The effects of CO<inf>2</inf>-insufflation with 5 and 10 mmHg during thoracoscopy on cerebral oxygenation and hemodynamics in piglets: an animal experimental study

Lisanne J.  Stolwijk; Stefaan H A J  Tytgat; Kristin Keunen; Nutnicha Suksamanapan; Maud Y A van Herwaarden; Floris Groenendaal; Petra M A Lemmers; David C. van der Zee

doi:10.1007/s00464-014-4009-5

The effects of CO<inf>2</inf>-insufflation with 5 and 10 mmHg during thoracoscopy on cerebral oxygenation and hemodynamics in piglets: an animal experimental study

Lisanne J. Stolwijk^*, Stefaan H A J Tytgat, Kristin Keunen, Nutnicha Suksamanapan, Maud Y A van Herwaarden, Floris Groenendaal, Petra M A Lemmers, David C. van der Zee

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Objective: To evaluate the effect of CO<inf>2</inf>-insufflation with 5 and 10 mmHg on cerebral oxygenation and hemodynamics in neonates. Background: An increasing percentage of surgical interventions in neonates are performed by minimal invasive techniques. Recently, concerns have been raised regarding a decrease of cerebral oxygenation in neonates during thoracoscopy as a result of CO<inf>2</inf>-insufflation. Methods: This was an animal experimental study. Piglets were anesthetized, intubated, ventilated, and surgically prepared for CO<inf>2</inf>-insufflation. Insufflation was done with 5 or 10 mmHg CO<inf>2</inf> during 1 h. Arterial saturation (SaO<inf>2</inf>), heart rate (HR), mean arterial blood pressure (MABP), and cerebral oxygenation (rScO<inf>2</inf>) were monitored. CFTOE, an estimator of cerebral oxygen extraction ((SaO<inf>2</inf> − rScO<inf>2</inf>)/SaO<inf>2</inf>)), was calculated. Arterial blood gases were drawn every 15′: pre (T0), during (T1-T4) and after CO<inf>2</inf>-insufflation (T5). Results: Ten piglets (4 kg) were randomized for 5 (P5) and 10 (P10) mmHg CO<inf>2</inf>-insufflation. Two P10 piglets needed resuscitation after insufflation, none P5. Linear mixed-effect modeling of paCO<inf>2</inf>, pH, and SaO<inf>2</inf> showed that values were dependent on time and time squared (p < 0.001) but were not different between the 5 and 10 mmHg groups. Analysis demonstrated significant changes over time in heart rate and MABP between the 5 and 10 mmHg groups, with a significant higher heart rate and lower blood pressure in the 10 mmHg group (p < 0.001). For rScO<inf>2</inf> and cFTOE, no group differences could be demonstrated, but a significant effect of time was found: rScO<inf>2</inf> increased and cFTOE decreased (p < 0.001). Conclusions: Insufflation of CO<inf>2</inf> during thoracoscopy with 10 mmHg caused more severe hemodynamic instability and seems to be related with a decrease of cerebral perfusion as represented by a higher oxygen extraction. CO<inf>2</inf>-insufflation of 5 mmHg for thoracoscopy seems to have no adverse effects on cerebral oxygenation.

Original language	English
Pages (from-to)	2781-2788
Number of pages	8
Journal	Surgical Endoscopy
Volume	29
Issue number	9
DOIs	https://doi.org/10.1007/s00464-014-4009-5
Publication status	Published - Sept 2015

Keywords

Cerebral oxygenation
CO2
Endoscopy
Esophageal atresia
Neonatal surgery
Pediatric
Thoracoscopy

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Stolwijk, L. J., Tytgat, S. H. A. J., Keunen, K., Suksamanapan, N., van Herwaarden, M. Y. A., Groenendaal, F., Lemmers, P. M. A., & van der Zee, D. C. (2015). The effects of CO<inf>2</inf>-insufflation with 5 and 10 mmHg during thoracoscopy on cerebral oxygenation and hemodynamics in piglets: an animal experimental study. Surgical Endoscopy, 29(9), 2781-2788. https://doi.org/10.1007/s00464-014-4009-5

