Choosing optimal anesthetic and method of general anesthesia for laser surgery retinopathy of prematurity

2021 ◽  
pp. 196-201
Author(s):  
S.I. Utkin ◽  
◽  
M.V. Stolyarov ◽  
D.Y. Ignatenko ◽  
E.A. Bachinin ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Laser Surgery ◽  
Breathing Circuit ◽  
Face Mask ◽  
Laser Coagulation ◽  
Efficacy And Safety ◽  
Continuous Sampling ◽  
Low Concentrations

Purpose. Comparative analysis of clinical efficacy and safety of inhalational general anesthesia (GA) with halothane and sevoflurane in premature infants with retinopathy of prematurity (ROP) during laser coagulation (LC) of the avascular retina. Material and methods. The clinical material included 284 children who underwent laser surgery of ROP in the period from 2008 to 2017 (method of continuous sampling). Introduction to anesthesia and maintenance of anesthesia was performed by inhalation of anesthetic (halothane or sevoflurane) with O2 using face mask and Mapleson breathing circuit. Two groups were formed: in the 1st group (167 people) halothane was used at anesthetic at oxygen concentration of 0.3 vol%, in the 2nd group (117 people) – sevoflurane at concentration of 1–1.5 vol%. Results. In case of GA with halothane in children of the 1st group, in 68 children (40.7%) developed negative reactions during anesthesia in the form of of respiratory depression, in several cases – up to pronounced bradypnea, bradycardia, prolonged awakening after surgery. In the 2nd group with GA with sevoflurane, negative reactions in the form of moderate bradycardia and bradypnea were observed only in 14 children (11.9%). All complications and reactions were promptly eliminated in all cases. Conclusion. Based on the obtained results, the optimal inhalation anesthetic for LC of retina in premature infants is sevoflurane in low concentrations (at the sedation level) using the Mapleson breathing circuit and face mask. With this method of anesthesia, the frequency of side effects of sevoflurane, negative reactions during anesthesia and the degree of their severity are extremely low. Key words: premature infants, retinopathy of premature, sevoflurane, general anesthesia, laser coagulation of the retina.

scholarly journals Visual Functions in Children in Remote Postoperative Period after Laser Treatment of Threshold Stages of Retinopathy of Prematurity

2018 ◽  
Vol 15 (2S) ◽  
pp. 18-23
Author(s):  
M. V. Pshenichnov ◽  
O. V. Kolenko ◽  
V. V. Egorov ◽  
E. L. Sorokin
Keyword(s):  
Visual Acuity ◽  
Postoperative Period ◽  
Retinopathy Of Prematurity ◽  
Vision Loss ◽  
State Institution ◽  
Laser Coagulation ◽  
Visual Functions ◽  
Functional Changes ◽  
Continuous Sampling ◽  
High Degree

Purpose.Analysis of visual functions in children in remote postoperative period after laser coagulation (LC) of threshold stages of retinopathy of prematurity (ROP).Patients and methods. In 2017, we selected and investigated 18 children, who previously had an LC of threshold stages of ROP in 2008–2009 in the Khabarovsk branch of the S.N. Fyodorov State Institution Eye Microsurgery Complex (continuous sampling method). There were 5 boys and 13 girls aged from 8 to 9 years at the time of LC. Anterior and posterior eye segments of the eyes (biomicroscopy, ophthalmoscopy), visual acuity, clinical refraction, concomitant pathology were evaluated.Results. We have revealed that regressive ROP after LC is characterized by the presence of serious anatomical and functional changes in the eyes. First, these are refractive disorders, which revealed in 90.5% of cases. Most often revealed: myopic refraction — 61% of all cases, of which more than half (53%) is its high degree; or its combination with compound myopic astigmatism (77% eyes); anisometropia was detected in 39% children. These refractive disorders led to the development of strabismus (61% children) and mixed amblyopia (60%). Despite the combined ophthalmologic pathology, 17% children developed visual functions with achievement of binocular vision, in most children visual functions still continue to develop, although they are not high due to amblyopia. High visual acuity (from 0.8 and above) in both eyes was formed in 22% children; visual acuity in the range of 0.5–0.7 in both eyes was formed in 17% children. Unfortunately, 44.5% children at the time of examination had low visual functions (in the range of 0.05–0.4) in both eyes. Extremely low visual acuity (from 0.01 to 0.04) in both eyes was identified in 11% children; absolute blindness in one of the eyes was in 11% children.Conclusions. LC is reliable way to prevent vision loss from retinal detachment in children with threshold stages of ROP. 

