Anesthetic Procedure for Left Thoracic Sympathectomy under Thoracoscope in Long QT Syndrome Patients_West China Medical Journal

Authors：

 ZhangHuiying ,  HouGuanghui , HeQiyue

Department of Anaesthesia, Benq Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210019, P. R. China;

Corresponding author：

HouGuanghui, Email: mike.hou@benqmedicalcenter.com

Keywords：

Long QT syndrome; Left thoracic sympathectomy; Arrhythmia; Anesthetic procedure

DOI：

10.7507/1002-0179.20160070

Video：

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Objective To discuss the anesthetic procedure for left thoracic sympathectomy under thoracoscope for long QT syndrome patients. Methods We selected 8 patients with long QT syndrome classified American Society of Anesthesiologists Ⅱ-Ⅲ who were going to undergo left thoracic sympathectomy under thoracoscope between July 2011 and October 2014 as our study subjects. They were given a moderate amount of beta blockers before operation, inducted with 0.1 mg/kg midazolam, 3-6 μg/kg fentanyl, 2-4 mg/kg propofol, 0.3-0.6 mg/kg cis-atracurium, and maintained with propofol 1-4 mg/(kg·h) combined with 0.025-2.000 μg/(kg·min) fentanyl. We recorded the mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO₂) and airway peak pressure, and end-tidal carbon dioxide before anesthesia induction (T₀), at endotracheal intubation (T₁), during artificial lung-collapse when surgery initiated (T₂), 5 minutes after surgery initiation (T₃), 15 minutes after surgery initiation (T₄), during artificial lung-collapse at the end of surgery (T₅) and during extubation (T₆). Results When compared with T₀, T₂ got a higher MAP, T₃ and T₄ had a slower HR (P<0.05), but all were within a normal range. All the patients showed little change in airway peak pressure and end-tidal carbon dioxide during the surgery with no statistically significant difference (P>0.05). Conclusion Proper anesthetic procedure for left thoracic sympathectomy under thoracoscope for long QT syndrome patients can reduce the incidence of perioperative malignant arrhythmia.

Citation： ZhangHuiying, HouGuanghui, HeQiyue. Anesthetic Procedure for Left Thoracic Sympathectomy under Thoracoscope in Long QT Syndrome Patients. West China Medical Journal, 2016, 31(2): 258-261. doi: 10.7507/1002-0179.20160070 Copy

1.	方俊标, 骆晓攀, 周冰, 等. 先天性QT间期延长综合征病人左侧胸交感神经离断术的麻醉处理[J]. 中华麻醉学杂志, 2005, 25(10):788.
2.	胡大一, 李翠兰, 王乐信, 等. 经胸腔镜行左侧心交感神经切除术治疗长QT综合征[J]. 中国心脏起搏与心电生理杂志, 2002, 16(3):174-177.
3.	陈彩霞, 张宏艳. 先天性长Q-T间期综合征基因诊断的研究进展[J]. 国外医学:儿科学分册, 2004, 31(2):57-59.
4.	Juang JJ, Chen CY,Yeh HM, et al. Clinical characteristics of patients with congenital long QT syndrome and bigenic mutations[J]. Chin Med J (Engl), 2014, 127(8):1482-1486.
5.	Liu WL, Hu DY, Li CL, et al. Mutation analysis of Potassium Channel genes KCNQ1 and KCNH2 in patients with long QT syndrome[J]. Chin Med J (Engl), 2003, 116(9):1333-1335.
6.	刘洋, 戴琳, 张远恒, 等. 维拉帕米减少2型长 QT 综合征楔形心肌块模型跨室壁复极离散度并预防尖端扭转型室速[J]. 中国药理学与毒理学杂志, 2014(4):503-509.
7.	李翠兰, 胡大一, 刘文玲, 等. 普萘洛尔对21例长QT综合征的临床疗效观察[J]. 中国心脏起搏与心电生理杂志, 2003, 17(6):412-415.
8.	Mandal B, Kaur G, Batra YK, et al. Manifestation of long QT syndrome with normal QTc interval under anesthesia:a case report[J]. Paediatr Anaesth, 2011, 21(12):1265-1267.
9.	王家和, 王惠军, 成文聪. Q-T间期延长综合征患者的全身麻醉[J]. 临床麻醉学杂志, 2009, 25(6):490-492.
10.	谢言虎, 方才, 马冬春, 等. 单孔电视胸腔镜下手汗症患者胸交感神经节切断术麻醉管理[J]. 安徽医科大学学报, 2010, 45(3):393-395.
11.	中华医学会心血管病学分会心律失常学组, 中华心血管病杂志编辑委员会. 中国心脏起搏与心电生理杂志编辑委员会等.获得性长QT间期综合征的防治建议[J]. 中华心血管病杂志, 2010, 38(11):961-969.
12.	戴国峰, 田新民, 蒋仲敏, 等. 胸腔镜胸交感神经切断术病人舒芬太尼复合异丙酚麻醉的效果[J]. 中华麻醉学杂志, 2008, 28(7):594-596.
13.	赵建英, 林健清, 林财珠, 等. 胸腔镜下胸交感神经干切断术治疗手汗症250例的麻醉体会[J]. 中国内镜杂志, 2007, 13(7):697-699.
14.	李翠兰, 胡大一, 史旭波, 等. 长QT综合征患者运动试验特征及左心交感神经切除术的影响[J]. 中华心血管病杂志, 2004, 32(增刊1):82-84.
15.	欧伟明, 刘洪珍, 王汉兵, 等. 手汗症患者电视纵隔镜下胸交感神经切断术的麻醉处理[J]. 中国内镜杂志, 2011, 17(11):1187-1189.
16.	李剑锋, 王俊, 胡大一, 等. 经胸腔镜切除左胸交感神经治疗先天性QT间期延长综合征[J]. 中华外科杂志, 2003, 41(9):660-661.
17.	Saussine M, Massad I, Raczka F, et al. Torsade de pointes during sevoflurane anesthesia in a child with congenital long QT syndrome[J]. Paediatr Anaesth, 2006, 16(1):63-65.
18.	Wang L, Feng G. Left cardiac sympathetic denervation as the first-line therapy for congenital long QT syndrome[J]. Med Hypotheses, 2004, 63(3):438-441.

