[size=20px]You are planning to operate on a 2.5-kg full term infant with esophageal atresia and distal tracheoesophageal fistula.

 

If you use three to five mmHg CO₂ insufflation pressure during thoracoscopic repair, compared to open repair, you would expect to

 

A decrease in mean arterial blood pressure.

 

B increase in paCO_2.

 

C decrease in pH.

 

D decrease in regional cerebral oxygen saturation.

 

E maintain similar pH and paCO_2.[/size]

(Untitled)

 

e

e

correct

 

The potential negative effect of laparoscopic and thoracoscopic carbon dioxide insufflation has been an area of extensive investigation. Recent concerns have been raised about the short and long term effects of CO₂ insufflation in neonatal thoracoscopic surgery. Reports by Bishay and Tytgat have reported that thoracoscopic CO₂ insufflation in neonates, specifically during the repair of esophageal atresia with tracheoesophageal fistula, did not result in significant (compared to open operations) or dangerous decreases in PaO₂, pH, regional cerebral oxygen saturations or increases in PaCO₂. On the other hand, Bishay did report that thoracoscopic repair of congenital diaphragmatic hernia did result in significant decreases in PaO₂ and pH and increases in PaCO₂. However, this paper did not report the CO₂ insufflation pressures used. Stowijk reports in animals that in thoracoscopic neonatal surgery, lower (i.e. less than 5 mmHg) CO₂ pressures are safer than higher (greater than10 mmHg) pressures.