Inhalation Anesthesia with Sevoflurane during Intravitreal Bevacizumab Injection in Infants with Retinopathy of Prematurity

Abstract

Bacground. To investigate the anesthetic management in premature infants with retinopathy of prematurity (ROP) treated with intravitreal bevacizumab (IVB) injections. Methods. A retrospective chart review was performed for the patients with ROP who had IVB injection. Clinical characteristics, demographic variables, anesthetic medications, operation techniques, time intervals, and complications were recorded. Results. Sixty-six eyes of 33 patients (23 males, 10 females) with type 1 ROP who were treated with IVB were included. A total of 66 anesthetic applications were performed. Mean gestational age at birth was 28.3 weeks (range 25–33). Mean birth weight was 1300 g (range 600–1850). Serious ocular and systemic complications were not observed in any infant. Conclusion. Inhalation anesthesia with sevoflurane during IVB treatment in premature infants with ROP may be appropriate for anesthetic management.

Biomarkers in Diabetic Retinopathy and the Therapeutic Implications

“…Although not currently approved by the FDA for such use, the injection of 0.75 mg–2.5 mg of bevacizumab into the vitreous cavity has been performed without significant intraocular toxicity [ 56 ]. Many retina specialists have noted impressive results in the setting of CNV, proliferative diabetic retinopathy, neovascular glaucoma, diabetic macular edema, retinopathy of prematurity, and macular edema secondary to retinal vein occlusions [ 57 , 58 ]. What is interesting is that in the last work of Suzuki et al 2013, after bevacizumab injection three days before vitrectomy, apart from VEGF reduction, the authors also showed lower levels of IL-1RA, IL-5, IL-10, IL-12, IL-13 cytokines, and IFN- γ [ 59 ].…”

Sedation Protocol During Bevacizumab Intravitreal Injection in Preterm Infants With Retinopathy of Prematurity

“…Owing to the small sample size, it is very difficult to determine what factors put a patient at greater risk of cardiopulmonary AEs. It is difficult to compare these findings to those of Tokgoz et al, 8 as they did not provide definitions for their cardiopulmonary AEs. Despite this, only 1 patient required an intervention with a dose of naloxone for oxygen desaturation, not responding to conventional therapy.…”

“…However, there is a paucity of literature regarding the most appropriate regimen for infants receiving intravitreal bevacizumab. Two studies 7,8 have described the use of analgesic ± sedative agents for these injections. One involved the use of topical agents, and the other report described the use of anesthetic gases in the operating room.…”

Sevoflurane for Short Painful Procedures in the Neonatal Intensive Care Unit

“…Sevoflurane use in newborns, besides surgery, has been previously reported for venous catheterizations, 10,16 intubation, 15 ophthalmoscopy screening for retinopathy of prematurity, 18 or intravitreal bevacizumab injections. 19 The small series of newborns of the study depict what happens every day in a NICU: during admission, infants with different gestational age, corrected postconceptional age, weight, and underlying disease, may require invasive diagnostic or therapeutic techniques (i.e., treatment of retinopathy of prematurity, central lines insertion, biopsy, thoracentesis, or bronchoscopy) with the potential capacity to produce significant pain and discomfort. In some of these situations, sevoflurane will not only allow to control pain-related symptoms, but also to achieve other meaningful results, such as maintaining spontaneous breathing and prevent intubation, get the necessary immobility for the success of the procedure, solve the lack of a venous access, return to clinical baseline situation quickly, and avoid volume overload.…”