Anaesthesia Modalities During Laser Photocoagulation for Retinopathy of Prematurity: a Retrospective, Longitudinal Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2017 Jan 26

PMID 28119385

Citations 12

Authors

Jing-Bo Jiang

Randy Strauss

Xian-Qiong Luo

Chuan Nie

Yan-Li Wang

Jia-Wen Zhang

Zhi-Wei Zhang

Affiliations

Soon will be listed here.

Abstract

Objectives: Laser photocoagulation surgery is a routine treatment for threshold retinopathy of prematurity (ROP). However, little is known about which anaesthesia protocols provide efficient pain control while minimising exposure risk to vulnerable infants. In this study, therefore, we assessed the efficacy and tolerability of multiple anaesthesia techniques used on premature infants during laser therapy.

Design And Main Outcome Measures: Anaesthesia modalities consisted of topical eye drops anaesthesia, general anaesthesia and intravenous fentanyl sedation with mechanical ventilation. Laser treatment efficacy and detailed operative information were retrospectively and consecutively analysed. Cardiorespiratory stability was assessed and compared. The Neonatal Pain Agitation and Sedation Scale (N-PASS) was used to evaluate tolerability in infants that underwent intravenous fentanyl sedation.

Results: 97 cases of prematurity were included in this study. In 94/97 (96.9%) cases, vascular proliferation regressed. In the topical anaesthesia groups, the ophthalmologist needed 12-16 min more to complete the treatment. During the 3 postoperative days, topical anaesthesia demonstrated the greatest instability; 4/31 (12.90%) infants in this group suffered from life threatening events requiring resuscitation. The only instability observed in general anaesthesia and fentanyl sedation was attributed to difficulty in extubating within 24 hours after surgery. During laser therapy, the N-PASS score increased to 1.8 in the fentanyl sedation group.

Conclusions: Topical anaesthesia was associated with more cardiorespiratory instability during ROP laser treatment. While general anaesthesia and fentanyl sedation had similar postoperative cardiorespiratory results, the latter demonstrated acceptable pain stress control. However, the difficulty of weaning off mechanical ventilation in some cases after surgery needs to be addressed in future studies.

Citing Articles

Reducing Intubations and Related Risks in Neonates with Retinopathy of Prematurity Undergoing Laser Photocoagulation.

Quinones Cardona V, Byrne E, Arthur N, Young M, Lavery D, Carroll A Pediatr Qual Saf. 2024; 10(1):e780.

PMID: 39734909 PMC: 11671073. DOI: 10.1097/pq9.0000000000000780.

Role of deferred retinal laser following intravitreal injection of bevacizumab in treatment of severe retinopathy of prematurity.

Bhat V, Patil S Oman J Ophthalmol. 2023; 16(2):233-236.

PMID: 37602171 PMC: 10433051. DOI: 10.4103/ojo.ojo_120_22.

Compared Methods for Reducing Stress in ROP Exams; Stake-Holding Examiner Perspective.

Cuddihee L, Giannulis P, Merriner S, Runge P, Pringels V, McGill V Clin Ophthalmol. 2023; 17:1953-1965.

PMID: 37465272 PMC: 10350462. DOI: 10.2147/OPTH.S418150.

Twelve-year outcomes of bedside laser photocoagulation for severe retinopathy of prematurity.

Yang B, Lian C, Tian R, Chen Y, Tang S, Xiang H Front Pediatr. 2023; 11:1189236.

PMID: 37425279 PMC: 10327642. DOI: 10.3389/fped.2023.1189236.

Respiratory outcomes in preterm infants following intravitreal bevacizumab for retinopathy of prematurity-a 10-year matched case study.

Huang Y, Hsu K, Chu S, Chiang M, Lien R, Chen K Eye (Lond). 2023; 37(17):3675-3681.

PMID: 37400566 PMC: 10686401. DOI: 10.1038/s41433-023-02579-9.

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