• Mark Bishay, Luca Giacomello, Giuseppe Retrosi, Mandela Thyoka, Shireen A Nah, Merrill McHoney, Paolo De Coppi, Joe Brierley, Stephen Scuplak, Edward M Kiely, Joe I Curry, David P Drake, Kate M K Cross, Simon Eaton, and Agostino Pierro.
• Great Ormond Street Hospital for Children and UCL Institute of Child Health, London, WC1N 1EH United Kingdom.
• J. Pediatr. Surg. 2011 Jan 1;46(1):47-51.

Background/PurposeCongenital diaphragmatic hernia (CDH) and esophageal atresia with tracheoesophageal fistula (EA/TOF) can be repaired thoracoscopically, but this may cause hypercapnia, acidosis, and reduced cerebral oxygenation. We evaluated the effect of thoracoscopy in infants on cerebral oxygen saturation (cSO(2)), arterial blood gases, and carbon dioxide (CO(2)) absorption.MethodsEight infants underwent thoracoscopy (6 CDH and 2 EA/TOF). Serial arterial blood gases were taken. Regional cSO(2) was measured using near-infrared spectroscopy. Absorption of insufflated CO(2) was calculated from exhaled (13)CO(2)/(12)CO(2) ratio measured by mass spectrometry.ResultsCO(2) absorption increased during thoracoscopy with a maximum 29% ± 6% of exhaled CO(2) originating from the pneumothorax. Paco(2) increased from 9.4 ± 1.3 kPa at the start to 12.4 ± 1.0 intraoperatively and then decreased to 7.6 ± 1.2 kPa at end of operation. Arterial pH decreased from 7.19 ± 0.04 at the start to 7.05 ± 0.04 intraoperatively and then recovered to 7.28 ± 0.06 at end of operation. Cerebral hemoglobin oxygen saturation decreased from 87% ± 4% at the start to 75% ± 5% at end of operation. This had not recovered by 12 (74% ± 4%) or 24 hours (73% ± 3%) postoperatively.ConclusionsThis preliminary study suggests that thoracoscopic repair of CDH and EA/TOF may be associated with acidosis and decreased cSO(2). The effects of these phenomena on future brain development are unknown.Copyright © 2011 Elsevier Inc. All rights reserved.

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