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RESPIRATORY OUTCOME IN PRETERM AND FORMER PRETERM INFANTS UNDERGOING LASER TREATMENT FOR RETINOPATHY OF PREMATURITY: AN IMPACT OF ANESTHETIC TECHNIQUE
Abstract Number: 98
Abstract Type: Original Research
Introduction: Retinopathy or prematurity (ROP) is a leading cause of potentially preventable blindness in infants and children (1). Current treatments consist of close monitoring of oxygen saturation levels, peripheral retinal ablation by cryotherapy or laser photocoagulation, and vitreoretinal surgery. Laser treatment (LT) for ROP may be associated with systemic stress response. No universal consensus on the optimum method of anesthesia for the treatment of ROP currently exists (2). The aim of our study was to evaluate the respiratory outcome in preterm (PT) and former preterm (FPT) infants undergoing LT for ROP under two different anesthetic techniques.
Materials and methods: Twenty one PT and FPT infants with ROP were scheduled for LT under general (sevoflurane, atracurium and opiod) based anesthesia with endotracheal intubation. The infants were randomly divided into two groups; 9 infants were included in the fentanyl, 10 mcg/kg intravenous (i.v.) bolus group (A), and 12 infants in the remifentanil, 0. 75 mcg/kg i.v. bolus at induction followed by the infusion 0.4 mcg/kg/min group (B). Mechanical ventilation was provided in pressure-control mode with respiratory rate and FiO2 adjusted to maintain oxygen saturation at no less than 93%. Postoperatively, an incidence of apnea, duration of mechanical ventilation, nasal continuous positive airway pressure (CPAP), and need for additional oxygen therapy were studied.
Results: There was no statistically significant association of outcome with birth age, birth weight, corrected gestational age and the duration of anesthesia. However, remifentanil based GA in infants with ROP resulted in a significantly shorter time of postoperative ventilatory support and less incidence of postoperative apnea. (Table 1).
Discussion: Decreasing the time of postoperative ventilatory support in infants with ROP is crucial and anesthetic technique (specifically the choice of an opiod for perioperative analgesia) may be a key factor. Recently remifentanil has been considered an optimal analgesic drug in preterm infants, but no clinical studies have been reported yet.
Conclusion: Our pilot study indicates that remifentanil is associated with good perioperative pain control and early extubation resulting in an excellent neonatal outcome in infants undergoing LT for ROP. This investigational approach requires further validation by multicenter studies.
1. Eye (Lond) 2010; 24:14-20.
2. Paediatr Anaesth 2008; 18:1103-5