Decreased cerebral oxygen saturation during thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia in infants

Bishay, Mark; Giacomello, Luca; Retrosi, Giuseppe; Thyoka, Mandela; Nah, Shireen Anne; McHoney, Merrill; Coppi, Paolo De; Brierley, Joe; Scuplak, Stephen; Kiely, Edward M.; Curry, Joe; Drake, D. P.; Cross, Kate; Eaton, Simon; Pierro, Agostino

doi:10.1016/j.jpedsurg.2010.09.062

Cited by 98 publications

(73 citation statements)

References 13 publications

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“…Other studies highlighted special characteristics of the patients, like cardiac malformations 14 . Also on anesthesiological subjects, including the effects of CO2 inflation 15,16 and pain after thoracoscopic repair was studied 17 . Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Another argument for MAS could be the reduced need for opioid administration postoperatively.The effects of MAS on post-operative pain as measured by opioid requirements were studied by Ceelie 17 15 using NIRS. But as mentioned earlier no comparative study has been done and the validation in open surgery for EA with TEF has not been done.…”

Section: Studies On Systemic Effects Of Masmentioning

confidence: 99%

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Systematic Review of the Literature: Comparison of Open and Minimal Access Surgery (Thoracoscopic Repair) of Esophageal Atresia with Tracheo-Esophageal Fistula (EA-TEF)

Oomen¹

2012

Front Lines of Thoracic Surgery

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Section: Resultsmentioning

confidence: 99%

Section: Studies On Systemic Effects Of Masmentioning

confidence: 99%

Systematic Review of the Literature: Comparison of Open and Minimal Access Surgery (Thoracoscopic Repair) of Esophageal Atresia with Tracheo-Esophageal Fistula (EA-TEF)

Oomen¹

2012

Front Lines of Thoracic Surgery

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“…Two recent publications by Bishay show that thoracoscopy in infants with pressures as high as 10 mmHg is associated with an extended decrease of rScO 2 , measured by near infrared spectroscopy (NIRS), and hypercapnia with extreme severe acidosis [12,13].…”

Section: Discussionmentioning

confidence: 99%

“…Where it seems to be safe in adults, recently concerns have been raised about the application in neonates [12,13] where high intrathoracic pressures up to 10 mmHg have been used. This is in contradiction to our normal clinical practice where a capnothorax in neonates is created using pressures of only 3 to a maximum of 5 mmHg and a flow of 1 L/min which seemingly does not result in the aforementioned disturbing effects.…”

mentioning

confidence: 99%

The effects of CO2-insufflation with 5 and 10 mmHg during thoracoscopy on cerebral oxygenation and hemodynamics in piglets: an animal experimental study

et al. 2014

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Objective To evaluate the effect of CO 2 -insufflation with 5 and 10 mmHg on cerebral oxygenation and hemodynamics in neonates. Background An increasing percentage of surgical interventions in neonates are performed by minimal invasive techniques. Recently, concerns have been raised regarding a decrease of cerebral oxygenation in neonates during thoracoscopy as a result of CO 2 -insufflation. Methods This was an animal experimental study. Piglets were anesthetized, intubated, ventilated, and surgically prepared for CO 2 -insufflation. Insufflation was done with 5 or 10 mmHg CO 2 during 1 h. Arterial saturation (SaO 2 ), heart rate (HR), mean arterial blood pressure (MABP), and cerebral oxygenation (rScO 2 ) were monitored. CFTOE, an estimator of cerebral oxygen extraction ((SaO 2 -rScO 2 )/ SaO 2 )), was calculated. Arterial blood gases were drawn every 15 0 : pre (T0), during (T1-T4) and after CO 2 -insufflation (T5). Results Ten piglets (4 kg) were randomized for 5 (P5) and 10 (P10) mmHg CO 2 -insufflation. Two P10 piglets needed resuscitation after insufflation, none P5. Linear mixed-effect modeling of paCO 2 , pH, and SaO 2 showed that values were dependent on time and time squared (p \ 0.001) but were not different between the 5 and 10 mmHg groups. Analysis demonstrated significant changes over time in heart rate and MABP between the 5 and 10 mmHg groups, with a significant higher heart rate and lower blood pressure in the 10 mmHg group (p \ 0.001). For rScO 2 and cFTOE, no group differences could be demonstrated, but a significant effect of time was found: rScO 2 increased and cFTOE decreased (p \ 0.001). Conclusions Insufflation of CO 2 during thoracoscopy with 10 mmHg caused more severe hemodynamic instability and seems to be related with a decrease of cerebral perfusion as represented by a higher oxygen extraction. CO 2 -insufflation of 5 mmHg for thoracoscopy seems to have no adverse effects on cerebral oxygenation.

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“…Однако сторонники минимально инвазивных операций всерьез дискутируют о без-опасности торакоскопии, так как использование карботоракса связано с некоторыми осложнения-ми, такими как дыхательный ацидоз, гиперкарбия, легочная гипертония [15,25], и его воздействие на новорожденного во время торакоскопии все еще остается неопределенным. Экспериментальная ра-бота G. Stratmann [26] и клиническое исследование M. Bishay [27] показали, что карботоракс ассоцииру-ется со значительным интраоперационным ацидо-зом, который может приводить к нейросенсорному поражению. Противоположных результатов добил-ся J. Fishman [28], который не обнаружил разницы в pH во время проведения открытых и торакоскопи-ческих операций реконструкции диафрагмальной грыжи у новорожденных.…”

Section: дискуссияunclassified

Endosurgical treatment of diaphragmatic diseases in infants

Kozlov¹,

Novozhilov²,

Kovalkov³

et al. 2015

Endosk. khir.

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Decreased cerebral oxygen saturation during thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia in infants

Cited by 98 publications

References 13 publications

Systematic Review of the Literature: Comparison of Open and Minimal Access Surgery (Thoracoscopic Repair) of Esophageal Atresia with Tracheo-Esophageal Fistula (EA-TEF)

Systematic Review of the Literature: Comparison of Open and Minimal Access Surgery (Thoracoscopic Repair) of Esophageal Atresia with Tracheo-Esophageal Fistula (EA-TEF)

The effects of CO2-insufflation with 5 and 10 mmHg during thoracoscopy on cerebral oxygenation and hemodynamics in piglets: an animal experimental study

Endosurgical treatment of diaphragmatic diseases in infants

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