[Sedated non-intubated bilateral thoracoscopic sympathectomy R3-R4]

Non-intubated thoracic surgery entails procedures performed through regional anesthesia method in awake or mildly sedated, spontaneously ventilating patients. This method represents advantages for the cardiovascular system, and reduces the orotracheal trauma, postoperative atelectasis, and pneumonia. It also possibly reduces costs. Other theoretical advantages are: easier acceptance of surgery, attenuated stress hormone and immune response, and possibly a better survival in oncological surgery. We show a 34-year-old woman with sever palmar-axillary hyperhidrosis. We performed the procedure with local anesthesia (ropivacaine 2 mg/ml) 5 ml in each wound trocar; 20 ml inside the thoracic cavity. The patient was mildly sedated with fentanyl and dexmedetomidine. The procedure was very simple, the patient was included in an outpatient program 90 minutes after the surgery. We conclude that sympathectomy with a non-intubated patient is safe and could be the beginning of other kinds of more complex procedures.