Near-infrared spectroscopy (NIRS) measured tissue oxygenation in neonates with gastroschisis:a pilot study

Background: Management of gastroschisis involves either primary or staged closure. Bowel ischemia and abdominal compartment syndrome (ACS) are possible complications that can be related to a method of treatment. NIRS monitoring has never been applied in this group of patients and may allow for earlier detection of complications.Objective: To assess near-infrared spectroscopy (NIRS) monitoring in neonates with gastroschisis for detecting changes in tissue oxygenation (rSO2) related to bowel reductions or height of bowel in the silo and for detecting tissue ischemia.Methods: Patients with gastroschisis and controls underwent continuous multi-channel assessment of oxygenation of the brain (CrSO2), kidney (RrSO2) and bowel (GrSO2) in a prospective pilot study.Results: Fifteen neonates were treated with primary closure (n = 3) or staged closure (n = 12); two had confirmed bowel ischemia, none developed ACS. There was no significant correlation between height of the bowel and GrSO2 at apex (p =.72) or base (p =.54) within the silo. During staged reductions there was a clinically non-significant change in RrSO2 (Δ-2.5%, p =.04), but no significant changes in CrSO2 (p =.11), and GrSO2 of apex (p =.97) and base (p =.31). Patients with confirmed ischemia had GrSO2 that were lower than controls.Conclusions: Measuring GrSO2 through a silo is feasible. Staged reduction seems safe based on NIRS measurements, with minimal effect of hydrostatic pressure on bowel oxygenation. NIRS was able to detect subtle changes in intra-abdominal renal perfusion during reduction and could differentiate healthy and ischemic bowel.</p

The metabolic and inflammatory response to laparoscopic surgery in infants and children

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Light at the End of the Tunnel: A Technical Note on Thoracoscopic Repair of Congenital Diaphragmatic Hernia

Thoracoscopic repair of congenital diaphra­gmatic hernia (CDH) has been described by a number of authors and is increasingly widely practiced. We present a technical learning point. CDH is associated with the presence of a hernia sac in around 20% of all cases. In this case the presence of a ruptured hernia sac complicated the thoracoscopic repair of a left sided CDH, as it was initially difficult to recognise. Once the anatomy was clarified the repair was satisfactorily completed and the child made a rapid postoperative recovery. This technical note is to warn other surgeons that a tunnel like appearance of the diaphragmatic defect may in fact be due to the presence of a torn hernia sac, which requires excision before closure of the defect

Carbon dioxide absorption and elimination in breath during minimally invasive surgery

Carbon dioxide (CO2) is the gas most commonly used to inflate the body cavities during 'keyhole' surgery (e.g. laparoscopy and thoracoscopy). However, CO2 can be absorbed, leading to increased arterial CO 2 and increased CO2 elimination from the lungs. These increases in CO2 are observed following a wide variety of procedures both in adults and in infants and children. Although it is usually assumed that increases in arterial or end-tidal CO2 directly reflect absorption of CO2 from body cavities, this is not necessarily true, as either increases in metabolically produced CO2 or respiratory compromise making it more difficult to eliminate CO2 could also be responsible for these changes. Recently, a new technique has been introduced which enables absorbed CO2 to be distinguished from metabolic CO2

Factors affecting ¹³C-natural abundance measurement of breath carbon dioxide during surgery : absorption of carbon dioxide during endoscopic procedures

The aim of this paper is to review the factors which may affect breath ¹³CO2/¹²CO2 natural abundance in patients undergoing surgery or intensive care. Intravenous glucose administration is a major determinant of the ¹³CO2/ ¹²CO2 of breath as intravenous glucose preparations are almost all derived from cornstarch. In addition, the oxidation of endogenous substrates can affect the ¹³CO2/¹²CO 2 ratio. During many endoscopic procedures, such as laparoscopic surgery, carbon dioxide insufflation is used to provide a working space. As medical CO2 is relatively depleted in ¹³CO2 compared with endogenous and exogenous metabolic CO2 sources, breath ¹³CO2/¹²CO2 measurements can be used to estimate CO2 absorption during these procedures. However, all these factors may also be affected by the bicarbonate pool, making a definitive attribution of changes in breath ¹³CO2/ ¹²CO2 to a single factor problematic.4 page(s

Thoracoscopic repair of congenital diaphragmatic hernia: intraoperative ventilation and recurrence

Abstract Introduction: Thoracoscopic repair of congenital diaphragmatic hernia (CDH) has been described, but its efficacy and safety have not been validated. The aim was to compare our experience of thoracoscopy with laparotomy repair. Methods: After ethics approval, we reviewed the notes of neonates with CDH operated in our institution between 2003 and 2008. Two historical groups were compared: infants who underwent laparotomy (2003-2008) or thoracoscopy (2007-2008). Data were compared by t test or Mann-Whitney tests. Results: Thirty-five children had open repair of CDH, and 13 had thoracoscopic repair. Groups were homogeneous for age and weight. Five (38%) neonates who had thoracoscopy were converted to open for surgical difficulties (n = 4) and O 2 desaturation (n = 1). Patch repair was used in 12 (34%) open and 6 (46%) thoracoscopic repairs. End-tidal CO 2 was significantly elevated during thoracoscopy, but this was not reflected in arterial CO 2 or pH. There were 3 (8%) recurrences after open repair and 2 (25%) after thoracoscopy (P = .19). Conclusion: Thoracoscopic repair of CDH is feasible. Arterial blood gases should be closely monitored. Despite higher EtCO 2 , conversion to open was mainly because of difficult repair. A randomized trial is necessary to assess the effect of thoracoscopy on ventilation and recurrences. © 2010 Elsevier Inc. All rights reserved. In recent years, there has been an increased use of minimally invasive techniques in both pediatric and neonatal surger