Intraoperative acidosis and hypercapnia during thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia/tracheoesophageal fistula

Zani, Augusto; Lamas-Pinheiro, Rúben; Paraboschi, Irene; King, Sebastian K.; Wolinska, Justyna M; Zani‐Ruttenstock, Elke; Eaton, Simon; Pierro, Agostino

doi:10.1111/pan.13178

Cited by 46 publications

(43 citation statements)

References 20 publications

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“…The duration of the surgical intervention in the PTS group was longer than that in the POS group, as found by others . The high occurrence of episodes of acidosis in the present study confirms the findings of Zani et al…”

Section: Discussionsupporting

confidence: 92%

“…Independent of the surgical technique used, periods of severe intraoperative acidosis, hypercapnia, hypocapnia, hyperoxia, and hypoxemia, mostly independent of hypo‐ and hypertension, occurred in the patients in this study. The hypercapnia and acidosis found in this study are most likely caused by compression of the lung (POS and PTS) and absorption of insufflated CO2 (PTS) . Hypercapnia should be avoided or solved by compensatory increase of the ventilation rate.…”

Section: Discussionmentioning

confidence: 76%

“…The influences of metabolic derangements on the long‐term neurodevelopmental outcome in humans are unknown, but preclinical animal research has shown a negative association of metabolic derangements with long‐term neurodevelopmental outcome . We suggest that non‐invasive intraoperative neuromonitoring could be beneficial for optimal registration of brain oxygenation and perfusion during EA repair.…”

Section: Discussionmentioning

confidence: 93%

“…Any interrelationships between intraoperative events, type of surgical approach—thoracoscopic or open—and (developmental) outcomes have not yet been elucidated. Comorbidities, intraoperative events like duration of surgery, the occurrence of hypercapnia (and its effect on cerebral autoregulation), acidosis, hypertension, postoperative complications (such as recurrence of the TEF, esophageal stricture formation, and gastro‐esophageal reflux) may negatively affect the short‐ and long‐term clinical outcomes . It is also not known what surgical technique is associated with the best outcome …”

Section: Introductionmentioning

confidence: 99%

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Perioperative management of esophageal atresia/tracheo‐esophageal fistula: An analysis of data of 101 consecutive patients

Hoorn

Costerus

Lau

et al. 2019

Pediatric Anesthesia

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Background The perioperative management of esophageal atresia/tracheo‐esophageal fistula by open or thoracoscopic approach can be complicated by metabolic derangements. Little is known, however, about the severity of derangements of vital and metabolic parameters in the perioperative period. Aim The aim of this study is to describe the perioperative courses of vital and metabolic parameters in 101 consecutive neonates undergoing surgical repair of esophageal atresia type C. Method In a retrospective cohort study, we extracted all data from the electronic anesthetic and medical charts of patients who underwent esophageal atresia type C repair within 30 days of life (2007‐2017). We distinguished three types of surgery: primary open, primary thoracoscopic, and primary thoracoscopic surgery converted to open surgery. Descriptive analysis was applied. Results The charts of 117 patients were reviewed: data of 101 were included. The perioperative anesthetic management was not standardized; various methods and medications were used for anesthesia induction and maintenance. Intraoperative blood gas analysis data of 72 patients were available and showed derangements regardless of type of surgery. The median pH‐value decreased to 7.21 [IQR 7.14‐7.30] and a pH‐value below 7.20 was found in 29 patients; in four cases below 7.0, with the lowest value 6.83. The median PaCO2 reached an upper level of 7.5kPa [IQR 5.8‐9.2]; in 13 cases above 10.0kPa, with a peak value of 25.8kPa. These high PaCO2 levels fluctuated with lowest measured PaCO2 of median 5.6 [IQR 4.5‐6.6], with the lowest value 2.8kPa. The median PaO2 level reached an upper level of 16.9kPa [IQR 11.8‐25.7], in 22 cases above 20.0kPa, with a peak value of 50.0kPa. These high levels fluctuated with lowest measured PaO2 levels of median 8.3kPa [IQR 6.73‐10.5]; the lowest PaO2 value was 4.7 kPa. Conclusion Open and thoracoscopic correction of esophageal atresia were associated with periods of severe metabolic derangements. These events need to be taken into account for the evaluation of esophageal atresia (surgical) care and in evaluations of short‐ and long‐term outcomes.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Perioperative management of esophageal atresia/tracheo‐esophageal fistula: An analysis of data of 101 consecutive patients

Hoorn

Costerus

Lau

et al. 2019

Pediatric Anesthesia

View full text Add to dashboard Cite

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“…In infants, there are some concerns with CO 2 insufflation for endoscopic procedures, including an age‐dependent reduced capacity for CO 2 elimination and increased susceptibility to cardiovascular depression and hypotension in response to hypercapnia, compared with older children and adults . Retrospective clinical studies report significant hypercapnia, acidosis, and decreased cerebral oxygen saturation during thoracoscopy with CO 2 insufflation to repair congenital diaphragmatic hernia and esophageal atresia in neonates . However, long‐term neurodevelopmental outcomes are lacking, and an overarching scarcity of high‐quality prospective evidence in this field limits data interpretation …”

Section: Carbon Dioxide Insufflation For Endoscopic Surgerymentioning

confidence: 99%

Partial amniotic carbon dioxide insufflation for fetal surgery

et al. 2018

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Partial amniotic carbon dioxide insufflation (PACI) involves insufflating the amniotic sac with carbon dioxide (CO2) and, in some cases, draining some of the amniotic fluid. The creation of a gaseous intra‐amniotic compartment improves visualization, even in the presence of limited bleeding, and creates the work space required for complex fetoscopic procedures. Clinically, PACI is mostly used to perform fetoscopic myelomeningocele (MMC) repair, enabling a minimally invasive alternative to open fetal surgery. However, evidence of the fetal safety of PACI is limited. Previous animal experiments in sheep demonstrate that PACI induces fetal hypercapnia and acidosis with largely unknown short and longer term implications. In this review, we examine the literature for the physiological effects of intrauterine insufflation pressure, duration, humidity, and the role of maternal hyperventilation on fetal physiology and well‐being.

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