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Br J Ophthalmol 1997;81:283-287 doi:10.1136/bjo.81.4.283
  • Original Article
    • Clinical science

Retinopathy of prematurity: systemic complications associated with different anaesthetic techniques at treatment

  1. Paul M Haigha,
  2. Malcolm L Chiswickb,
  3. Eamonn P O’Donoghuea
  1. aManchester Royal Eye Hospital, bRegional Neonatal Medical Unit, St Mary’s Hospital, Whitworth Park, Manchester
  1. Mr E P O’Donoghue, Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WH.
  • Accepted 20 November 1996

Abstract

BACKGROUND Treatment of retinopathy of prematurity (ROP) in the UK is subject to considerable regional variation in terms of anaesthetic support. Change in practice at St Mary’s neonatal medical unit from topical to general anaesthesia and, subsequently, to sedation/analgesia allowed comparison of the impact of these three modalities on infants’ early postoperative course in a consecutive, non-randomised, observational study.

METHODS The study population consisted of 30 babies undergoing treatment of threshold ROP. Twelve were treated using topical anaesthesia alone (group A), six using general anaesthesia (group B), and 12 using sedation/analgesia combined with elective intubation and artificial ventilation (group C). Daily measurements of infant health were recorded starting 4 days preoperatively and continuing for 7 days postoperatively to facilitate the formulation of a cardiorespiratory stability index as follows: (0) improvement from baseline, (1) no change from baseline, (2) mild instability, (3) marked instability, and (4) life threatening event.

RESULTS Within the first 48 hours postoperatively in group A 5/12 showed mild instability and 4/12 showed marked instability (including three babies suffering life threatening events requiring emergency resuscitation). In group B within the first 48 hours postoperatively 1/6 showed mild and 1/6 showed marked instability, and in group C 5/12 babies showed mild instability alone. There was a significant difference for cardiorespiratory stability scores between the three groups overall for the 7 days postoperatively (repeated measures ANOVA, p = 0.018).

CONCLUSIONS Premature infants undergoing cryotherapy for ROP who were treated using topical anaesthesia alone had more severe and protracted cardiorespiratory complications.

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