• Robert Sümpelmann, Lars Witt, Timon Schröder, Natascha Teich, Carmen Dingemann, Joachim Kübler, and Dietmar Böthig.
• Clinic of Anaesthesiology, Hannover Medical School, Hannover, Germany. witt.lars-henrik@mh-hannover.de
• Paediatr Anaesth. 2012 Aug 1;22(8):793-8.

ObjectivesVideo-assisted thoracoscopic surgery (VATS) has become a standard procedure in pediatric surgery. To facilitate surgical access, the dependent lung has to collapse using intrathoracic carbon dioxide insufflation and/or single-lung ventilation. These procedures can induce hemodynamic deteriorations in adults. The potential impacts of single-lung ventilation in combination with capnothorax on hemodynamics in infants have never been studied before.AimWe conducted a randomized experimental study focusing on hemodynamic and respiratory changes during single-lung ventilation with or without capnothorax in a pediatric animal model.MethodsTwelve piglets were randomly assigned to receive single-lung ventilation with (SLV-CO(2) ) or without (SLV) capnothorax with an insufflation pressure of 5 mmHg for a period of two hours. Before, during, and after single-lung ventilation, hemodynamic and respiratory parameters were measured.ResultsAlthough mean arterial pressure remained stable during the course of the study and no critical incidents were monitored, cardiac index (CI) decreased significantly with SLV-CO(2) (baseline 3.6 ± 1.6 l · min(-1) · m(-2) vs 2.9 ± 1.1 l · min(-1) · m(-2) at 120 min, P < 0.05). Furthermore, global end-diastolic volume and intrathoracic blood volume (ITBV) decreased as well significantly with SLV-CO(2) , causing a significant between-group difference in ITBV (P < 0.05).ConclusionsDespite a decrease in CI and preload parameters, the combination of single-lung ventilation and low-pressure capnothorax was well tolerated in piglets and could justify further clinical studies to be performed in infants and children focusing on hemodynamic and respiratory changes during VATS.© 2011 Blackwell Publishing Ltd.

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