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Open Access 01-07-2016

Neonatal brain oxygenation during thoracoscopic correction of esophageal atresia

Authors: Stefaan H. A. J. Tytgat, Maud Y. A. van Herwaarden, Lisanne J. Stolwijk, Kristin Keunen, Manon J. N. L. Benders, Jurgen C. de Graaff, Dan M. J. Milstein, David C. van der Zee, Petra M. A. Lemmers

Published in: Surgical Endoscopy | Issue 7/2016

Abstract

Background

Little is known about the effects of carbon dioxide (CO₂) insufflation on cerebral oxygenation during thoracoscopy in neonates. Near-infrared spectroscopy can measure perioperative brain oxygenation [regional cerebral oxygen saturation (rScO₂)].

Aims

To evaluate the effects of CO₂ insufflation on rScO₂ during thoracoscopic esophageal atresia (EA) repair.

Methods

This is an observational study during thoracoscopic EA repair with 5 mmHg CO₂ insufflation pressure. Mean arterial blood pressure (MABP), arterial oxygen saturation (SaO₂), partial pressure of arterial carbon dioxide (paCO₂), pH, and rScO₂ were monitored in 15 neonates at seven time points: baseline (T0), after anesthesia induction (T1), after CO₂-insufflation (T2), before CO₂-exsufflation (T3), and postoperatively at 6 (T4), 12 (T5), and 24 h (T6).

Results

MABP remained stable. SaO₂ decreased from T0 to T2 [97 ± 3–90 ± 6 % (p < 0.01)]. PaCO₂ 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 rScO₂ was significantly higher at T1 compared to T2 [77 ± 10–73 ± 7 % (p < 0.05)]. Mean rScO₂ levels never dropped below a safety threshold of 55 %.

Conclusion

The impact of neonatal thoracoscopic repair of EA with insufflation of CO₂ at 5 mmHg was studied. Intrathoracic CO₂ insufflation caused a reversible decrease in SaO₂ and pH and an increase in paCO₂. The rScO₂ was higher at anesthesia induction but remained stable and within normal limits during and after the CO₂ 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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Title: Neonatal brain oxygenation during thoracoscopic correction of esophageal atresia
Authors: Stefaan H. A. J. Tytgat
Maud Y. A. van Herwaarden
Lisanne J. Stolwijk
Kristin Keunen
Manon J. N. L. Benders
Jurgen C. de Graaff
Dan M. J. Milstein
David C. van der Zee
Petra M. A. Lemmers
Publication date: 01-07-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 7/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4559-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Neonatal brain oxygenation during thoracoscopic correction of esophageal atresia

Abstract

Background

Aims

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Aims

Methods

Results

Conclusion

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