Tocopherol Efficacy and Safety for Preventing Retinopathy of Prematurity: A Randomized, Controlled, Double-Masked Trial

PEDIATRICS ◽  
1987 ◽  
Vol 79 (4) ◽  
pp. 489-500 ◽  
Author(s):  
Dale L. Phelps ◽  
Arthur L. Rosenbaum ◽  
Sherwin J. lsenberg ◽  
Rosemary D. Leake ◽  
Frederick J. Dorey
Keyword(s):  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Plasma Levels ◽  
Late Onset ◽  
Retinal Hemorrhage ◽  
Efficacy And Safety ◽  
Randomized Controlled ◽  
Late Onset Sepsis ◽  
Prospective Monitoring

To test the efficacy and safety of vitamin E in preventing retinopathy of prematurity, 287 infants with birth weights of less than 1.5 kg or gestational ages of less than 33 weeks were enrolled within 24 hours of birth in a randomized, double-masked trial of IV, followed by oral, placebo v tocopherol (adjusted to plasma levels of 3 to 3.5 mg/dL). In the 196 infants completing ophthalmic follow-up, tocopherol did not prevent retinopathy of prematurity of any stage (28% placebo treated v 26% tocopherol treated) or moderately severe retinopathy of prematurity (8% placebo treated v 11% tocopherol treated). Cicatricial sequelae were not significantly different (1/97 placebo treated v 3/99 tocopherol treated), with one placebo-treated infant and one tocopherol-treated infant having retinal detachments. Among all 232 infants examined, those treated with tocopherol had more retinal hemorrhage than placebo-treated infants (8/121 placebo treated v 16/111 tocopherol treated), and retinal hemorrhage correlated positively (P < .01) with plasma levels of tocopherol after the first 2 weeks of age. Prospective monitoring of morbidity including late-onset sepsis, necrotizing enterocolitis, etc revealed no differences between groups except that grades 3 and 4 intraventricular hemorrhage occurred more frequently in infants weighing less than 1 kg at birth who had received tocopherol (14/42, 33%) v those who had received placebo (4/43, 9%) (P < .02). Our data do not support the use of tocopherol for prophylaxis against retinopathy of prematurity in premature infants and suggest that IV tocopherol treatment starting on day 1 may increase the incidence of hemorrhagic complications of prematurity, particularly in infants with birth weights of less than 1 kg.

Two-Year Outcomes of Infants with Stage 2 or Higher Retinopathy of Prematurity: Results from a Large Multicenter Registry

2019 ◽  
Vol 37 (02) ◽  
pp. 196-203
Author(s):  
Veeral N. Tolia ◽  
Kaashif A. Ahmad ◽  
Jack Jacob ◽  
Amy S. Kelleher ◽  
Nick McLane ◽  
...  
Keyword(s):  
Primary Care ◽  
Retinal Detachment ◽  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Laser Surgery ◽  
Significant Risk ◽  
Inclusion Criteria ◽  
Multicenter Registry

