Rapid and excessive carbon dioxide insufflation into the closed chest cavity may create a tension pneumopthorax, displace the mediastinum, and compress the lungs and great vessels with consequent haemodynamic instability. During carbon dioxide insufflation using endobronchial intubation, Hartrey and colleagues reported a decrease in systolic arterial pressure of > 20 mm Hg in 21% of patients. Similarly, we have reported sudden hypotension and bradycardia after injudicious carbon dioxide insufflation.
In common with other surgical procedures, routine monitoring during thorascopic sympathectomy should include ECG, pulse oximetry and capnography. However, during thorascopic surgery, SpO2 and end-tidal carbon dioxide have the additional function of monitoring the surgical technique.
BJA 1997;79: 113-119