@article{4c1b89bf3d9340fcacab760d64035f79,

title = "The effects of CO2-insufflation with 5 and 10 mmHg during thoracoscopy on cerebral oxygenation and hemodynamics in piglets: an animal experimental study",

abstract = "Objective: To evaluate the effect of CO2-insufflation with 5 and 10 mmHg on cerebral oxygenation and hemodynamics in neonates. Background: An increasing percentage of surgical interventions in neonates are performed by minimal invasive techniques. Recently, concerns have been raised regarding a decrease of cerebral oxygenation in neonates during thoracoscopy as a result of CO2-insufflation. Methods: This was an animal experimental study. Piglets were anesthetized, intubated, ventilated, and surgically prepared for CO2-insufflation. Insufflation was done with 5 or 10 mmHg CO2 during 1 h. Arterial saturation (SaO2), heart rate (HR), mean arterial blood pressure (MABP), and cerebral oxygenation (rScO2) were monitored. CFTOE, an estimator of cerebral oxygen extraction ((SaO2 − rScO2)/SaO2)), was calculated. Arterial blood gases were drawn every 15′: pre (T0), during (T1-T4) and after CO2-insufflation (T5). Results: Ten piglets (4 kg) were randomized for 5 (P5) and 10 (P10) mmHg CO2-insufflation. Two P10 piglets needed resuscitation after insufflation, none P5. Linear mixed-effect modeling of paCO2, pH, and SaO2 showed that values were dependent on time and time squared (p < 0.001) but were not different between the 5 and 10 mmHg groups. Analysis demonstrated significant changes over time in heart rate and MABP between the 5 and 10 mmHg groups, with a significant higher heart rate and lower blood pressure in the 10 mmHg group (p < 0.001). For rScO2 and cFTOE, no group differences could be demonstrated, but a significant effect of time was found: rScO2 increased and cFTOE decreased (p < 0.001). Conclusions: Insufflation of CO2 during thoracoscopy with 10 mmHg caused more severe hemodynamic instability and seems to be related with a decrease of cerebral perfusion as represented by a higher oxygen extraction. CO2-insufflation of 5 mmHg for thoracoscopy seems to have no adverse effects on cerebral oxygenation.",

keywords = "Cerebral oxygenation, CO2, Endoscopy, Esophageal atresia, Neonatal surgery, Pediatric, Thoracoscopy",

author = "Stolwijk, {Lisanne J.} and Tytgat, {Stefaan H A J} and Kristin Keunen and Nutnicha Suksamanapan and {van Herwaarden}, {Maud Y A} and Floris Groenendaal and Lemmers, {Petra M A} and {van der Zee}, {David C.}",

year = "2015",

month = sep,

doi = "10.1007/s00464-014-4009-5",

language = "English",

volume = "29",

pages = "2781--2788",

journal = "Surgical Endoscopy",

issn = "0930-2794",

publisher = "Springer New York",

number = "9",

}

Stolwijk, LJ, Tytgat, SHAJ, Keunen, K, Suksamanapan, N, van Herwaarden, MYA , Groenendaal, F , Lemmers, PMA & van der Zee, DC 2015, 'The effects of CO<inf>2</inf>-insufflation with 5 and 10 mmHg during thoracoscopy on cerebral oxygenation and hemodynamics in piglets: an animal experimental study', Surgical Endoscopy, vol. 29, no. 9, pp. 2781-2788. https://doi.org/10.1007/s00464-014-4009-5

The effects of CO<inf>2</inf>-insufflation with 5 and 10 mmHg during thoracoscopy on cerebral oxygenation and hemodynamics in piglets: an animal experimental study. / Stolwijk, Lisanne J. ; Tytgat, Stefaan H A J ; Keunen, Kristin et al.
In: Surgical Endoscopy, Vol. 29, No. 9, 09.2015, p. 2781-2788.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - The effects of CO2-insufflation with 5 and 10 mmHg during thoracoscopy on cerebral oxygenation and hemodynamics in piglets

T2 - an animal experimental study

AU - Stolwijk, Lisanne J.

AU - Tytgat, Stefaan H A J

AU - Keunen, Kristin

AU - Suksamanapan, Nutnicha

AU - van Herwaarden, Maud Y A

AU - Groenendaal, Floris

AU - Lemmers, Petra M A

AU - van der Zee, David C.

