Hypercapnia and Acidosis During Open and Thoracoscopic Repair of Congenital Diaphragmatic Hernia and Esophageal Atresia

Abstract

This pilot randomized controlled trial shows that thoracoscopic repair of CDH is associated with prolonged and severe intraoperative hypercapnia and acidosis, compared with open surgery. These findings do not support the use of thoracoscopy with CO2 insufflation and conventional ventilation for the repair of CDH, calling into question the safety of this practice. The effect of thoracoscopy on blood gases during repair of EA/TEF in neonates requires further evaluation. (ClinicalTrials.gov Identifier: NCT01467245).

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

“…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].…”

“…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.…”

History of thoracoscopic treatment of esophageal atresia

“…В этом вопросе консенсус до сих пор не найден. Не-давно проведенный сравнительный анализ [24] то-ракоскопического и открытого лечения врожденной диафрагмальной грыжи и атрезии пищевода показал значительное повышение гиперкапнии и ацидоза в группе минимально инвазивного хирургического вмешательства. Однако другие исследования, вы-полненные в рамках Европейской ассоциации дет-ских хирургов (European Pediatric Surgeons' Association, EUPSA) и IPEG, не выявили данных проблем [25].…”

Minimally invasive surgery in neonates

“…Anestezistin yapacağı en iyi yol hiperventilasyondur. Torakoskopi esnasında masif karbondioksit absorbsiyonu sonucu nörotoksik etkiler gözlenmiştir (9,10) . Laparoskopide karın içi basıncın artmasıyla böbrek fonksiyonları etkilenebilmektedir.…”

“…Landsdale'in yaptığı meta analizde torakoskopik yaklaşımın süresinin daha uzun olması ve rekürrens oranının yüksek olması nedeniyle açık cerrahinin daha avantajlı olduğu belirlenmiştir (39) . Ayrıca torakoskopik girişimde karbondioksit emilimine bağlı olarak nörotoksik yan etkilerin olması, uzun süren hiperkapni ve asidoz olması açık cerrahiyi tercih ettirmektedir (9) . Yenidoğan minimal invazif uygulamalarda (5 kg altı infantlar dahil) en sık açık cerrahiye geçiş oranı %15'tir ve diyafram hernisi onarımında görülmektedir (40) .…”