Neonatal brain oxygenation during thoracoscopic correction of esophageal atresia
Background Little is known about the effects of carbon dioxide (CO 2 ) insufflation on cerebral oxygenation during thoracoscopy in neonates. Near-infrared spectroscopy can measure perioperative brain oxygenation [regional cerebral oxygen saturation (rScO 2 )]. Aims To evaluate the effects of CO 2 in...
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Published in | Surgical endoscopy Vol. 30; no. 7; pp. 2811 - 2817 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
New York
Springer US
01.07.2016
Springer Nature B.V |
Subjects | |
Online Access | Get full text |
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Summary: | Background
Little is known about the effects of carbon dioxide (CO
2
) insufflation on cerebral oxygenation during thoracoscopy in neonates. Near-infrared spectroscopy can measure perioperative brain oxygenation [regional cerebral oxygen saturation (rScO
2
)].
Aims
To evaluate the effects of CO
2
insufflation on rScO
2
during thoracoscopic esophageal atresia (EA) repair.
Methods
This is an observational study during thoracoscopic EA repair with 5 mmHg CO
2
insufflation pressure. Mean arterial blood pressure (MABP), arterial oxygen saturation (SaO
2
), partial pressure of arterial carbon dioxide (paCO
2
), pH, and rScO
2
were monitored in 15 neonates at seven time points: baseline (T0), after anesthesia induction (T1), after CO
2
-insufflation (T2), before CO
2
-exsufflation (T3), and postoperatively at 6 (T4), 12 (T5), and 24 h (T6).
Results
MABP remained stable. SaO
2
decreased from T0 to T2 [97 ± 3–90 ± 6 % (
p
< 0.01)]. PaCO
2
increased from T0 to T2 [41 ± 6–54 ± 15 mmHg (
p
< 0.01)]. pH decreased from T0 to T2 [7.33 ± 0.04–7.25 ± 0.11 (
p
< 0.05)]. All parameters recovered during the surgical course. Mean rScO
2
was significantly higher at T1 compared to T2 [77 ± 10–73 ± 7 % (
p
< 0.05)]. Mean rScO
2
levels never dropped below a safety threshold of 55 %.
Conclusion
The impact of neonatal thoracoscopic repair of EA with insufflation of CO
2
at 5 mmHg was studied. Intrathoracic CO
2
insufflation caused a reversible decrease in SaO
2
and pH and an increase in paCO
2
. The rScO
2
was higher at anesthesia induction but remained stable and within normal limits during and after the CO
2
pneumothorax, which suggest no hampering of cerebral oxygenation by the thoracoscopic intervention. Future studies will focus on the long-term effects of this surgery on the developing brain. |
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Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23 |
ISSN: | 0930-2794 1432-2218 |
DOI: | 10.1007/s00464-015-4559-1 |