부산대학교 도서관

In the past year we had 36 patients operated for transthoracic endoscopic sympathectomy to treat palmar hyperhidrosis. The first group composed of 17 patients receiving anesthesia with double-lumen endobronchial-tube ventilation from July-92 to April-93, and the second group composed of 19 patients receiving anesthesia with laryngeal mask ventilation from April-93 to August-93. During right lung collapse for sympathectomy, the first group patients' SaO_2 (oxygen saturation) decreased from 99.65 ± 0.62 mmHg (pre-operation) to 95.12 ± 5.48 mmHg (at cauterization), 95.24 ± 5.41 mmHg (5 minutes after cauterization) and resumed 99.53 ± 0.62 mmHg after the procedure completed. During left lung collapse for left side sympathectomy, the same group patients' SaO_2 decreased from 99.59 ± 0.62 mmHg to 97.35±3.06 mmHg, 97.82±2.53 mmHg and resumed 99.65 ± 0.49 mmHg respectively. The second group using laryngeal mask ventilation had SaO_2 changes during right side sympathectomy from 99.68 ± 0.58 mmHg (pre-cauterization) to 99.74±0.45 mmHg (when cauterization), 99.79 ± 0.42 mmHg (5 minutes after cauterization) and resumed 99.84±0.37 mmHg after the procedure completed. During left side sympathectomy the second group patients' SaO_2 changed from 99.84±0.39 mmHg to 99.42± 1.50 mmHg, 99.47 ± 1.46 mmHg and resumed 99.74±0.59 mmHg respectively. After 2-Way ANOVA with repeated measures of the SaO_2 value, we could see that no matter what side operation, there were differences existed between these two group (＜0.001). After further analysis, we could attribute these differences to the decrease of SaO_2 of the endobronchial tube group at cauterization and 5' after cauterization (p＜0.05). On the contrast, the laryngeal group had no such decrease of SaO_2 (p ＞ 0.05). We could see that the SaO_2 of the patients using laryngeal mask ventilation remained nearly the same as pre-operation. Compared with the patients using double-lumen endobronchial-tube ventilation, the second group could keep their oxygenation in a safer range. The differences between these two groups might be attributed to two factors: double-lumen endobronchial-tube malposition and development of shunting during one-lung ventilation. On the other hand, the second group didn't take more time to perform the procedure. Obviously, it is not necessary and may be dangerous to anesthetize patients by one-lung ventilation with double-lumen endobronchial-tube in transthoracic endoscopic sympathectomy.