A comparison of peripheral skin blood flow and temperature during endoscopic thoracic sympathotomy

John H. Eisenach, Tasha L. Pike, Diane E. Wick, Niki M. Dietz, Robert D. Fealey, John L.D. Atkinson, Nisha Charkoudian

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


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°C ± 0.3°C and 1.5°C ± 0.6°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.

Original languageEnglish (US)
Pages (from-to)269-276
Number of pages8
JournalAnesthesia and analgesia
Issue number1
StatePublished - Jan 2005

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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