Hemodynamics following endoscopic thoracic sympathotomy for palmar hyperhidrosis

Abstract

Purpose We studied patients with palmar hyperhidrosis before and after endoscopic thoracic sympathotomy (ETS) to determine the effect of chronic sympathetic denervation on 1) forearm blood flow (FBF) response to mental stress and 2) exercise tolerance. Methods and Results 22 healthy patients were evaluated before ETS, and 17 returned after surgery (11 F; 19–32 yr). We measured heart rate (HR; 12-lead), blood pressure, and FBF (plethysmography, ml/100ml forearm volume/min). Supine HR tended to decrease after ETS (69 ± 10 vs 66 ± 6, p=0.2). Mental stress FBF was recorded during baseline, 3 min Stroop Color Word test, and 2 min recovery. Mental stress responses were unaffected by ETS. However during post-mental stress recovery period, ETS resulted in a significant elevation in FBF (2 ± 1 vs 3 ± 1), FVC (3 ± 1 vs 4 ± 2), and a decrease in FVR (52 ± 22 vs 32 ± 16, p < 0.01 for all). ETS resulted in a reduction in pre-exercise seated baseline HR (94 ± 2.5 beats/min preoperatively vs 84 ± 4.3 beats/min post-operatively, p<0.05), maximal HR response to cycle exercise, and exercise systolic blood pressure (172 ± 5.2 mmHg pre-op vs 158 ± 5.9 mmHg postop, p<0.05) but not mean or diastolic pressure. VO2 max and exercise duration determined by cycle ergometry was unchanged. Conclusions Functional evidence of upper limb denervation is observed during the FBF recovery period from mental stress and hemodynamic alterations associated with upright cycle exercise. However, the sustained exercise capacity suggests modest clinical consequences.

Increased ischemia-modified albumin and malondialdehyde levels in videothoracoscopic surgery

“…Decrease in heart rate and vascular resistance is observed after sympathectomy since sympathetic cardiac nerves extend from the upper thoracic chain. [ 4 ] Moreover, a decrease is observed in end-diastolic pressure and arterial pressure, as well. [ 5 ] CO 2 infusion is applied into intrapleural cavity and lungs are collapsed during this operation.…”