RETINOPATHY OF PREMATURITY - SYSTEMIC COMPLICATIONS ASSOCIATED WITH DIFFERENT ANESTHETIC TECHNIQUES AT TREATMENT

Background-Treatment of retinopathy of prematurity (ROP) in the UK is subject to considerable regional variation in terms of anaesthetic sup port. Change in practice at St Mary's neonatal medical unit from topic al to general anaesthesia and, subsequently, to sedation/analgesia all owed comparison of the impact of these three modalities on infants' ea rly postoperative course in a consecutive, non-randomised, observation al study. Methods-The study population consisted of 30 babies undergoi ng treatment of threshold ROP. Twelve were treated using topical anaes thesia alone (group A), six using general anaesthesia (group B), and 1 2 using sedation/analgesia combined with elective intubation and artif icial ventilation (group C). Daily measurements of infant health were recorded starting 4 days preoperatively and continuing for 7 days post operatively to facilitate the formulation of a cardiorespiratory stabi lity index as follows: (0) improvement from baseline, (1) no change fr om baseline, (2) mild instability, (3) marked instability, and (4) lif e threatening event. Results-Within the first 48 hours postoperatively in group A 5/12 showed mild instability and 4/12 showed marked instab ility (including three babies suffering life threatening events requir ing emergency resuscitation). In group B within the first 48 hours pos toperatively 1/6 showed mild and 1/6 showed marked instability, and in group C 5/12 babies showed mild instability alone. There was a signif icant difference for cardiorespiratory stability scores between the th ree groups overall for the 7 days postoperatively (repeated measures A NOVA, p = 0.018). Conclusions-Premature infants undergoing cryotherapy for ROP who were treated using topical anaesthesia alone had more sev ere and protracted cardiorespiratory complications.