Korean J Anesthesiol.  2008 Jul;55(1):111-113. 10.4097/kjae.2008.55.1.111.

Cardiovascular collapse developing during thoracoscopic thoracic sympathectomy in a patient with essential palmar hyperhidrosis: A case report

• Park SJ
• Jee DL

• KMID: 1782531
• DOI: http://doi.org/10.4097/kjae.2008.55.1.111

Abstract

Thoracoscopic thoracic sympathectomy (TTS) is usually a safe and uncomplicated procedure for treating essential palmar hyperhidrosis. However, we report a case of cardiovascular collapse that developed in a healthy patient undergoing TTS. The surgeon performed the left sympathectomy without incident. However, scarcely had an incision been made in the skin of the right chest when the patient developed sinus bradycardia and sudden, severe hypotension. Pulseless ventricular tachycardia occurred immediately thereafter, which rapidly progressed to ventricular fibrillation and cardiovascular collapse. The patient required resuscitation with 200 J of direct current shock defibrillation along with an intravenous injection of epinephrine 1 mg. She recovered without sequelae. We believe the Bezold-Jarisch reflex was triggered by pooling of venous blood and surgical stimuli, and the patient developed cardiovascular collapse as a result.

Keyword

Bezold-Jarisch reflex; cardiovascular collapse; essential palmar hyperhidrosis; thoracoscopic thoracic sympathectomy

MeSH Terms

Bradycardia
Epinephrine
Humans
Hyperhidrosis
Hypotension
Injections, Intravenous
Reflex
Resuscitation
Shock
Skin
Sympathectomy
Tachycardia, Ventricular
Thorax
Ventricular Fibrillation
Epinephrine