Bilateral Sympathectomy

Last updated: February 9, 2026

Access
PIV x2. Consider an arterial line for hemodynamic stability.
Airway
Double lumen oral ETT. Kelly clamps available (protect the ends with a bit of red rubber tubing, the kind used for stomas).
Induction
Standard
Maintenance
Gas and paralytic
Emergence
Awake
Antibiotics
Cefazolin
Position
Lateral. Similar to other thoracic procedures, bed breaking.

Notes

Monitor for hypotension after sympathetic chain interruption and support hemodynamics appropriately.