1. 方俊标, 骆晓攀, 周冰, 等. 先天性QT间期延长综合征病人左侧胸交感神经离断术的麻醉处理[J]. 中华麻醉学杂志, 2005, 25(10):788.
2. 胡大一, 李翠兰, 王乐信, 等. 经胸腔镜行左侧心交感神经切除术治疗长QT综合征[J]. 中国心脏起搏与心电生理杂志, 2002, 16(3):174-177.
3. 陈彩霞, 张宏艳. 先天性长Q-T间期综合征基因诊断的研究进展[J]. 国外医学:儿科学分册, 2004, 31(2):57-59.
4. Juang JJ, Chen CY,Yeh HM, et al. Clinical characteristics of patients with congenital long QT syndrome and bigenic mutations[J]. Chin Med J (Engl), 2014, 127(8):1482-1486.
5. Liu WL, Hu DY, Li CL, et al. Mutation analysis of Potassium Channel genes KCNQ1 and KCNH2 in patients with long QT syndrome[J]. Chin Med J (Engl), 2003, 116(9):1333-1335.
6. 刘洋, 戴琳, 张远恒, 等. 维拉帕米减少2型长 QT 综合征楔形心肌块模型跨室壁复极离散度并预防尖端扭转型室速[J]. 中国药理学与毒理学杂志, 2014(4):503-509.
7. 李翠兰, 胡大一, 刘文玲, 等. 普萘洛尔对21例长QT综合征的临床疗效观察[J]. 中国心脏起搏与心电生理杂志, 2003, 17(6):412-415.
8. Mandal B, Kaur G, Batra YK, et al. Manifestation of long QT syndrome with normal QTc interval under anesthesia:a case report[J]. Paediatr Anaesth, 2011, 21(12):1265-1267.
9. 王家和, 王惠军, 成文聪. Q-T间期延长综合征患者的全身麻醉[J]. 临床麻醉学杂志, 2009, 25(6):490-492.
10. 谢言虎, 方才, 马冬春, 等. 单孔电视胸腔镜下手汗症患者胸交感神经节切断术麻醉管理[J]. 安徽医科大学学报, 2010, 45(3):393-395.
11. 中华医学会心血管病学分会心律失常学组, 中华心血管病杂志编辑委员会. 中国心脏起搏与心电生理杂志编辑委员会等.获得性长QT间期综合征的防治建议[J]. 中华心血管病杂志, 2010, 38(11):961-969.
12. 戴国峰, 田新民, 蒋仲敏, 等. 胸腔镜胸交感神经切断术病人舒芬太尼复合异丙酚麻醉的效果[J]. 中华麻醉学杂志, 2008, 28(7):594-596.
13. 赵建英, 林健清, 林财珠, 等. 胸腔镜下胸交感神经干切断术治疗手汗症250例的麻醉体会[J]. 中国内镜杂志, 2007, 13(7):697-699.
14. 李翠兰, 胡大一, 史旭波, 等. 长QT综合征患者运动试验特征及左心交感神经切除术的影响[J]. 中华心血管病杂志, 2004, 32(增刊1):82-84.
15. 欧伟明, 刘洪珍, 王汉兵, 等. 手汗症患者电视纵隔镜下胸交感神经切断术的麻醉处理[J]. 中国内镜杂志, 2011, 17(11):1187-1189.
16. 李剑锋, 王俊, 胡大一, 等. 经胸腔镜切除左胸交感神经治疗先天性QT间期延长综合征[J]. 中华外科杂志, 2003, 41(9):660-661.
17. Saussine M, Massad I, Raczka F, et al. Torsade de pointes during sevoflurane anesthesia in a child with congenital long QT syndrome[J]. Paediatr Anaesth, 2006, 16(1):63-65.
18. Wang L, Feng G. Left cardiac sympathetic denervation as the first-line therapy for congenital long QT syndrome[J]. Med Hypotheses, 2004, 63(3):438-441.

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