title: Brain Oxygenation During Thoracoscopic Repair of Long Gap Esophageal Atresia.
abstract: 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.
  
  
  
  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 rScO2were monitored. For analysis 10 time periods of 10' during surgery and in the perioperative period were selected.
  
  
  
  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 rScO2varied 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 rScO2increased after erythrocytes transfusion. Patient 5 also showed a rScO2of 50% with a Hb <6 mmol/L during all procedures, except for a substantial increase during a high paCO2of 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.
  
  
  
  This prospective case series of NIRS during consecutive thoracoscopic repair of LGEA showed that cerebral oxygenation remained stable. Transient outliers in rScO2occurred 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.
authors.affiliation: Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands. L.J.Stolwijk@umcutrecht.nl.|Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands. L.J.Stolwijk@umcutrecht.nl.|Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. L.J.Stolwijk@umcutrecht.nl.
authors.forename: Lisanne J
authors.initials: LJ
authors.lastname: Stolwijk
authors.affiliation: Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: David C
authors.initials: DC
authors.lastname: van der Zee
authors.affiliation: Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Stefaan
authors.initials: S
authors.lastname: Tytgat
authors.affiliation: Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Desiree
authors.initials: D
authors.lastname: van der Werff
authors.affiliation: Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands.|Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Manon J N L
authors.initials: MJNL
authors.lastname: Benders
authors.affiliation: Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Maud Y A
authors.initials: MYA
authors.lastname: van Herwaarden
authors.affiliation: Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands.|Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Petra M A
authors.initials: PMA
authors.lastname: Lemmers
mesh_terms: D001921:Brain / Q000378:metabolism*; D002560:Cerebrovascular Circulation; D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010100:Oxygen / Q000378:metabolism*; D011446:Prospective Studies; D013906:Thoracoscopy
chemical_list: D010100:Oxygen