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Gavriilidou A, Seliniotaki AK, Arvanitaki Z, Ziakas N, Haidich AB, Mataftsi A. Safety profile of anesthetic modalities during laser treatment for retinopathy of prematurity: a systematic review. J Perinatol 2023; 43:685-693. [PMID: 36709402 DOI: 10.1038/s41372-023-01622-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/09/2023] [Accepted: 01/20/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To determine the anesthetic approach with the least adverse events and better cardiorespiratory stability profile, used in infants undergoing laser photocoagulation for retinopathy of prematurity. STUDY DESIGN A systematic review was conducted. PubMed, Scopus, and Cochrane Library were searched until 27th October 2021. Reference lists of relevant studies, and abstract books of international annual meetings of pediatric Οphthalmology for the years 2020 and 2021 were also looked at, as well as Clinical trials registry ( https://clinicaltrials.gov/ ). RESULT Overall 18 primary studies (3 randomized controlled trials, 3 cohorts, 12 case series) were included, investigating different anesthetic modalities. Cardiopulmonary instability was more common, and hypothermia was less common in the sedation groups of pentazocine/midazolam and fentanyl/midazolam, compared to the general anesthesia group of air/oxygen/sevoflurane (AOS). Cardiorespiratory instability was also more common in sedation with propofol/ketamine compared to general anesthesia with AOS, while postoperative mechanical ventilation was more frequently needed in the latter. Αpnea, need for supplemental oxygen and cardiorespiratory instability was more frequent in infants receiving fentanyl as opposed to ketamine. Fentanyl compared to morphine presented no differences in safety parameters. Finally, topical anesthesia showed the greatest instability with a higher mean postoperative cardiorespiratory index, compared to both sedation and general anesthesia. Episodes of life-threatening events were reported after topical anesthesia, while hypothermia and oliguria presented less often after topical, compared to general anesthesia and sedation. CONCLUSION Significant heterogeneity among studies precludes direct comparisons and generalizability of the results. No specific anesthetic modality for treatment of ROP with laser photocoagulation was shown to be superior in terms of safety. Well-designed studies are required to establish the optimal anesthetic approach, considering that laser photocoagulation still remains one of the main therapeutic modalities for ROP.
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Affiliation(s)
- Ariadni Gavriilidou
- Department of Ophthalmology, 424 General Military Hospital, Thessaloniki, Greece
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini K Seliniotaki
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Zoi Arvanitaki
- Department of Anesthesiology, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asimina Mataftsi
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Barry GP, Tauber KA, Greenberg S, Lajoie J, Afroze F, Oechsner H, Finucane E, Binenbaum G. A Comparison of Respiratory Outcomes after Treating Retinopathy of Prematurity with Laser Photocoagulation or Intravitreal Bevacizumab. Ophthalmol Retina 2020; 4:1202-1208. [PMID: 32512055 DOI: 10.1016/j.oret.2020.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/21/2020] [Accepted: 06/01/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE To compare respiratory outcomes after treatment of retinopathy of prematurity (ROP) between infants treated with laser therapy under general anesthesia and infants treated with intravitreal bevacizumab under bedside sedation. DESIGN Retrospective cohort study. PARTICIPANTS One hundred thirty-eight consecutive infants treated for ROP from September 2010 through September 2018 at 1 institution. METHODS Retrospective medical, procedural, and ophthalmologic data were collected, including preprocedure (baseline) and postprocedure (24 hours, 48 hours, 7 days, and 28 days) respiratory status, birth weight, gestational age, gender, ROP treatment method, postmenstrual age at treatment, and coincident nonocular procedures during anesthesia. Respiratory outcomes at 48 hours were compared between infants treated with laser therapy under general anesthesia and infants treated with intravitreal bevacizumab under local sedation using multivariate logistic regression analysis to control for potentially confounding factors. MAIN OUTCOME MEASURES Proportion of infants who had returned to their respiratory baseline by 48 hours after ROP treatment. RESULTS Return to respiratory baseline was significantly less common among 119 infants initially treated with laser therapy compared with 19 infants initially treated with bevacizumab at 24 hours (40% vs. 74%; P = 0.0115), 48 hours (53% vs. 79%; P = 0.0453), and 7 days (79% vs. 100%; P = 0.0242). In a multivariate logistic regression analysis, infants treated with laser therapy were less likely to return to respiratory baseline at 48 hours (odds ratio, 0.14; 95% confidence interval, 0.04-0.54). At 28 days, no difference was found between groups (laser, 97%; bevacizumab, 100%; P > 0.99). CONCLUSIONS Infants treated with intravitreal bevacizumab using bedside sedation returned to their preprocedure respiratory baseline faster than infants treated with laser under general anesthesia, with the differences persisting at least to 7 days or more after the procedure.
