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Anaesthesia modalities during laser photocoagulation for retinopathy of prematurity: a retrospective, longitudinal study
  1. Jing-bo Jiang1,2,
  2. Randy Strauss3,
  3. Xian-qiong Luo2,
  4. Chuan Nie2,
  5. Yan-li Wang2,
  6. Jia-wen Zhang2,
  7. Zhi-wei Zhang1
  1. 1Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
  2. 2Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou, China
  3. 3Virginia Tech Carilion Research Institute, Roanoke, Virginia, USA
  1. Correspondence to Dr Zhi-wei Zhang; ball.1361{at}icloud.com

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.

  • retinopathy of prematurity
  • laser
  • stress response
  • fentanyl
  • cardio-respiratory

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors J-bJ and Z-wZ conceived the study. X-qL and CN contributed to developing the statistical methodology for the study. Y-lW, J-wZ prepared the data for analysis. All authors contributed to covariate selection and interpretation of the results. J-bJ prepared the first draft of the paper. Randy Strauss took the responsibility to revise the manuscript.

  • Funding All phases of this study were supported by Guangdong Provincial Scientific Institute Supportive and Innovative Program (2015B 070701008) and National Natural Science Foundation of China (71173055, 2011).

  • Competing interests None declared.

  • Parental consent Obtained.

  • Ethics approval The ethics committee of Guangdong Province Women and Children's Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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