PY - 2015/9

Y1 - 2015/9

N2 - Objective: To evaluate the effect of CO2-insufflation with 5 and 10 mmHg on cerebral oxygenation and hemodynamics in neonates. Background: An increasing percentage of surgical interventions in neonates are performed by minimal invasive techniques. Recently, concerns have been raised regarding a decrease of cerebral oxygenation in neonates during thoracoscopy as a result of CO2-insufflation. Methods: This was an animal experimental study. Piglets were anesthetized, intubated, ventilated, and surgically prepared for CO2-insufflation. Insufflation was done with 5 or 10 mmHg CO2 during 1 h. Arterial saturation (SaO2), heart rate (HR), mean arterial blood pressure (MABP), and cerebral oxygenation (rScO2) were monitored. CFTOE, an estimator of cerebral oxygen extraction ((SaO2 − rScO2)/SaO2)), was calculated. Arterial blood gases were drawn every 15′: pre (T0), during (T1-T4) and after CO2-insufflation (T5). Results: Ten piglets (4 kg) were randomized for 5 (P5) and 10 (P10) mmHg CO2-insufflation. Two P10 piglets needed resuscitation after insufflation, none P5. Linear mixed-effect modeling of paCO2, pH, and SaO2 showed that values were dependent on time and time squared (p < 0.001) but were not different between the 5 and 10 mmHg groups. Analysis demonstrated significant changes over time in heart rate and MABP between the 5 and 10 mmHg groups, with a significant higher heart rate and lower blood pressure in the 10 mmHg group (p < 0.001). For rScO2 and cFTOE, no group differences could be demonstrated, but a significant effect of time was found: rScO2 increased and cFTOE decreased (p < 0.001). Conclusions: Insufflation of CO2 during thoracoscopy with 10 mmHg caused more severe hemodynamic instability and seems to be related with a decrease of cerebral perfusion as represented by a higher oxygen extraction. CO2-insufflation of 5 mmHg for thoracoscopy seems to have no adverse effects on cerebral oxygenation.

AB - Objective: To evaluate the effect of CO2-insufflation with 5 and 10 mmHg on cerebral oxygenation and hemodynamics in neonates. Background: An increasing percentage of surgical interventions in neonates are performed by minimal invasive techniques. Recently, concerns have been raised regarding a decrease of cerebral oxygenation in neonates during thoracoscopy as a result of CO2-insufflation. Methods: This was an animal experimental study. Piglets were anesthetized, intubated, ventilated, and surgically prepared for CO2-insufflation. Insufflation was done with 5 or 10 mmHg CO2 during 1 h. Arterial saturation (SaO2), heart rate (HR), mean arterial blood pressure (MABP), and cerebral oxygenation (rScO2) were monitored. CFTOE, an estimator of cerebral oxygen extraction ((SaO2 − rScO2)/SaO2)), was calculated. Arterial blood gases were drawn every 15′: pre (T0), during (T1-T4) and after CO2-insufflation (T5). Results: Ten piglets (4 kg) were randomized for 5 (P5) and 10 (P10) mmHg CO2-insufflation. Two P10 piglets needed resuscitation after insufflation, none P5. Linear mixed-effect modeling of paCO2, pH, and SaO2 showed that values were dependent on time and time squared (p < 0.001) but were not different between the 5 and 10 mmHg groups. Analysis demonstrated significant changes over time in heart rate and MABP between the 5 and 10 mmHg groups, with a significant higher heart rate and lower blood pressure in the 10 mmHg group (p < 0.001). For rScO2 and cFTOE, no group differences could be demonstrated, but a significant effect of time was found: rScO2 increased and cFTOE decreased (p < 0.001). Conclusions: Insufflation of CO2 during thoracoscopy with 10 mmHg caused more severe hemodynamic instability and seems to be related with a decrease of cerebral perfusion as represented by a higher oxygen extraction. CO2-insufflation of 5 mmHg for thoracoscopy seems to have no adverse effects on cerebral oxygenation.

KW - Cerebral oxygenation

KW - CO2

KW - Endoscopy

KW - Esophageal atresia

KW - Neonatal surgery

KW - Pediatric

KW - Thoracoscopy

UR - http://www.scopus.com/inward/record.url?scp=84939558976&partnerID=8YFLogxK

U2 - 10.1007/s00464-014-4009-5

DO - 10.1007/s00464-014-4009-5

M3 - Article

C2 - 25487546

AN - SCOPUS:84939558976

SN - 0930-2794

VL - 29

SP - 2781

EP - 2788

JO - Surgical Endoscopy

JF - Surgical Endoscopy

IS - 9

ER -

The effects of CO<inf>2</inf>-insufflation with 5 and 10 mmHg during thoracoscopy on cerebral oxygenation and hemodynamics in piglets: an animal experimental study

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