Anesthesia management of laser photocoagulation for retinopathy of prematurity. A retrospective review of perioperative adverse events

Abstract

Aims: 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. Methods: 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. Results: 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 weekday 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. Conclusion: 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.

High rate and large intercentre variability in retreatment of retinopathy of prematurity in infants born <24 gestational weeks

“…Infants undergoing laser treatment have been found to be at high risk of intraoperative and postoperative adverse events like hypotension, bradycardia and apnoea. 33 Repeated anaesthetic procedures may affect the infants' neurodevelopment, and there are concerns about the long-term effects of anti-VEGF treatment on neurodevelopmental outcome. 34 Thus, it is crucial that the ROP screening and treatment procedures are as efficient and gentle as possible, especially as several authors have stressed that ROP is a biomarker for brain volumes at term and later neurodevelopmental outcomes.…”

Our General Anesthesia Experiences in Premature Patients Undergoing Laser Photocoagulation in Retinopathy Treatment: A Retrospective Evaluation

“…Apart from postoperative apnea and hypoventilation, one of the reservations about the use of opioids and muscle relaxants is prolonged intubation times. In a study in which all infants were intubated with sevoflurane, opioids and muscle relaxants, only 19.4% of the infants could be extubated at the end of the procedure and 40.3% continued mechanical ventilation after 24 hours (23). In 71 cases reported by Nath, LMA was placed in all infants using only sevoflurane and only one infant needed postoperative ventilation, and two infants developed postoperative apnea and bradycardia (24).…”

Anesthesia in retinopathy of prematurity

“…However, it carries moderate rates of intraoperative hypotension and postextubation apnea. [ 79 80 ] Likewise, for aggressive ROP requiring vitrectomy, studies have shown that half of the patients were successfully extubated in the operating room, no postoperative complications were observed, and that early vitrectomy is effective despite the perioperative risks. [ 81 ]…”

“…[ 82 ] A summary of reviewed GA studies during ROP treatment is shown in Table 7 . [ 8 9 16 59 76 79 80 81 82 83 84 85 86 87 88 ]…”