Objective To define the incidence of ophthalmologic morbidities in the first 2 years of life among infants diagnosed with stage 2 or higher retinopathy of prematurity (ROP). Study Design We prospectively enrolled premature infants with stage 2 or higher ROP. The infants were followed up for 2 years, and we report on data collected from outpatient ophthalmology and primary care visits. Results We enrolled 323 infants who met inclusion criteria, of which 112 (35%) received treatment with laser surgery (90) or bevacizumab (22). Two-year follow-up was available for 292 (90%) of the cohort. The most common ophthalmologic conditions at follow-up were hyperopia (35%), astigmatism (30%), strabismus (21.9%), myopia (19.2%), anisometropia (12%), and amblyopia (12%). Severe ophthalmologic morbidities such as retinal detachment and cataracts were rare, but occurred in both treated and untreated infants. Overall, 22.6% of the infants were wearing glasses at 2 years, including 8.5% of the untreated infants. Conclusion Patients with stage 2 or higher ROP remain at significant risk for ophthalmological morbidity through 2 years of age. Infants with regression of subthreshold ROP who do not require treatment represent an underrecognized population at long-term ophthalmological risk. ClinicalTrials.gov Identifier NCT01559571.

On the question of choosing the optimal method of anesthesia for laser coagulation of the retina in infants with retinopathy of prematurity

2021 ◽  
pp. 5-10
Author(s):  
A.V. Konstantinov ◽  
◽  
S.V. Chistyakov ◽  
I.G. Trifanenkova ◽  
◽  
...  
Keyword(s):  
Heart Rate ◽  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Laser Photocoagulation ◽  
State Institution ◽  
Laryngeal Mask ◽  
Federal State ◽  
Laser Coagulation ◽  
Central Position ◽  
Airway Patency

Purpose. To evaluate the method of anesthesia used in the Kaluga branch of the Fyodorov Eye Microsurgery Federal State Institution for retinal laser photocoagulation in premature infants with retinopathy of prematurity. Materials and methods. The data of children diagnosed with retinopathy of prematurity was analyzed for the period 2017– 2019. These children underwent retinal laser photocoagulation under general anesthesia at the Kaluga branch of the Fyodorov Eye Microsurgery Federal State Institution. As an anesthetic aid, inhalation monoanesthesia with sevoflurane by the method of «bolus» induction was carried out starting from 6–8 vol% with a Mapleson circuit filled with a gas-narcotic mixture of oxygen and air. Induction with using a face mask with reaching the surface level of the surgical stage of anesthesia was fixed by 4–5 minutes. Then, for better airway patency, the laryngeal mask was fixed. Results. With «bolus» induction, the surgical stage of anesthesia occurred within 3–4 minutes. The patient was in the optimal anesthetic condition for laser surgery during the entire surgical process. The eyeballs had a fixed central position, muscle tone was reduced, breathing was even, and there was no reaction to pain stimulus. No significant changes in the heart rate were revealed when monitoring the parameters of the state of the cardiovascular system during induction was being performed. In children with profound prematurity, a slight increase in heart rate was determined (10–15%) in the intraoperative period. The heart rate returned to its original values at the end of anesthesia. The exit from the narcotic state was characterized by smoothness and was carried out immediately after the elimination of the anesthetic within 4–8 minutes. Severe complications from vital systems and pronounced changes in behavioral reactions were not observed, in the immediate postoperative period. Conclusion. The use of this technology makes it possible to provide high-quality anesthetic treatment for premature infants during laser treatment of ROP, minimize the negative impact of anesthesia on the patient's body and optimize the work of an anesthesiologist. Key words: retinopathy of prematurity, retinal laser photocoagulation, anesthetic aid, sevoflurane, Mapleson's contour, laryngeal mask.

Clinical-epidemiological and therapeutic aspects of prematurity retinopathy

2019 ◽  
pp. 26-36
Author(s):  
Sergey V. BELIKOV ◽  
Andrey P. GOYDIN ◽  
Oleg L. FABRIKANTOV ◽  
Pavel L. VOLODIN
Keyword(s):  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Laser System ◽  
Laser Coagulation ◽  
Laser Exposure ◽  
Medical Systems ◽  
Optimal Method ◽  
Advantages And Disadvantages ◽  
Long Term Treatment ◽  
Eye Retina

