Anesthesia management of laser photocoagulation for retinopathy of prematurity. A retrospective review of perioperative adverse events.
anesthesia
general
infant
lasers
premature
retinopathy of prematurity
Journal
Paediatric anaesthesia
ISSN: 1460-9592
Titre abrégé: Paediatr Anaesth
Pays: France
ID NLM: 9206575
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
12
04
2020
revised:
13
08
2020
accepted:
15
08
2020
pubmed:
28
8
2020
medline:
13
7
2021
entrez:
28
8
2020
Statut:
ppublish
Résumé
The aim of this study was to report the incidence of perioperative adverse events occurring in infants undergoing diode laser photocoagulation of retinopathy of prematurity and to identify clinical risk factors that may affect the incidence. This was a retrospective study of anesthetic and medical records of premature infants who were treated in the neonatal intensive care unit or an operating theater with laser photocoagulation in our institution between January 2014 and December 2019. Infants less than 38 weeks post-menstrual age or less than 2000 grams were considered high risk for complications. Electronic medical records were evaluated for clinical and demographic characteristics, comorbidities, and perioperative complications of anesthesia. Sixty-one infants (39 males, 22 females) underwent 72 laser treatments. The mean gestational age was 25.3 weeks (SD 1.6), and mean birth weight was 730 grams (SD 202). At treatment, the mean postmenstrual age was 37.5 weeks (SD 2.7) and weight was 2320 g (SD 610). Laser therapy was performed in an operating theater in 66 procedures (91.7%) and in the neonatal unit in 6 cases (8.3%). Twenty-nine (40.3%) laser surgeries occurred outside normal week-day daytime operating hours. Intraoperative hypotension occurred in 12 procedures (16.7%) but was not significantly different in high-risk infants (16.1% vs 16.7% OR 0.94 P = .94) or in procedures performed in-hours (16.3% vs 17.2% OR 0.93 P = .91). Post-extubation apnea occurred in 21 procedures (29%) but was not significantly different in high-risk infants (29.0% vs 27.3% OR 0.98 P = .34) or in procedures performed in-hours (27.9% vs 31.1% OR 0.86 P = .77). Infants remained intubated at the end of the procedure in 58 (80.5%) cases and 29 (40.3%) remained ventilated more than 24 hours after the procedure. The incidence of perioperative adverse events was not associated with patient's age, current weight, timing, or location of the procedure. Extubating infants at the end of the procedure is however associated with a high rate of apneas and bradycardia, and consideration should be given to keeping low weight infants undergoing prolonged procedures out-of-hours intubated.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1261-1268Informations de copyright
© 2020 John Wiley & Sons Ltd.
Références
Fierson WM. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2018;142(6):e20183061.
Hellstrom A, Smith LE, Dammann O. Retinopathy of prematurity. Lancet. 2013;382(9902):1445-1457.
Good WV, Early Treatment for Retinopathy of Prematurity Cooperative Group. Final results of the Early Treatment for Retinopathy of Prematurity (ETROP) randomized trial. Trans Am Ophthalmol Soc. 2004;102:233-248;discussion 48-50.
Good WV, Hardy RJ, Dobson V, et al. Final visual acuity results in the early treatment for retinopathy of prematurity study. Arch Ophthalmol. 2010;128(6):663-671.
Chen SD, Sundaram V, Wilkinson A, Patel CK. Variation in anaesthesia for the laser treatment of retinopathy of prematurity-a survey of ophthalmologists in the UK. Eye. 2007;21(8):1033-1036.
Klein KS, Aucott S, Donohue P, Repka M. Anesthetic and airway management during laser treatment for retinopathy of prematurity: a survey of US ophthalmologists and neonatologists. J AAPOS. 2013;17(2):221-222.
Piersigilli F, Di Pede A, Catena G, et al. Propofol and fentanyl sedation for laser treatment of retinopathy of prematurity to avoid intubation. J Matern Fetal Neonatal Med. 2019;32(3):517-521.
De Andrade LM, Isenberg SJ. Does general anesthesia or intravitreal injection affect neurodevelopment in children undergoing ophthalmic procedures? Curr Opin Ophthalmol. 2019;30(5):326-330.
Haigh PM, Chiswick ML, O'Donoghue EP. Retinopathy of prematurity: systemic complications associated with different anaesthetic techniques at treatment. Br J Ophthalmol. 1997;81(4):283-287.
Jiang J-B, Strauss R, Luo X-Q, et al. Anaesthesia modalities during laser photocoagulation for retinopathy of prematurity: a retrospective, longitudinal study. BMJ Open. 2017;7(1):e013344.
Sato Y, Oshiro M, Takemoto K, et al. Multicenter observational study comparing sedation/analgesia protocols for laser photocoagulation treatment of retinopathy of prematurity. J Perinatol. 2015;35(11):965-969.
Engorn BM, Kahntroff SL, Frank KM, et al. Perioperative hypothermia in neonatal intensive care unit patients: effectiveness of a thermoregulation intervention and associated risk factors. Paediatr Anaesth. 2017;27(2):196-204.
Bremer DL, Rogers DL, Good WV, Tung B, Hardy RJ, Fellows R. Glaucoma in the Early Treatment for Retinopathy of Prematurity (ETROP) study. J AAPOS. 2012;16(5):449-452.
Long JB, Fiedorek MC, Oraedu O, Austin TM. Neonatal intensive care unit patients recovering in the post anesthesia care unit: An observational analysis of postextubation complications. Paediatr Anaesth. 2019;29(12):1186-1193.
Dannelley JF, Johnson PN, Anderson MP, Oestreich K, Siatkowski RM, Miller JL. Assessment of outcomes with a sedation protocol during laser photocoagulation in preterm infants with retinopathy of prematurity. J Pediatr Pharmacol Ther. 2018;23(5):410-416.
Kirwan C, O'Keefe M, Prendergast M, Twomey A, Murphy J. Morphine analgesia as an alternative to general anaesthesia during laser treatment of retinopathy of prematurity. Acta Ophthalmol Scand. 2007;85(6):644-647.
Gutierrez-Padilla JA, Barrera-DeLeon JC, Meza-Anguiano A, et al. Propofol for procedural anaesthesia during laser treatment of retinopathy of prematurity in the neonatal intensive care unit (NICU). Journal of Neonatal Biology. 2015;4(3):180-184.
Demirel N, Bas A, Kavurt S, et al. Remifentanil analgesia during laser treatment for retinopathy of prematurity: a practical approach in neonatal intensive care unit. Am J Perinatol. 2014;31(11):983-986.
Sammartino M, Bocci MG, Ferro G, et al. Efficacy and safety of continuous intravenous infusion of remifentanil in preterm infants undergoing laser therapy in retinopathy of prematurity: clinical experience. Paediatr Anaesth. 2003;13(7):596-602.
Wang YL, Jeng SF, Tsao PN, Chou HC, Chen CY, Hsieh WS. Operating room within the neonatal intensive care unit-experience of a medical center in Taiwan. Pediatr Neonatol. 2015;56(4):220-225.
Morgan DJR, Ho KM, Ong YJ, Kolybaba ML. Out-of-office hours' elective surgical intensive care admissions and their associated complications. ANZ J Surg. 2017;87(11):886-892.