hakký Ulutaþ², Muharrem Uçar¹, Mustafa Said Aydoðan¹, Feray Erdil¹, Muhammed Reha Çelik², Mahmut Durmuþ^1
1Inonu University Medical School Department Of Anesthesiology And Reanimation
²Inonu University Medical School Department Of Thoracic Surgery

INTRODUCTION: Thoracic sympathectomy is a simple and reliable method in the treatment of primary hyperhidrosis and some vascular diseases. Sympathectomy applications performed before thoracotomy are done with thoracoscopic procedure with video-assisted minimally invasive surgical techniques. In this retrospective study, we aimed to present the anesthetic management of thoracic sympathectomy performed on 84 patients.
METHODS: It was included 84 patients in the study perfomed thoracic sympathectomy in between 1999-2014 after obtaining ethical approval. Information about the patient were obtained from patient files and anesthesia records.
RESULTS: The average age of patients treated thoracic sympathectomy were 23.65 ± 6.93, 51(60.7%) were female and 33(39.3%) male. The average operative time was recorded as 86.01±42.31 minutes. Surgery was scheduled because of 64(76.2%) of the patients for hyperhidrosis, 13 (15.5%) of the patinets for Raynaud's syndrome and 7(8.3%) of the patinets for reflex sympathetic dystrophy. Surgical techniques were applied in 11 patients(13.2%) with open thoracotomy, 17(20.2%) patients with uniport VATS and 56(66.6%) patients with 3-port VATS. No complication was observed in 73(86.9%) patient, pneumothorax in the early postoperative period was seen in 8(9.5%) patients, prolonged air leak in 2(2.4%) patients, and transient paresthesia on foot in 1(1.2%) patient. The average discharge time was recorded as 3: 02 ± 2: 42 day.
DISCUSSION AND CONCLUSION: In Conclusion, in this group of considered low risk patients should also be careful in terms for postoperative complications and intraoperative management declined complications, mortality and morbidity rates, analgesic drug requirement and duration of the operation depending on the developments in surgical procedures in thoracic sympathectomy application.

Keywords: Video-assisted Thoracoscopic Surgery, sympathectomy, postoperative analgesia

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Torasik Sempatektomi Cerrahisinde Anestezi Yönetimi: Retrospektif Klinik Araþtýrma

Ahmet Selim Özkan¹, Hakký Ulutaþ², Muharrem Uçar¹, Mustafa Said Aydoðan¹, Feray Erdil¹, Muhammed Reha Çelik², Mahmut Durmuþ^1
1Ýnönü Üniversitesi Týp Fakültesi Anesteziyoloji Ve Reanimasyon Anabilim Dalý
²Ýnönü Üniversitesi Týp Fakültesi Göðüs Cerrahisi Anabilim Dalý

GÝRÝÞ ve AMAÇ: Torasik sempatektomi, primer hiperhidrozis ve bazý vasküler hastalýklarýn tedavisinde uygulanan basit ve güvenilir bir yöntemdir. Daha önce torakotomi ile yapýlan sempatektomi uygulamalarý, artýk minimal invazif cerrahi teknik olan video-yardýmlý torakoskopik yöntemle yapýlmaktadýr. Bu retrospektif çalýþmada, torasik sempatektomi uygulanan 84 hastanýn anestezi yönetimini sunmayý amaçladýk.
YÖNTEM ve GEREÇLER: Etik kurul onayý alýndýktan sonra 1999-2014 yýllarý arasýnda torasik sempatektomi uygulanan 84 hasta çalýþmaya dahil edildi. Hastalar ile ilgili bilgiler hasta dosyasý ve anestezi kayýtlarýndan elde edildi.
BULGULAR: Torasik sempatektomi uygulanan hastalarýn yaþ ortalamasý 23,65±6.93 idi, 51'i (%60.7) kadýn 33'ü (%39.3) erkekti. Operasyon süresi ortalama 86.01±42.31 dakika olarak kaydedildi. Hastalarýn 64'üne(%76.2) hiperhidrozis, 13'üne(%15.5) raynaud sendromu ve 7'sine(%8.3) refleks sempatik distrofi nedeniyle cerrahi planlandý. Cerrahi teknik olarak hastalarýn 11'ine(%13.2) açýk torakotomi, 17'sine(%20.2) uniport VATS ve 56'sýna(%66.6) 3-port VATS uygulandý. 73(%86.9) hastada komplikasyon görülmezken 8(%9.5) hastada postoperatif erken dönemde pnömotoraks, 2(%2.4) hastada uzamýþ hava kaçaðý ve 1(%1.2) hastada ayakta geçici parestezi görüldü. Ortalama taburcu süresi 3.02±2.42 gün olarak kaydedildi.
TARTIÞMA ve SONUÇ: Sonuç olarak, cerrahi yöntemlerdeki geliþmelere baðlý olarak torasik sempatektomi uygulamalarýndaki komplikasyon, mortalite ve morbidite oranlarý, analjezik ilaç ihtiyacý ve operasyon süreleri azalsa da düþük riskli kabul edilen bu hasta grubunda intraoperatif yönetim ve postoperatif komplikasyonlar açýsýndan dikkatli olunmalýdýr.

Anahtar Kelimeler: Video yardýmlý torakoskopik cerrahi, sempatektomi, postoperatif analjezi

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