Link: http://www.ncbi.nlm.nih.gov/pubmed/26282505

Pediatr Surg Int. 2015 Oct;31(10):899-904. doi: 10.1007/s00383-015-3767-z. Epub 2015 Aug 18.
Safety of surgery for neonatal congenital diaphragmatic hernia as reflected by arterial blood gas monitoring: thoracoscopic versus open repair.
Okazaki T1, Okawada M2, Koga H2, Miyano G2, Doi T2, Ogasawara Y3, Yazaki Y3,2, Nishimura K4, Inada E4, Lane GJ2, Yamataka A2.
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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.

KEYWORDS:
Acidemia; Congenital diaphragmatic hernia; Hypercapnia; Thoracoscopic repair
PMID: 26282505 [PubMed - in process]