Relevance of the study . Blindness and hypovision due to retinopathy of prematurity dominate in the structure of the causes of visual impairment from childhood in both developed and developing countries, despite all the achievements of science and practical medicine. A huge role in preventing blindness from retinopathy of prematurity belongs to the effectiveness of treatment. The most discussed topic among global ophthalmology community is readings and the time of laser coagulation of the eye retina. Aim of the study . To evaluate the advantages and disadvantages of laser coagulation various methods in retinopathy of prematurity, to determine the most optimal method in the treatment of active phases of the disease. Materials and methods . We consider retinopathy of prematurity modern methods of diagnosis and treatment, also we carry out advantages and disadvantages comparative analysis. We consider the organization statistics of ophthalmic care for premature infants in the Tambov Region and the long-term treatment results of premature infants with retinopathy of prematurity. Results and discussion . The generally accepted standard methodology applied for screening examination, is the reverse binocular ophthalmoscopy (possible in humidicrib) when medication dilate pupils. If necessary, an examination is carried out using the retinal pediatric camera “RetCam Shuttle” (Clarity Medical Systems Inc., USA), which allows to document and save the survey results in a database. To date, timely and sufficient laser coagulation of the avascular zone of the retina is the only proven effective method of active retinopathy of prematurity treatment. The most modern method of retinal laser coagulation is the technology of pattern scanning laser coagulation, which automated the procedure for applying coagulants. The main trends in the retinopathy of prematurity treatment are earlier implementation of laser coagulation and over dosed coagulation, according to the ETROP recommendations. When using a pattern laser system, laser pulses are delivered in sequence at the highest speed. The result of the use of this technology is a high accuracy of coagulation, so that the eye retina receives the least energy impact, compared with the classical laser coagulation. Conclusion. 1. Timely and adequate laser coagulation of the avascular areas of the eye retina reduces the risk of severe anatomical and functional outcomes of active retinopathy of prematurity. 2. The use of the technology of transpupillary scanning pattern laser coagulation of the eye retina (PASCAL) can significantly reduce the duration of laser exposure and anesthesia for a premature baby, improve the efficiency and safety of treatment.

scholarly journals Systematic review of mydriatics used for screening of retinopathy in premature infants

2019 ◽  
Vol 3 (1) ◽  
pp. e000448 ◽  
Author(s):  
Lisa Jean Kremer ◽  
David M Reith ◽  
Natalie Medlicott ◽  
Roland Broadbent
Keyword(s):  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Case Reports ◽  
Combination Regimen ◽  
Efficacy And Safety ◽  
Limited Evidence ◽  
Level Of Evidence ◽  
Effective Combination ◽  
Eye Examination ◽  
High Level

IntroductionRoutine retinopathy of prematurity eye examinations are an important part of neonatal care, and mydriatic medicines are essential in dilating the pupil for the eye examination. There are concerns about the level of evidence for efficacy and safety of these mydriatic medicines.ObjectiveThis review evaluates both efficacy and safety evidence of mydriatics used during the retinopathy of prematurity eye examination.MethodSystematic literature review.ResultsThere is limited evidence guiding clinical practice for safety and efficacy of mydriatics. The majority of publications are underpowered and with an unclear to high level of bias. There are a wide variety of mydriatic regimens evaluated for efficacy and safety, and multiple regimens are associated with case reports.ConclusionsCurrent international guideline seems unnecessarily high, especially when the reviewed literature suggest that lower doses are effective, albiet from underpowered studies. The lowest effective combination regimen appears to be phenylephrine 1% and cyclopentolate 0.2% (1 drop). Microdrop administration of this regimen would further increase the safety profile, however, efficacy needs to be assessed.

scholarly journals Identification of candidate genes and pathways in retinopathy of prematurity by whole exome sequencing of preterm infants enriched in phenotypic extremes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sang Jin Kim ◽  
◽  
Kemal Sonmez ◽  
Ryan Swan ◽  
J. Peter Campbell ◽  
...  
Keyword(s):  
Exome Sequencing ◽  
Whole Exome Sequencing ◽  
Preterm Infants ◽  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Smooth Endoplasmic Reticulum ◽  
Enrichment Analysis ◽  
Retinal Disease ◽  
Gene Set Enrichment Analysis ◽  
Whole Exome

