Bedside Diode Laser Photocoagulation Under Remifentanil Analgesia for Retinopathy of Prematurity: Early Structural Outcomes

Şekeroğlu, Mehmet Ali; Hekimoğlu, Emre; Özcan, Beyza; Baş, Ahmet Yağmur; Demirel, Nihal; Karakaya, Jale

doi:10.4274/tjo.04557

Cited by 5 publications

(2 citation statements)

References 18 publications

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“…[19] Laser photocoagulation was performed using an 810-nm diode laser (İridex, Oculight SL, USA) to the entire avascular retina under remifentanil sedoanalgesia in the neonatal intensive care unit. [20]…”

Section: Methodsmentioning

confidence: 99%

Effect of birth weight on retinopathy of prematurity in discordant twin pairs

Petriçli

Kara

Işık

et al. 2019

Indian J Ophthalmol

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Purpose: Since twin pairs with discordance have equal gestational age (GA), discordant twins may constitute an appropriate group to investigate the specific effect that birth weight (BW) has on the development of retinopathy of prematurity (ROP). The present study aims to investigate the effect of BW on any and severe stages of ROP development in twin pairs. Methods: Fifty-two discordant twin pairs (104 preterms) born ≤32 gestational weeks, who were diagnosed with a minimum of 18% discordance between their BWs, were retrospectively analyzed. Twin pairs were separated into two groups based on the BW of each pair. The rate of any stage of ROP, Type 1 ROP, and perinatal risk factors were compared statistically among twin pairs. Results: The rate of any stage of ROP and Type 1 ROP was 24.0% and 4.8% in the whole group, respectively. A statistically significant difference was shown between lower and higher BW groups at any stage of ROP development (34.6% vs. 13.4%, P = 0.02). However, no difference was observed in Type 1 ROP development (7.7% vs. 1.9%, P = 0.17). No significant differences were found between twin pairs regarding neonatal morbidities. The number of small GA (SGA) infants in the smaller twin group was statistically higher than larger group and regression analysis showed that being SGA had significant correlation with any stage of ROP (odds ratio: 4.98, P = 0.02). Conclusion: This study showed that BW serves an effective role at any stage of ROP development in discordant twin pairs; however, no significant difference in terms of Type 1 ROP.

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Section: Methodsmentioning

confidence: 99%

Effect of birth weight on retinopathy of prematurity in discordant twin pairs

Petriçli

Kara

Işık

et al. 2019

Indian J Ophthalmol

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“…This practice not only subjects the infant to severe and prolonged pain but also adverse longterm neurodevelopmental consequences like impairment in cognition, learning disorders, attentional disorders, behavioural problems and motor abnormalities. 4 5 Opioid analgesics (morphine, fentanyl and remifentanil) and ketamine have been found to be useful for providing sedation and analgesia during laser photocoagulation in multiple studies [6][7][8][9][10][11][12] ; however, their optimal dosage and safety profile have not been well studied in neonates. Recently, we conducted a randomised trial comparing intravenous fentanyl (continuous infusion of 1 µg/kg/hour throughout the procedure) and oral 24% dextrose in providing analgesia to the infants undergoing laser photocoagulation.…”

Section: Introductionmentioning

confidence: 99%

‘NOPAIN-ROP’ trial: Intravenous fentanyl and intravenous ketamine for pain relief during laser photocoagulation for retinopathy of prematurity (ROP) in preterm infants: A randomised trial

et al. 2021

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ObjectivesTo investigate if intravenous fentanyl or intravenous ketamine can provide adequate analgesia in preterm infants undergoing laser photocoagulation for retinopathy of prematurity (ROP).DesignOpen-label randomised trial.SettingTertiary care institution.ParticipantsPreterm infants who underwent laser photocoagulation for ROP.InterventionsInfants were randomised to receive fentanyl as intravenous bolus dose of 2 µg/kg, followed by an intravenous infusion of 1 µg/kg/hour increased to a maximum of 3 µg/kg/hour or intravenous ketamine as bolus dose of 0.5 mg/kg, followed by further intermittent intravenous bolus doses of 0.5 mg/kg to a maximum of 2 mg/kg in the initial phase and intravenous fentanyl (bolus of 2 µg/kg followed by infusion of 2 µg/kg/hour to a maximum of 5 µg/kg/hour) or intravenous ketamine (bolus dose of 1 mg/kg followed by intermittent bolus doses of 0.5 mg/kg to a maximum of 4 mg/kg) in the revised regimen phase.Main outcome measuresProportion of infants with adequate analgesia defined as the presence of both: (1) all the Premature Infant Pain Profile-Revised scores measured every 15 min less than seven and (2) proportion of the procedure time the infant spent crying less than 5%.Secondary outcomes included apnoea, cardiorespiratory or haemodynamic instability, feed intolerance and urinary retention requiring catheterisation during and within 24 hours following the procedure.ResultsA total of 97 infants were randomised (fentanyl=51, ketamine=46). The proportions of infants with adequate analgesia were 16.3% (95% CI 8.5% to 29%) with fentanyl and 4.5% (95% CI 1.3% to 15.1%) with ketamine. Ten infants (19.6%) in the fentanyl group and seven infants (15.2%) in the ketamine group had one or more side effects. In view of inadequate analgesia with both the regimens, the study steering committee recommended using a higher dose of intravenous fentanyl and intravenous ketamine. Consequently, we enrolled 27 infants (fentanyl=13, ketamine=14). With revised regimens, the proportions of infants with adequate analgesia were higher: 23.1% (95% CI 8.2% to 50.2%) with fentanyl and 7.1% (95% CI 1.3% to 31.5%) with ketamine. However, higher proportions of infants developed apnoea (n=4; 30.7%), need for supplemental oxygen (n=5, 38.4%) and change in cardiorespiratory scores (n=7; 53.8%) with fentanyl but none with ketamine.ConclusionsFentanyl-based and ketamine-based drug regimens provided adequate analgesia only in a minority of infants undergoing laser photocoagulation for ROP. More research is needed to find safe and effective regimens that can be employed in resource constrained settings.Trial registration numberCTRI/2018/03/012878.

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Retinopathy of prematurity treatment: Asian perspectives

Sen

Chandra

et al. 2019

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Bedside Diode Laser Photocoagulation Under Remifentanil Analgesia for Retinopathy of Prematurity: Early Structural Outcomes

Cited by 5 publications

References 18 publications

Effect of birth weight on retinopathy of prematurity in discordant twin pairs

Effect of birth weight on retinopathy of prematurity in discordant twin pairs

‘NOPAIN-ROP’ trial: Intravenous fentanyl and intravenous ketamine for pain relief during laser photocoagulation for retinopathy of prematurity (ROP) in preterm infants: A randomised trial

Retinopathy of prematurity treatment: Asian perspectives

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