Non-intubated anesthesia as a practice of enhanced recovery after surgery in endoscopic thoracic sympathectomy for primary hyperhidrosis

Abstract

Objective To investigate the application of non-intubated anesthesia (NIA) in endoscopic thoracic sympathectomy (ETS) for patients with primary hyperhidrosis (PH), and to promote the practice of enhanced recovery after surgery(ERAS) in ETS. Methods Methods 37 patients with PH undergone bilateral ETS were retrospectively analyzed. The patients were divided into NIA group (n=12) and intubated group (n=25); the right thoracic sympathetic nerve was cut off firstly at T3 level, and then the left thoracic sympathetic nerve at T4 level for all patients. Routine monitoring and palm temperature monitoring were arranged, and mean arterial pressure (MAP), heart rate (HR) and oxygen saturation (SpO2) were recorded at four different time points as t1(before anesthesia), t2(when the right T3 was cut), t3(when the left T4 was cut) and t4(after surgery). Different indexes were compared between the two groups, such as anesthesia time, operation time, postoperative hospital stay, postoperative VAS, postoperative complications and the total cost of hospitalization. Results There was no significant difference in MAP, HR and SpO2 between the two groups at the same time point (P> 0.05). There was no significant difference in the operation time between the two groups (P> 0.05). The palm temperature gradually increased after ETS by (1.6-2.9) ℃, an average of (2.2±0.6) ℃. Patients in NIA group had a shorter anesthesia time, less postoperative hospital stay, less VAS score and postoperative complications (P<0.05). The cost of hospitalization was significantly lower in NIA group than those of intubated group (P <0.05). Conclusions The application of NIA in the bilateral ETS has the advantages of less injury, more comfortable postoperative experience, faster postoperative recovery, shorter hospitalization time and less hospitalization cost, in accordance with the concept of ERAS. Key words: Non-intubated anesthesia; Primary hyperhidrosis; Enhanced recovery after surgery; Endoscopic thoracic sympathectomy