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Affiliation(s)
- Gerard P Barry
- Department of Ophthalmology, Albany Medical College, Albany, New York; Department of Pediatrics, Albany Medical College, Albany, New York.
| | - Kate A Tauber
- Department of Pediatrics, Albany Medical College, Albany, New York
| | - Scott Greenberg
- Department of Ophthalmology, Albany Medical College, Albany, New York
| | - Juliann Lajoie
- Department of Ophthalmology, Albany Medical College, Albany, New York
| | - Farzana Afroze
- Department of Anesthesia, Albany Medical College, Albany, New York
| | - Helena Oechsner
- Department of Anesthesia, Albany Medical College, Albany, New York
| | | | - Gil Binenbaum
- Department of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Pirelli A, Savant Levet P, Garetti E, Ancora G, Merazzi D, Bellieni CV, Lago P. Literature review informs clinical guidelines for pain management during screening and laser photocoagulation for retinopathy of prematurity. Acta Paediatr 2019; 108:593-599. [PMID: 30054933 DOI: 10.1111/apa.14523] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 06/29/2018] [Accepted: 07/25/2018] [Indexed: 01/12/2023]
Abstract
AIM The aim of this study was to carry out a literature review and develop clinical guidelines for pain prevention and control during screening and laser photocoagulation for retinopathy of prematurity (ROP) in neonatal intensive care units (NICUs). METHODS The Italian Society of Neonatology assessed papers published between 1986 and June 2017 and used the Grading of Recommendations, Assessment, Development and Evaluation approach, to develop new guidelines on pain and ROP. RESULTS The Society's pain experts assessed the full texts of 47 papers, including randomised or quasi-randomised controlled trials and case-control studies on nonpharmacological and pharmacological measures used in NICUs during the screening and laser photocoagulation of neonates for ROP. The literature suggested methods for reducing the stress and pain associated with ROP screening procedures. The panel concluded that the literature showed that it was feasible to provide laser photocoagulation for ROP in spontaneously breathing patients with adequate analgesia. CONCLUSION This literature review on managing pain in infants with ROP in NICUs led to the development of national guidelines, which will help physicians and nurses to reduce the stress and pain experienced by premature newborn infants during unavoidable screening and treatment for ROP.
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Affiliation(s)
- Anna Pirelli
- NICU; Women's and Children's Health Department; ASST Rhodense; Ospedale of Rho; Rho Italy
| | | | - Elisabetta Garetti
- NICU; Women's and Children's Health Department; Azienda Ospedaliera-University of Modena; Modena Italy
| | - Gina Ancora
- Women's and Children's Health Department; Infermi Hospital; Azienda Ospedaliera of Rimini; Rimini Italy
| | - Daniele Merazzi
- NICU; Mother's and Infant's Department; Valduce Hospital; Como Italy
| | | | - Paola Lago
- NICU; Women's and Children's Health Department; Azienda Ospedaliera-University of Padova; Padova Italy
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Piersigilli F, Di Pede A, Catena G, Lozzi S, Auriti C, Bersani I, Capolupo I, Lipreri A, Di Ciommo V, Dotta A, Sgrò S. Propofol and fentanyl sedation for laser treatment of retinopathy of prematurity to avoid intubation. J Matern Fetal Neonatal Med 2017; 32:517-521. [DOI: 10.1080/14767058.2017.1383379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Fiammetta Piersigilli
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Alessandra Di Pede
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Gino Catena
- Department of Ophthalmology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Simona Lozzi
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Cinzia Auriti
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Iliana Bersani
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Irma Capolupo
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Anna Lipreri
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Vincenzo Di Ciommo
- Unit of Clinical Epidemiology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Andrea Dotta
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Stefania Sgrò
- Department of Anesthesiology, Bambino Gesù Children’s Hospital, Rome, Italy
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Multicenter observational study comparing sedation/analgesia protocols for laser photocoagulation treatment of retinopathy of prematurity. J Perinatol 2015; 35:965-9. [PMID: 26355942 DOI: 10.1038/jp.2015.112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 07/17/2015] [Accepted: 08/03/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to identify the best sedation/analgesia protocol for laser photocoagulation (PC) of retinopathy of prematurity (ROP). STUDY DESIGN This multicenter observational study included five hospitals, each using a specific sedation/analgesia protocol: local anesthesia with oxybuprocaine hydrochloride (Group L); intravenous pentazocine (Group P); intravenous fentanyl (Group F); air, oxygen and sevoflurane (AOS) inhalation (Group I). The groups were compared for pain responses, vital signs and adverse events. RESULTS Heart rates and systemic blood pressures were elevated by PC in Groups L and P and Groups L, P and F, respectively. Moreover, poor analgesic efficacy was recognized in Groups L, P and F. In contrast, Group I experienced hypothermia, enteral feeding intolerance and apnea more frequently. CONCLUSION From the viewpoint of sedation/pain relief, AOS anesthesia should be the best protocol. However, considering all the various factors together, the most reasonable one can be varied based on the patient's condition and hospital.
