Retinopathy of prematurity: systemic complications associated with different anaesthetic techniques at treatment

• Published in: British journal of ophthalmology 1997-04, Vol.81 (4), p.283-287
• Main Authors: Haigh, Paul M, Chiswick, Malcolm L, O’Donoghue, Eamonn P
• Format: Article
• Language: English
• Subjects: anaesthetic techniques; Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics - adverse effects; Biological and medical sciences; Bronchopulmonary Dysplasia - etiology; Child, Preschool; complications; Humans; Infant, Newborn; Medical sciences; Original articles - Clinical science; Orthopedic surgery. Maxillofacial surgery. Otorhinolaryngologic surgery. Stomatology. Ophtalmology. Investigation and treatment technics; Postoperative Complications - etiology; Pulmonary Surfactants - therapeutic use; Respiration, Artificial; retinopathy of prematurity; Retinopathy of Prematurity - surgery; Steroids - therapeutic use; Treatment Outcome
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.81.4.283

BACKGROUND Treatment of retinopathy of prematurity (ROP) in the UK is subject to considerable regional variation in terms of anaesthetic support. Change in practice at St Mary’s neonatal medical unit from topical to general anaesthesia and, subsequently, to sedation/analgesia allowed comparison of the impact of these three modalities on infants’ early postoperative course in a consecutive, non-randomised, observational study. METHODS The study population consisted of 30 babies undergoing treatment of threshold ROP. Twelve were treated using topical anaesthesia alone (group A), six using general anaesthesia (group B), and 12 using sedation/analgesia combined with elective intubation and artificial ventilation (group C). Daily measurements of infant health were recorded starting 4 days preoperatively and continuing for 7 days postoperatively to facilitate the formulation of a cardiorespiratory stability index as follows: (0) improvement from baseline, (1) no change from baseline, (2) mild instability, (3) marked instability, and (4) life threatening event. RESULTS Within the first 48 hours postoperatively in group A 5/12 showed mild instability and 4/12 showed marked instability (including three babies suffering life threatening events requiring emergency resuscitation). In group B within the first 48 hours postoperatively 1/6 showed mild and 1/6 showed marked instability, and in group C 5/12 babies showed mild instability alone. There was a significant difference for cardiorespiratory stability scores between the three groups overall for the 7 days postoperatively (repeated measures ANOVA, p = 0.018). CONCLUSIONS Premature infants undergoing cryotherapy for ROP who were treated using topical anaesthesia alone had more severe and protracted cardiorespiratory complications.