Aim of the study Infants undergoing neonatal surgery for thoracoscopic esophageal atresia repair are at high risk of adverse neurodevelopmental outcomes. Increasing concerns have been raised about the incidence of perioperative brain injury, this is suggested to be due to haemodynamic instability and hypoxia perioperatively. We evaluated the effects of CO2-insufflation on regional cerebral oxygen saturation (rScO₂) during thoracoscopic esophageal atresia repair.

Methods Observational study of 20 neonates undergoing thoracoscopic esophageal atresia repair. During surgery mean blood pressure (MABP), FiO₂, arterial saturation and the cerebral oxygen saturation (rScO₂) were continuously monitored.

Four periods of 10 min were selected: (T=0) during anaesthesia, (T=1 and T=2) during CO₂-insufflation and (T=3) after desufflation.

Main results Complete registration was obtained in 14 neonates (median GA 36.9 [30.6–41.9], birth weight 2358 g [1395–4490]) and were included.

After CO₂-insufflation the FiO₂ increased from 41% to 58%, whilst the saturation decreased from 96.3% to 92.5%(p < 0.05).

The arterial pCO₂ (mmHg) changed from 47 ± 6.9 to 56 ± 13(p < 0.05) after CO₂-insufflation and remained stable at the end of insufflation and after desufflation.

The rScO₂ did not change after CO₂-insufflation or desufflation.

Conclusion Intrathoracic CO₂-insufflation causes a decrease in arterial saturation and an increase in arterial pCO₂. However, more importantly these changes did not result in significant fluctuations in cerebral oxygenation throughout the procedure. The insufflation of CO₂ with 5 mmHg during thoracoscopy seems to be safe in neonates, since the cerebral oxygenation was preserved during the procedure.