Journal de biologie néonatale

Abstrait

Propofol for Procedural Anaesthesia During Laser Treatment of Retinopathy of Prematurity in the Neonatal Intensive Care Unit (NICU)

José Alfonso Gutiérrez-Padilla , Juan Carlos Barrera-De León , Alonso Meza-Anguiano , Fernando Aguilar-Rodríguez, Pablo CastañedaCastañeda , Daniel Pérez Rulfo-Ibarra , Daysi Karina Muñoz Ruvalcaba and L. Consuelo Zepeda-Romero

Background: Anaesthesia in preterm neonates poses certain risks due to such patients’ systemic instability and concurrent pathologies, as the procedure itself can accentuate such instability and morbidity in these patients. Anaesthesia for LASER procedures for ROP must be a safe procedure that ensures the patient’s stability during and after the procedure. The purpose of this paper is to describe the anaesthesia techniques used in the neonatal intensive care units (NICUs), and evaluate their results.

Methods: Retrospective cross-sectional study carried out from January to December 2012, which included 79 out of 102 patients operated on during such period using laser photocoagulation for ROP under general anaesthesia with intravenous Fentanyl and Propofol administered by a Paediatric Anaesthesiologist.

Results: The anaesthesia had a median duration of 75 minutes, and no periods of hypotension were reported. Seventy-eight patients (98%) were extubated at the end of the surgery and one patient remained intubated due to hemodynamic instability related to sepsis. Additionally, it was necessary to re-intubate 2 patients (3%) and 1 patient (1%) required nasal cannulas for 12 hours due to low O2Sat.

Conclusions: In the NICU, a combination of Fentanyl and Propofol-without administration of muscle relaxants— is a safe, useful technique for treatment of preterm neonates undergoing brief surgical procedures such as laser photocoagulation. The rapid recovery associated to this technique helps to meet the increasing demand for ROP surgeries and reduces the length of hospitalization. A multivariate regression model considering the complications of intravenous general anesthesia with propofol as the dependent variable was carried out. We observed that the Durbin-Watson test score presented independence of errors (2,135). For the regression model with independent variables, we found that none of them explains the variance of the dependent variable as shown in Table 5. The ANOVA of the regression model with these variables indicates that this does not significantly improve the prediction of complication DV (F = 1.607 and p = 0.129). For the coefficients of the regression model, T-scores reflect that the variables taken into account do not significantly contribute to the prediction model, and therefore that the values obtained can not be generalized to the greater population