Anesth Analg 2005;100:269-276
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000139934.15659.7F
GENERAL ARTICLES
A Comparison of Peripheral Skin Blood Flow and Temperature During Endoscopic Thoracic Sympathotomy
John H. Eisenach, MD*,
Tasha L. Pike*,
Diane E. Wick*,
Niki M. Dietz, MD*,
Robert D. Fealey, MD ,
John L. D. Atkinson, MD , and
Nisha Charkoudian, PhD
Departments of *Anesthesiology,
Neurology,
Neurosurgery,
and Physiology, Mayo Clinic College of Medicine, Rochester, Minnesota
Address correspondence and reprint requests to John H. Eisenach, MD, Mayo Clinic, Department of Anesthesiology, 200 First St. S.W., Rochester, MN 55905. Address e-mail to eisenach.john{at}mayo.edu
The assessment of sympathetic denervation to the upper extremities during surgery for hyperhidrosis is essential in predicting postoperative outcome, particularly for endoscopic thoracic chain sympathotomy, a recently described, minimally destructive technique that minimizes postoperative compensatory hyperhidrosis. To test the hypothesis that skin blood flow (SkBF; laser Doppler flowmetry) provides a faster and more reliable indication of denervation than temperature (temp), we prospectively compared palmar SkBF and fingertip temp in 10 patients undergoing endoscopic thoracic chain sympathotomy for essential hyperhidrosis. From baseline to peak values, palmar SkBF (mean ± SEM) increased 273.3 ± 24.7 arbitrary units and 252.4 ± 30.1 arbitrary units, whereas temp increased 0.9°C ± 0.3°C and 1.5°C ± 0.6°C on the right and left, respectively. Upon effective sympathotomy of the right thoracic chain, the time to peak SkBF was 43 ± 13 s, whereas the time to peak temp was 277 ± 53 s (P < 0.001). On the left, the time to peak SkBF was 81 ± 14 s, and time to peak temp was 305 ± 34 s (P < 0.001). All patients considered the sympathotomy successful. We conclude that laser Doppler SkBF is superior to temp in temporal resolution for assessment of denervation during sympathotomy and that it provides a superior qualitative and quantitative adjunct to monitoring denervation.
IMPLICATIONS: Termed sympathotomy, endoscopic surgical disconnection of the sympathetic chain to the upper extremities is an effective therapy for people affected with excessive sweating of the hands. Success relies on intraoperative monitoring of denervation, which can be determined rapidly by monitoring skin blood flow with laser Doppler flowmetry.
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