Tadaharu Okazaki1, Manabu Okawada2, Hiroyuki Koga2, Go Miyano2, Takashi Doi2, Yuki Ogasawara3, Yuta Yazaki3,2, Kinya Nishimura4, Eiichi Inada4, Geoffrey J Lane2, Atsuyuki Yamataka2. 1. Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan. okazakit@juntendo.ac.jp. 2. Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan. 3. Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan. 4. Department of Anesthesiology, Juntendo University School of Medicine, Tokyo, Japan.
Abstract
PURPOSE: We monitored arterial blood gases during thoracoscopic (TR) and open repair (OR) of congenital diaphragmatic hernia (CDH) to assess the safety of intraoperative hypercapnia and acidosis. METHODS: We reviewed 30 neonatal CDH cases (OR = 10, TR = 20) diagnosed prenatally or within 6 h of birth at out institution from 2002 to 2014 not requiring inhaled nitric oxide (NO) intraoperatively. OR, routine until 2006 was replaced by TR in 2007. All subjects were managed identically. RESULTS: Five TR cases requiring conversion to OR were excluded. Prenatal diagnosis, gestational age at birth, gender, birth weight, and side of CDH were similar. Preoperative PaCO2 and pH were not significantly different. However, while intraoperative increase in mean PaCO2 (38.8-62.8 mmHg; p < 0.01) and decrease in mean pH (7.44-7.25; p < 0.01) were significant in TR, intraoperative PaCO2 was <70 mmHg in 12/15 cases and intraoperative pH was >7.20 in 11/15 cases. Both PaCO2 and pH reverted to normal on completion of surgery; pre- and postoperative results were comparable. There were no postoperative complications. CONCLUSIONS: It would appear that neonatal cases of CDH not requiring NO can tolerate TR, despite transient reversible deterioration in acid/base balance, indicating that TR is safe for the treatment of selected cases of CDH.
PURPOSE: We monitored arterial blood gases during thoracoscopic (TR) and open repair (OR) of congenital diaphragmatic hernia (CDH) to assess the safety of intraoperative hypercapnia and acidosis. METHODS: We reviewed 30 neonatal CDH cases (OR = 10, TR = 20) diagnosed prenatally or within 6 h of birth at out institution from 2002 to 2014 not requiring inhaled nitric oxide (NO) intraoperatively. OR, routine until 2006 was replaced by TR in 2007. All subjects were managed identically. RESULTS: Five TR cases requiring conversion to OR were excluded. Prenatal diagnosis, gestational age at birth, gender, birth weight, and side of CDH were similar. Preoperative PaCO2 and pH were not significantly different. However, while intraoperative increase in mean PaCO2 (38.8-62.8 mmHg; p < 0.01) and decrease in mean pH (7.44-7.25; p < 0.01) were significant in TR, intraoperative PaCO2 was <70 mmHg in 12/15 cases and intraoperative pH was >7.20 in 11/15 cases. Both PaCO2 and pH reverted to normal on completion of surgery; pre- and postoperative results were comparable. There were no postoperative complications. CONCLUSIONS: It would appear that neonatal cases of CDH not requiring NO can tolerate TR, despite transient reversible deterioration in acid/base balance, indicating that TR is safe for the treatment of selected cases of CDH.
Authors: Edmund Y Yang; Nikki Allmendinger; Sidney M Johnson; Catherine Chen; Jay M Wilson; Steven J Fishman Journal: J Pediatr Surg Date: 2005-09 Impact factor: 2.545
Authors: Richard Keijzer; Cees van de Ven; John Vlot; Cornelius Sloots; Gerard Madern; Dick Tibboel; Klaas Bax Journal: J Pediatr Surg Date: 2010-05 Impact factor: 2.545
Authors: Julia R Fishman; Simon C Blackburn; Niall J Jones; Nicholas Madden; Diane De Caluwe; Munther J Haddad; Simon A Clarke Journal: J Pediatr Surg Date: 2011-03 Impact factor: 2.545
Authors: Marjorie J Arca; Douglas C Barnhart; Joseph L Lelli; Jonathon Greenfeld; Carroll M Harmon; Ronald B Hirschl; Daniel H Teitelbaum Journal: J Pediatr Surg Date: 2003-11 Impact factor: 2.545
Authors: Pramod Puligandla; Erik Skarsgard; Martin Offringa; Ian Adatia; Robert Baird; Michelle Bailey; Mary Brindle; Priscilla Chiu; Arthur Cogswell; Shyamala Dakshinamurti; Hélène Flageole; Richard Keijzer; Douglas McMillan; Titilayo Oluyomi-Obi; Thomas Pennaforte; Thérèse Perreault; Bruno Piedboeuf; S. Patricia Riley; Greg Ryan; Anne Synnes; Michael Traynor Journal: CMAJ Date: 2018-01-29 Impact factor: 8.262