{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T23:10:19Z","timestamp":1788995419838,"version":"build-2803163510"},"reference-count":20,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2017,5,24]],"date-time":"2017-05-24T00:00:00Z","timestamp":1495584000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Intraoperative hypercapnia and acidosis are risk factors during thoracoscopy in neonates and infants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a prospective pilot study, we evaluated the effects of thoracoscopy in neonates and infants on cerebral microcirculation, oxygen saturation, and oxygen consumption. Regional cerebral oxygen saturation and blood flow were measured noninvasively using a new device combining laser Doppler flowmetry and white light spectrometry. Additionally, cerebral fractional tissue oxygen extraction and approximated oxygen consumption were calculated.<\/jats:p><jats:p>Fifteen neonates and infants undergoing thoracoscopy were studied using the above\u2010mentioned method. The chest was insufflated with carbon dioxide with a pressure of 2\u20106 mm Hg. Single lung ventilation was not used. As control group served 15 neonates and infants undergoing abdominal surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data are presented as median and range. The 95% confidence intervals for differences of means (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>) are given for the mean difference from baseline values.<\/jats:p><jats:p>We observed a correlation between intrathoracic pressure exceeding 4 mm Hg and transient decrease in regional cerebral oxygen saturation of 12.7% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 9.7\u201317.2, <jats:italic>P<\/jats:italic>&lt;.001). Peripheral oxygen saturation was normal at the same time.<\/jats:p><jats:p>Intraoperative increase in arterial pa<jats:styled-content style=\"fixed-case\">CO<\/jats:styled-content><jats:sub>2<\/jats:sub> (median maximum value: 48.8 mm Hg, range: [36.5\u201065.4]; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: \u221216.0 to \u22123.0, <jats:italic>P<\/jats:italic>=.002) and decrease in arterial <jats:styled-content style=\"fixed-case\">pH<\/jats:styled-content> (median minimum value: 7.3, range: [7.2\u20107.4]; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.04\u20100.12, <jats:italic>P<\/jats:italic>=.008) were observed during thoracoscopy with both parameters recovering at the end of the procedure.<\/jats:p><jats:p>Periods of regional cerebral oxygen saturation below 20% from baseline were significantly more frequent during thoracoscopy as compared to the control group (median maximum value: 1.3%min\/h, range: [0.0\u201066.2] vs median maximum value: 0.0%min\/h, range: [0.0\u20104.0]; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: \u221216.6 to \u22121.1, <jats:italic>P<\/jats:italic>=.028).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We suggest that thoracoscopic surgery in neonates and infants, although generally safe, may be associated with a decrease in regional cerebral oxygen saturation correlating with the applied intrathoracic pressure. According to our data an inflation pressure &gt;4 mm Hg should be avoided during thoracoscopic surgery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.13161","type":"journal-article","created":{"date-parts":[[2017,5,25]],"date-time":"2017-05-25T17:08:55Z","timestamp":1495732135000},"page":"752-759","source":"Crossref","is-referenced-by-count":28,"title":["Elevated intrathoracic <scp>CO<\/scp><sub>2<\/sub> pressure during thoracoscopic surgery decreases regional cerebral oxygen saturation in neonates and infants\u2014A pilot study"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6818-7276","authenticated-orcid":false,"given":"Felix","family":"Neunhoeffer","sequence":"first","affiliation":[{"name":"Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine University Children's Hospital Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven W.","family":"Warmann","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Pediatric Urology University Children's Hospital Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hofbeck","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine University Children's Hospital Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alisa","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine University Children's Hospital Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Fideler","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine University Hospital Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Seitz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery University Hospital Giessen\/Marburg Marburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin U.","family":"Schuhmann","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery University Hospital Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans\u2010Joachim","family":"Kirschner","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Pediatric Urology University Children's Hospital Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Kumpf","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine University Children's Hospital Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Pediatric Urology University Children's Hospital Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,5,24]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2004.10.021"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-008-0025-7"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1089\/lap.2010.0349"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1089\/lap.2011.0356"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2013.47"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2011.10.002"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31828fab55"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2010.09.062"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/ANA.0b013e3181bea439"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e3182178bc9"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer227"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12397"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00710.2002"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2010.01902.x"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2010.03772.x"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.575167"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1726-4901(09)70301-6"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1203\/01.pdr.0000182180.80645.0c"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-014-4009-5"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1179\/1743132814Y.0000000397"}],"container-title":["Pediatric 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