A Comparison of Peripheral Skin Blood Flow and Temperature During Endoscopic Thoracic Sympathotomy

Abstract

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 degrees C +/- 0.3 degrees C and 1.5 degrees C +/- 0.6 degrees 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.

Uniform Distribution of Skin-Temperature Increase After Different Regional-Anesthesia Techniques of the Lower Extremity

“…However, changes in Ts measured by infrared thermometry have been shown to represent heat-exchange vessels located deeper than superficial vessels within a depth of only 1 to 2 mm detected by laser flowmetry. 12,13 Recently, Eisenach et al 14 reported an initial drop in Ts after acute sympathectomy of the upper extremity in anesthetized patients. An initial drop of Ts during regional anesthesia was described before by Butterworth et al 15 and was explained by temporary vasoconstriction triggered by pain through injection of local anesthetics.…”

Chirurgia Toracica Videoassistita

“…Tuttavia vi sono metodi che, applicati intraoperatoriamente, permettono di valutare la risposta acuta alla denervazione e dunque di predire l'outcome: la misurazione della temperatura della falange di un dito della mano (cala di 1-3°C) o, più attendibile, l'esame laser-doppler delle modificazioni del flusso ematico a livello della pelle della mano [90]. Tuttavia vi sono metodi che, applicati intraoperatoriamente, permettono di valutare la risposta acuta alla denervazione e dunque di predire l'outcome: la misurazione della temperatura della falange di un dito della mano (cala di 1-3°C) o, più attendibile, l'esame laser-doppler delle modificazioni del flusso ematico a livello della pelle della mano [90].…”

Intestinal effects of thoracic epidural anesthesia

“…The presence of complete craniocaudal sympathetic block might have interfered with thoracic skin temperature regulation in the canine study [13]. The use of laser Doppler imaging in the rat study is disturbed by differences in microvascular anatomy and regulation in nonglabrous skin [9,10]. This notion is supported by the fact that thermography suggested an increased thoracic skin temperature in the same study [9].…”

“…Many data were derived from indirect techniques relying on measurements of altered effector organ function after inhibition of sympathetic activity [8 ]. These parameters are, however, prone to the effects of microvascular anatomy, emotional and thermoregulatory state or the presence of general anesthesia [9][10][11].…”