Thorascopic sympathectomy in the treatment of palmar hyperhidrosis: Anaesthetic implications

As a result of technical advances, endoscopic surgery has become the technique of choice for many intra-abdominal and thoracic surgical procedures. The advantages of endoscopic surgery include less postoperative pain, shorter hospital admission, earlier return to normal activity and improved cosmetic result. Thorascopic surgery differs from other endoscopic procedures in that adequate surgical exposure requires collapse or retraction of the lung. Whether achieved by one-lung ventilation or carbon dioxide insufflation, these interventions may be associated with significant cardiorespiratory disturbances. In this review thorascopic sympathectomy in the treatment of palmar hyperhidrosis and related controversies are discussed. Special emphasis is placed on the anaesthetic considerations of this procedure. Finally, based on our clinical experience, recommendations are made regarding the anaesthetic of choice.