Mark Wefers Bettink

Mitochondrial oxygen monitoring during surgical repair of congenital diaphragmatic hernia or esophageal atresia: 9 169 An Alacare ® plaster has a square format of 2 by 2 cm and contains 2mg per cm 2 ALA (Alacare, photonamic, Pinneberg, Germany). The plaster is covered by an aluminum layer to protect the primed skin to light exposure (Figure 1) (28). The plaster was applied in the pediatric intensive care unit (ambient temperature of approximately 22 degrees of Celsius) on the skin on the frontal side of the upper leg for at least 4 hours before starting the measurement. Research in adults showed that a priming time of 4 hours or more was needed to synthesize the suitable concentration of PpIX to enables measurements of mitoPO2 in the skin (15).The same minimal priming time was maintained in this study. Fig 1. The ALA plaster with the aluminium cover (A) and the ALA side (B), double-sided tape (C) which is used for the application of the COMET-skin sensor (red arrow) on the frontal side of the upper leg (D) and the Cellular Oxygen METabolism (COMET) monitor (E). The COMET-skin sensor has a biocompatible housing of 7 x 2 x 2 cm. The skin sensor was placed on the primed skin and was attached to the skin by a double-sided plaster provided by the COMET manufacturer (Figure 1). The influence of light on the primed skin during the application of the COMET-skin sensor was minimized by turning off the surgical luminaires/lamps. After the application of the skin sensor, the biocompatible housing was covered with aluminum foil. Continuous registration of routine vital parameters, regional cerebral oxygenation (rSO 2 ) (INVOS TM 5100C) and mitochondrial saturation (COMET) were obtained and stored for off-line analyses. Sampling rate of the vital parameters was every second, rSO 2 every 6 seconds and mitochondrial oxygen tension (mitoPO 2 ) every 60 seconds. Intraoperative management was registered in our Patient Data Management System. Patients received