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Coşkun M, Dağlıoğlu MC, Davran R, İlhan N, İlhan Ö, Ayhan Tuzcu E, Ayıntap E, Keskin U, Öksüz H. Effects of sub-Tenon’s anaesthesia on ocular hemodynamics. Can J Ophthalmol 2014; 49:141-4. [DOI: 10.1016/j.jcjo.2013.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 09/24/2013] [Accepted: 10/13/2013] [Indexed: 10/25/2022]
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Pain score assessment in babies undergoing laser treatment for retinopathy of prematurity under sub-tenon anaesthesia. Eye (Lond) 2013; 27:1405-10. [PMID: 24051409 DOI: 10.1038/eye.2013.205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 07/12/2013] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To assess the tolerability and outcomes of laser treatment for retinopathy of prematurity (ROP) under sub-tenon anaesthetic with oral or rectal sedation using a reliable, multidimensional, and internationally accepted tool for assessment of neonatal pain. METHODS Sixty-two babies have had ROP laser treatment in our neonatal unit in the 7-year interval between 1 March 2005 and 28 February 2012; 44% (27 of the 62) were performed using sub-tenon anaesthesia. Pain scores were routinely assessed using the Neonatal Pain Agitation and Sedation Scale (N-PASS) every 10 min during laser treatment. The outcome and requirement for re-treatment in this group was compared with that in the intravenous sedation group. RESULTS Pain scores were available in 19 of the 27 babies treated under sub-tenon anaesthesia. The mean pain score during treatment was 2.7 (SD ± 1.7, range 0.5-6.2). There was no statistically significant correlation between the mean pain score and duration of treatment (Spearman correlation coefficient (ρ) = 0.31; P = 0.09), number of laser burns (ρ = 0.32; P = 0.09), or post-menstrual age of the baby at the time of treatment (ρ = 0.38; P = 0.052). Treatments performed under sub-tenon anaesthesia were as successful as those performed under intravenous sedation. The mean pain scores during laser treatment under sub-tenon anaesthesia in our study were lower than those previously reported during ROP screening or heel-stick procedure.Conclusion Our study demonstrated that sub-tenon anaesthesia with oral or rectal sedation provides sufficient pain control for laser treatment for ROP without the need or risks of intravenous sedation and intubation.
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Anesthetic and airway management during laser treatment for retinopathy of prematurity: a survey of US ophthalmologists and neonatologists. J AAPOS 2013; 17:221-2. [PMID: 23622455 DOI: 10.1016/j.jaapos.2012.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 11/08/2012] [Accepted: 11/19/2012] [Indexed: 11/21/2022]
Abstract
Ophthalmologists and neonatologists were surveyed to assess current practices for anesthetic and airway management techniques used during laser treatment for retinopathy of prematurity. Of the 351 practitioners who completed the survey, most perform fewer than 10 treatments annually. Intravenous sedation, rather than general anesthesia, is used by 60% of respondents. Routine intubation is used by 58%, whereas 36% monitor infants at their current level of respiratory support.
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Sub-Tenon's anaesthesia: a well tolerated and effective procedure for ophthalmic surgery. Curr Opin Ophthalmol 2009; 20:205-9. [PMID: 19367161 DOI: 10.1097/icu.0b013e328329b6af] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW To report recent advancements with sub-Tenon's anaesthesia for ocular surgery, accentuating the efficacy and safety of this technique. Further clinical implications are reviewed with regard to its technique, indications, benefits, and reported complications. RECENT FINDINGS Sub-Tenon's anaesthesia, a versatile and technically easy procedure to master, has gained popularity with both ophthalmic surgeons and anaesthetists. This block is achieving repute as the block of choice, providing anaesthesia as well as akinesia during ophthalmic surgery. As the technique has further evolved and novel cannulae introduced, increasing complications have been documented. SUMMARY Currently, there is no absolutely well tolerated orbital regional block technique. However, well founded evidence appears to support sub-Tenon's block as a safer option. Sound knowledge of orbital anatomy, pharmacology of anaesthetic agents, and prevention of potential complications are therefore crucial to perform sub-Tenon's block effectively and safely.
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Current world literature. Curr Opin Pediatr 2009; 21:272-80. [PMID: 19307901 DOI: 10.1097/mop.0b013e32832ad5c0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Eipe N, Kim J, Ramsey G, Mossdorf P. Anesthesia for laser treatment for retinopathy of prematurity--all clear now? Paediatr Anaesth 2008; 18:1103-5. [PMID: 18717809 DOI: 10.1111/j.1460-9592.2008.02682.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ah-Chan J, Rubinstein A, Patel CK. Anterior sub-Tenon's anesthesia for the treatment of retinopathy of prematurity. J Pediatr Ophthalmol Strabismus 2008; 45:186-8. [PMID: 18524202 DOI: 10.3928/01913913-20080501-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors describe a technique of combined oral chloral hydrate and sub-Tenon's anesthesia that is simple, avoids the risks of general anesthesia, and provides superior anesthesia to topical agents alone.
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Affiliation(s)
- John Ah-Chan
- Oxford Eye Hospital, Radcliffe Infirmary, Oxford, UK
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Mead AL, Chen SD, Wilkinson A, Patel CK. Anaesthesia for the laser treatment of neonates with retinopathy of prematurity. Eye (Lond) 2008; 22:734. [PMID: 18188171 DOI: 10.1038/sj.eye.6703083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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