Dataset Information

Brain Oxygenation During Thoracoscopic Repair of Long Gap Esophageal Atresia.

ABSTRACT:

Background

Elongation and repair of long gap esophageal atresia (LGEA) can be performed thoracoscopically, even directly after birth. The effect of thoracoscopic CO₂-insufflation on cerebral oxygenation (rScO₂) during the consecutive thoracoscopic procedures in repair of LGEA was evaluated.

Methods

Prospective case series of five infants, with in total 16 repetitive thoracoscopic procedures. A CO₂-pneumothorax was installed with a pressure of maximum 5 mmHg and flow of 1 L/min. Parameters influencing rScO₂ were monitored. For analysis 10 time periods of 10' during surgery and in the perioperative period were selected.

Results

Median gestational age was 35+3 [range 33+4 to 39+6] weeks; postnatal age at time of first procedure 4 [2-53] days and time of insufflation 127[22-425] min. Median rScO₂ varied between 55 and 90%. Transient outliers in cerebral oxygenation were observed in three patients. In Patient 2 oxygenation values below 55% occurred during a low MABP and Hb < 6 mmol/L. The rScO₂ increased after erythrocytes transfusion. Patient 5 also showed a rScO₂ of 50% with a Hb <6 mmol/L during all procedures, except for a substantial increase during a high paCO₂ of 60 mmHg. Patient 4 had a rScO₂ > 85% during the first procedure with a concomitant high FiO₂ > 45%. All parameters recovered during the surgical course.

Conclusions

This prospective case series of NIRS during consecutive thoracoscopic repair of LGEA showed that cerebral oxygenation remained stable. Transient outliers in rScO₂ occurred during changes in hemodynamic or respiratory parameters and normalized after interventions of the anesthesiologist. This study underlines the importance of perioperative neuromonitoring and the close collaboration between pediatric surgeon, anesthesiologist and neonatologist.

SUBMITTER: Stolwijk LJ

PROVIDER: S-EPMC5394154 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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Publications

Brain Oxygenation During Thoracoscopic Repair of Long Gap Esophageal Atresia.

Stolwijk Lisanne J LJ van der Zee David C DC Tytgat Stefaan S van der Werff Desiree D Benders Manon J N L MJNL van Herwaarden Maud Y A MYA Lemmers Petra M A PMA

World journal of surgery 20170501 5

<h4>Background</h4>Elongation and repair of long gap esophageal atresia (LGEA) can be performed thoracoscopically, even directly after birth. The effect of thoracoscopic CO<sub>2</sub>-insufflation on cerebral oxygenation (rScO<sub>2</sub>) during the consecutive thoracoscopic procedures in repair of LGEA was evaluated.<h4>Methods</h4>Prospective case series of five infants, with in total 16 repetitive thoracoscopic procedures. A CO<sub>2</sub>-pneumothorax was installed with a pressure of maxim ...[more]

PMID: 28058473

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Dataset Information

Brain Oxygenation During Thoracoscopic Repair of Long Gap Esophageal Atresia.

Background

Methods

Results

Conclusions

Publications

Brain Oxygenation During Thoracoscopic Repair of Long Gap Esophageal Atresia.

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