Volume 27, Issue 7 pp. 752-759
RESEARCH REPORT

Elevated intrathoracic CO2 pressure during thoracoscopic surgery decreases regional cerebral oxygen saturation in neonates and infants—A pilot study

Felix Neunhoeffer

Corresponding Author

Felix Neunhoeffer

Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany

Correspondence

Felix Neunhoeffer, Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children's Hospital Tuebingen, Tuebingen, Germany.

Email: [email protected]

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Steven W. Warmann

Steven W. Warmann

Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tuebingen, Germany

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Michael Hofbeck

Michael Hofbeck

Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany

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Alisa Müller

Alisa Müller

Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany

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Frank Fideler

Frank Fideler

Department of Anesthesiology and Intensive Care Medicine, University Hospital, Tuebingen, Germany

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Guido Seitz

Guido Seitz

Department of Pediatric Surgery, University Hospital Giessen/Marburg, Marburg, Germany

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Martin U. Schuhmann

Martin U. Schuhmann

Department of Pediatric Neurosurgery, University Hospital, Tuebingen, Germany

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Hans-Joachim Kirschner

Hans-Joachim Kirschner

Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tuebingen, Germany

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Matthias Kumpf

Matthias Kumpf

Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany

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Jörg Fuchs

Jörg Fuchs

Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tuebingen, Germany

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First published: 24 May 2017
Citations: 22
Section Editor: Francis Veyckemans

Summary

Background

Intraoperative hypercapnia and acidosis are risk factors during thoracoscopy in neonates and infants.

Methods

In a prospective pilot study, we evaluated the effects of thoracoscopy in neonates and infants on cerebral microcirculation, oxygen saturation, and oxygen consumption. Regional cerebral oxygen saturation and blood flow were measured noninvasively using a new device combining laser Doppler flowmetry and white light spectrometry. Additionally, cerebral fractional tissue oxygen extraction and approximated oxygen consumption were calculated.

Fifteen neonates and infants undergoing thoracoscopy were studied using the above-mentioned method. The chest was insufflated with carbon dioxide with a pressure of 2-6 mm Hg. Single lung ventilation was not used. As control group served 15 neonates and infants undergoing abdominal surgery.

Results

Data are presented as median and range. The 95% confidence intervals for differences of means (95% CI) are given for the mean difference from baseline values.

We observed a correlation between intrathoracic pressure exceeding 4 mm Hg and transient decrease in regional cerebral oxygen saturation of 12.7% (95% CI: 9.7–17.2, P<.001). Peripheral oxygen saturation was normal at the same time.

Intraoperative increase in arterial paCO2 (median maximum value: 48.8 mm Hg, range: [36.5-65.4]; 95% CI: −16.0 to −3.0, P=.002) and decrease in arterial pH (median minimum value: 7.3, range: [7.2-7.4]; 95% CI: 0.04-0.12, P=.008) were observed during thoracoscopy with both parameters recovering at the end of the procedure.

Periods of regional cerebral oxygen saturation below 20% from baseline were significantly more frequent during thoracoscopy as compared to the control group (median maximum value: 1.3%min/h, range: [0.0-66.2] vs median maximum value: 0.0%min/h, range: [0.0-4.0]; 95% CI: −16.6 to −1.1, P=.028).

Conclusion

We suggest that thoracoscopic surgery in neonates and infants, although generally safe, may be associated with a decrease in regional cerebral oxygen saturation correlating with the applied intrathoracic pressure. According to our data an inflation pressure >4 mm Hg should be avoided during thoracoscopic surgery.

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