Propofol and fentanyl sedation for laser treatment of retinopathy of prematurity to avoid intubation

Piersigilli, Fiammetta; Pede, Alessandra Di; Catena, G.; Lozzi, Simona; Auriti, Cinzia; Bersani, Iliana; Capolupo, Irma; Lipreri, Anna; Ciommo, Vincenzo Di; Dotta, Andrea; Sgrò, Stefania

doi:10.1080/14767058.2017.1383379

Cited by 17 publications

(16 citation statements)

References 24 publications

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“…Propofol, however, has been widely used as well during intubation and other procedures for sedation and anaesthesia 34–36. Thereby, the level of sedation achieved by the use of propofol was considered satisfactory during surgery in the study of Piersigilli et al , but this was not evaluated objectively 35…”

Section: Discussionmentioning

confidence: 99%

Sedation during minimal invasive surfactant therapy: a randomised controlled trial

Dekker

Lopriore

Zanten

et al. 2018

Arch Dis Child Fetal Neonatal Ed

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Section: Discussionmentioning

confidence: 99%

Sedation during minimal invasive surfactant therapy: a randomised controlled trial

Dekker

Lopriore

Zanten

et al. 2018

Arch Dis Child Fetal Neonatal Ed

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“…Piersigili et al [12] demonstrated that fentanyl analgesia and propofol sedation were effective in this short-term surgery and had no side effects, thus forming the basis of a randomized trial to evaluate propofol safety. They stated that their aim was to avoid intubation in the neonatal patient group, but they used a laryngeal mask for airway safety.…”

Section: Discussionmentioning

confidence: 98%

Sedoanalgesia modality during laser photocoagulation for retinopathy of prematurity: Intraoperative complications and early postoperative follow

Saylan

Akdoğan

Kader

et al. 2020

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Laser photocoagulation (LPC) is a surgical procedure used in the treatment of premature retinopathy that may cause retinal detachment and blindness if not diagnosed and treated early. The anesthesia method used in LPC varies from sedoanalgesia to general anesthesia and airway management varies from spontaneous ventilation to endotracheal intubation. In this study, we aimed to evaluate the effectiveness of sedoanalgesia applications and this anesthesia procedure concerning intraoperative and postoperative complications by avoiding intubation and mechanical ventilation in premature infants with a fragile population. METHODS:This retrospective study included 89 patients who underwent laser photocoagulation under anesthesia for premature retinopathy. Patients' demographic characteristics, preoperative risk factors, anesthesia technique, especially airway management, changes in ventilation status during surgery, intraoperative complications, postoperative complications, and intensive care follow-up, were recorded and analyzed statistically. RESULTS:Two of the 89 patients who underwent laser photocoagulation were excluded from this study because they were followed up intubated. The number of patients who received mask ventilation due to intraoperative complications was 12 (13.8%). The mean operation time was 36.2±10.1 minutes. In 86.2% (n=75) of the patients, the surgical procedure was completed with sedoanalgesia while maintaining spontaneous ventilation. CONCLUSION:Sedoanalgesia application during the surgical intervention of patients with Retinopathy of Prematurity (ROP) requiring early diagnosis and emergency treatment will minimize intraoperative and postoperative complications. We believe that sedoanalgesia as an anesthetic method can be applied as an effective alternative method while preserving spontaneous ventilation.

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“…6 While general anesthesia with intubation may be superior to intravenous sedation in providing ideal operating conditions, it does introduce risk associated with intubation and ventilation of premature infants previously stabilized on non-invasive ventilation strategies. Laryngeal mask airway use has been described with variable success 7 To minimize the risk of a poor retinal outcome, treatment should be performed as soon as possible. 1 Staffing issues however can create a scenario where the only option is to provide laser therapy out of normal working hours.…”

Section: Backg Round and S I G Nific An Cementioning

confidence: 99%

“…While general anesthesia with intubation may be superior to intravenous sedation in providing ideal operating conditions, it does introduce risk associated with intubation and ventilation of premature infants previously stabilized on non‐invasive ventilation strategies. Laryngeal mask airway use has been described with variable success 7 Alternative approaches based on opiate sedation and avoidance of volatile anesthetics have been promoted by units where the availability of ophthalmologists, operating theater sessions, and pediatric anesthetists is limited. Other concerns include avoidance of repeated anesthetic exposure as they may affect neurodevelopment 8 …”

Section: Background and Significancementioning

confidence: 99%

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

Kaur

Carden

Wong

et al. 2020

Pediatric Anesthesia

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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.

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Propofol and fentanyl sedation for laser treatment of retinopathy of prematurity to avoid intubation

Abstract: The good level of anesthesia and analgesia achieved sustains the efficacy of sedation with propofol during laser photocoagulation to avoid intubation and mechanical ventilation during and after the procedure.

Cited by 17 publications

References 24 publications

Sedation during minimal invasive surfactant therapy: a randomised controlled trial

Sedation during minimal invasive surfactant therapy: a randomised controlled trial

Sedoanalgesia modality during laser photocoagulation for retinopathy of prematurity: Intraoperative complications and early postoperative follow

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

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