AbstractRetinopathy of prematurity (ROP) is a vasoproliferative retinal disease affecting premature infants. In addition to prematurity itself and oxygen treatment, genetic factors have been suggested to predispose to ROP. We aimed to identify potentially pathogenic genes and biological pathways associated with ROP by analyzing variants from whole exome sequencing (WES) data of premature infants. As part of a multicenter ROP cohort study, 100 non-Hispanic Caucasian preterm infants enriched in phenotypic extremes were subjected to WES. Gene-based testing was done on coding nonsynonymous variants. Genes showing enrichment of qualifying variants in severe ROP compared to mild or no ROP from gene-based tests with adjustment for gestational age and birth weight were selected for gene set enrichment analysis (GSEA). Mean BW of included infants with pre-plus, type-1 or type 2 ROP including aggressive posterior ROP (n = 58) and mild or no ROP (n = 42) were 744 g and 995 g, respectively. No single genes reached genome-wide significance that could account for a severe phenotype. GSEA identified two significantly associated pathways (smooth endoplasmic reticulum and vitamin C metabolism) after correction for multiple tests. WES of premature infants revealed potential pathways that may be important in the pathogenesis of ROP and in further genetic studies.

Effects of Marginal Hypoxemia on Recovery from Oxygen-Induced Retinopathy in the Kitten Model

PEDIATRICS ◽  
1984 ◽  
Vol 73 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Dale L. Phelps ◽  
Arthur L. Rosenbaum
Keyword(s):  
Clinical Trials ◽  
Premature Infants ◽  
Vascular Injury ◽  
Retinopathy Of Prematurity ◽  
Oxygen Supplementation ◽  
Predictive Variable ◽  
Oxygen Induced Retinopathy ◽  
Oxygen Administration

Prolonged oxygen administration in premature infants is the most predictive variable for severe retinopathy of prematurity, after degree of prematurity itself. It was noted that infants receiving prolonged oxygen supplementation are probably hypoxemic relative to their healthy counterparts. Therefore, hypoxemia during recovery from a hyperoxic-induced retinal vascular injury was tested in the kitten model of oxygen-induced retinopathy. Twelve litters were exposed to 80% inspired O2 for 65 hours on day 3, and recovered in room air, 13% or 17% oxygen. The retinas were scored at 4 weeks, and 13% oxygen recovery (PO2 = 39 ± 18 torr) was found to worsen significantly the retinopathy compared with that in room air-recovered littermates (P < .01). Hemorrhages occurred more frequently in the retinas from the hypoxemic-recovered kittens. Clinical trials of this hypothesis are indicated in humans.

VITAMIN B12 AND FOLIC ACID VALUES IN PREMATURE INFANTS

PEDIATRICS ◽  
1972 ◽  
Vol 50 (4) ◽  
pp. 584-589
Author(s):  
Ambadas Pathak ◽  
Herman A. Godwin ◽  
Luis M. Prudent
Keyword(s):  
Folic Acid ◽  
Vitamin B12 ◽  
Premature Infants ◽  
Serum Vitamin ◽  
Serum Folate ◽  
Born Infant ◽  
Low Concentrations ◽  
Folate And Vitamin B12 ◽  
Relationship Of ◽  
The Relationship

The relationship of serum vitamin B12 and folic acid was studied in 24 premature infants. In 14 of the 24, low serum vitamin B12 values were found around 40 days of age. Serum folic acid concentrations were less frequently depressed and were usually associated with normal red cell folate values. No correlation between hematocrits and vitamin B12 or folate levels was found. It is suggested that low concentrations of serum folate and vitamin B12 result from low dietary intake coupled with increased demand by the prematurely born infant.

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