Systemic Manifestations in Response to Mydriasis and Physical Examination During Screening for Retinopathy of Prematurity

Rush, Ryan B; Rush, Sloan W; Nicolau, John; Chapman, Karen; Naqvi, Mubariz

doi:10.1097/00006982-200404000-00009

Cited by 87 publications

(53 citation statements)

References 10 publications

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“…Oxygen saturation significantly decreases and pulse rate significantly increases during physical manipulation of the eye, and variations in these parameters may be associated with significant neonatal distress. [12][13][14] The use of topical anesthesia alone is associated with an increased incidence of potentially life-threatening cardiorespiratory events when compared to the use of GA. 15 The current survey shows that the methods and availability of different forms of anaesthesia used during laser treatment of ROP varies widely. Although a number of ophthalmologists who perform ROP treatment may have been overlooked during the initial stage of the survey, we are confident that most were identified.…”

Section: Discussionmentioning

confidence: 99%

Variation in anaesthesia for the laser treatment of retinopathy of prematurity—a survey of ophthalmologists in the UK

Chen¹,

Sundaram²,

Wilkinson

et al. 2006

Eye

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Purpose Laser treatment for retinopathy of prematurity (ROP) may be associated with systemic stress for the infant. No national consensus on the optimum method of anaesthesia for the treatment of ROP currently exists. This study ascertains the anaesthetic practices employed for the treatment of ROP by ophthalmologists in the United Kingdom (UK), and also their attitudes towards these practices. Materials and methods A postal questionnaire was sent to 46 consultant ophthalmologists identified as performing treatment for ROP in the UK. The consultants were asked to estimate the annual number of babies with ROP that they treated with laser, what methods of anaesthesia they employed, for comments regarding the arrangements for, and types of anaesthesia employed and whether they believed that the neonatal stress response to laser treatment was associated with a significant risk of systemic complications. Results In all, 35 (76%) questionnaires were returned. A total of 30 (86%) respondents reported performing laser treatment for ROP. Of these, 15 (50%) used general anaesthesia for all cases and 11 (37%) intravenous sedation combined with topical anaesthesia for all cases. Oral sedation combined with topical anaesthesia, rectal chloral hydrate and paracetamol combined with topical anaesthesia, intravenous ketamine combined with topical anaesthesia, and subtenon's local anesthesia were used by one (3%) respondent each. There were no ophthalmologists using subconjunctival or topical anaesthetic alone or treating without anaesthesia. Conclusion This survey reveals considerable variation in practice among UK ophthalmologists regarding the anaesthetic methods employed in the treatment of ROP, and their beliefs regarding the systemic stress associated with treatment.

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Section: Discussionmentioning

confidence: 99%

Variation in anaesthesia for the laser treatment of retinopathy of prematurity—a survey of ophthalmologists in the UK

Chen¹,

Sundaram²,

Wilkinson

et al. 2006

Eye

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“…These may be related to the manipulation performed during the ophthalmologic examination, or to the medication used to generate mydriasis 5,6 . These side effects can occur immediately, such as altered vital signs, changes in heart rate, blood pressure, apnea events, hypoxemia among others 7 .…”

Section: Discussionmentioning

confidence: 99%

“…There are also other factors other than the application of mydriatics that are associated with side effects, similar to the procedure, which generates pain and the oculo-cardiac reflex, which can condition apnea, bradycardia, changes in oxygen saturation, pulse and Blood pressure 6,13 .…”

Section: Discussionmentioning

confidence: 99%

Palidez peri orbitaria post aplicación de midriaticos en neonatos con hidrocefalia asociado a efectos sistémicos

Socarras

Rodríguez

2017

Rev. chil. pediatr.

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Keywords:Phenylephrine, hydrocephalus, preterm, mydriatic drops AbstractAdequate pupil dilation is needed to evaluate some neonates at risk of developing illness during this stage. However, this procedure is not free of adverse effects, either local or systemic. One of these complications is the local vasoconstriction of the preterm baby's skin following the application of mydriatic eye drops. Objective: To describe secondary local and systemic complications of pharmacological pupil dilation in 2 newborns. Clinical case 1: Full term baby with diagnosis of low-birth weight and hydrocephalia. An ophtalmological evaluation was performed at 5 days of age due to the presence of corneal opacities. Peri ocular pallor was observed during the procedure, as well as tachycardia and hypertension 2 hours later, spontaneosly recovered. Case 2: Preterm newborn, 27 weeks of gestational age. Neonatal respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage and hydrocephalia were diagnosed at birth. At 28 days of life an ophtalmological evaluation was performed. After 10 minutes of mydriatic drops administration to evaluate preterm retinopathy, peri ocular pallor was observed, with spontaneous resolution; however, 24 hours later, the patient showed abdominal distention and feeding intolerance. Necrotizing enterocolitis was discarded, and symptoms were spontaneosly recovered. Conclusion: The establishment of protocols in relation to the number of drops to apply for dilation is needed to reduce deleterious effects on high risk infants, such as premature babies and those with hydrocephalus. Therefore this monitoring practice should be performed during the evaluation.clinical caSe

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“…[25][26][27] Of note, our trisomy 21 data do not distinguish between the presence of a complete additional chromosome versus partial translocations. 30 Retinal hemorrhages have been reported from ocular manipulation and dilating eye drops can have adverse systemic effects. 31 Most worrisome is the increase in apneic events that occur in the 24-to 48-hour postexamination period.…”

Section: Discussionmentioning

confidence: 99%

Trisomy 21 and Risk of Retinopathy of Prematurity

Movsas¹,

Spitzer

Gewolb

2015

Pediatrics

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Systemic Manifestations in Response to Mydriasis and Physical Examination During Screening for Retinopathy of Prematurity

Cited by 87 publications

References 10 publications

Variation in anaesthesia for the laser treatment of retinopathy of prematurity—a survey of ophthalmologists in the UK

Variation in anaesthesia for the laser treatment of retinopathy of prematurity—a survey of ophthalmologists in the UK

Palidez peri orbitaria post aplicación de midriaticos en neonatos con hidrocefalia asociado a efectos sistémicos

Trisomy 21 and Risk of Retinopathy of Prematurity

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