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Excerpt
Background: The preference treatment for essential hyperhidrosis (EH) consist of the interruption of the sympathetic chain at the D2-D4 level. That surgery could cause some cardiac neurophysiology alterations. The purpose of this study was to analyse the impact of this surgery over haemodynamic parameters. The cardiac denervation causes autonomic neuropathy with a consequent increment of the morbi-mortality.
Material and methods: In a prospective study, nine patients (3 males and 6 females) ASA 1 with an average age of 24.3 (±6.8SD) and informed consent, were recruited. All patients underwent routine bilateral thoracoscopic sympathectomy. The following test were applied both 24 h before and 48 h after surgery. Orthostatic dysfunction, Vasalva's manoeuvre, isometric exercise and cold pressor. Intraarterial catherization was required and the variables EKG (II Lead), heart rate, blood pressure and breathing were continuously graphical registered. Student's paired t-test was used for those haemodynamic parameters comparison.
Results and discussion: In basal resting conditions, a reduction in systolic, diastolic and mean pressures, and heart rate, was observed, being significant the systolic blood pressure reduction (mean difference ± standard error of difference (SED); 9.11 ± 3.23; P < 0.05). Pathological orthostatic hypotension was found in three patients. Seven patients presented abnormal response in Vasalva's manoeuvre. In isometric exercise, only one of the patients showed an abnormal result. The cold pressor test was normal in all cases.
Conclusion: Sympathectomy provokes sympathetic nervous system alterations. These alterations are particularly evident in Vasalva's manoeuvre test. Autonomic neuropathy may occur in early postoperative period after a sympathicolysis.
