Hyperhidrosis is the distressing condition of abnormal sweating which affects the palm, sole and axillary region. Transthoracic endoscopic sympathectomy is recommended as the treatment of choice for hyperthidrosis, especially when the upper limbs
are
affected.
We experienced a case of accidental cauterization of right azygos vein in a healthy 23 year old male during endoscopic transthoracic sympathectomy. We changed the single lumen endotracheal tube to a double lumen tube which meade it easier to
perform the
explo-thoracotomy and bleeder ligation under one lung ventilation. Crystalloid and colloid solutions, and packed RBC were loaded during explo-thoracotomy. Monitoring showed the signs indicating pulmonary edema. Pulmonary arterial catheterization
revealed global heart failure. The patient was transfered to ICU for intensive management for heart failure.
On the 4th postoperative day, pulmonary dema and heart failure were cured; and the patient was extumbated. But in the evening of the same day ST-segment elevation and Qwave were notd on ECG monitoring. On the 13th postoperative day coronary
angiography
was performed. This revealed left apex focal hypokinesia, patent coronary artery and accidental right coronay spasm, treated by vasodilator. On the 14 day, after surgery, he was discharged to return to work.
|