Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia.
Department of Ophthalmology, Royal Children's Hospital, Parkville, Victoria, Australia.
Paediatr Anaesth. 2020 Nov;30(11):1261-1268. doi: 10.1111/pan.14008. Epub 2020 Sep 13.
The aim of this study was to report the incidence of perioperative adverse events occurring in infants undergoing diode laser photocoagulation of retinopathy of prematurity and to identify clinical risk factors that may affect the incidence.
This was a retrospective study of anesthetic and medical records of premature infants who were treated in the neonatal intensive care unit or an operating theater with laser photocoagulation in our institution between January 2014 and December 2019. Infants less than 38 weeks post-menstrual age or less than 2000 grams were considered high risk for complications. Electronic medical records were evaluated for clinical and demographic characteristics, comorbidities, and perioperative complications of anesthesia.
Sixty-one infants (39 males, 22 females) underwent 72 laser treatments. The mean gestational age was 25.3 weeks (SD 1.6), and mean birth weight was 730 grams (SD 202). At treatment, the mean postmenstrual age was 37.5 weeks (SD 2.7) and weight was 2320 g (SD 610). Laser therapy was performed in an operating theater in 66 procedures (91.7%) and in the neonatal unit in 6 cases (8.3%). Twenty-nine (40.3%) laser surgeries occurred outside normal week-day daytime operating hours. Intraoperative hypotension occurred in 12 procedures (16.7%) but was not significantly different in high-risk infants (16.1% vs 16.7% OR 0.94 P = .94) or in procedures performed in-hours (16.3% vs 17.2% OR 0.93 P = .91). Post-extubation apnea occurred in 21 procedures (29%) but was not significantly different in high-risk infants (29.0% vs 27.3% OR 0.98 P = .34) or in procedures performed in-hours (27.9% vs 31.1% OR 0.86 P = .77). Infants remained intubated at the end of the procedure in 58 (80.5%) cases and 29 (40.3%) remained ventilated more than 24 hours after the procedure.
The incidence of perioperative adverse events was not associated with patient's age, current weight, timing, or location of the procedure. Extubating infants at the end of the procedure is however associated with a high rate of apneas and bradycardia, and consideration should be given to keeping low weight infants undergoing prolonged procedures out-of-hours intubated.
本研究旨在报告在接受早产儿视网膜病变二极管激光光凝治疗的婴儿中发生的围手术期不良事件的发生率，并确定可能影响发生率的临床危险因素。
这是一项回顾性研究，纳入了 2014 年 1 月至 2019 年 12 月期间在我院新生儿重症监护病房或手术室接受激光光凝治疗的早产儿的麻醉和医疗记录。胎龄小于 38 周或体重小于 2000 克的婴儿被认为有发生并发症的高风险。对电子病历进行了评估，以了解临床和人口统计学特征、合并症以及麻醉的围手术期并发症。
61 名婴儿（39 名男性，22 名女性）接受了 72 次激光治疗。平均胎龄为 25.3 周（标准差 1.6），平均出生体重为 730 克（标准差 202 克）。治疗时，平均孕龄为 37.5 周（标准差 2.7），体重为 2320 克（标准差 610 克）。66 例（91.7%）激光手术在手术室进行，6 例（8.3%）在新生儿病房进行。29 例（40.3%）激光手术在非工作日正常白天手术时间之外进行。12 例（16.7%）术中出现低血压，但在高危婴儿中并无显著差异（16.1%比 16.7%，比值比 0.94，P=0.94），也与正常工作时间内手术（16.3%比 17.2%，比值比 0.93，P=0.91）无显著差异。21 例（29%）术后发生拔管后呼吸暂停，但在高危婴儿中并无显著差异（29.0%比 27.3%，比值比 0.98，P=0.34），也与正常工作时间内手术（27.9%比 31.1%，比值比 0.86，P=0.77）无显著差异。58 例（80.5%）婴儿在手术结束时仍需插管，29 例（40.3%）婴儿在手术后 24 小时以上仍需呼吸机通气。
围手术期不良事件的发生率与患儿的年龄、当前体重、手术时间或地点无关。然而，在手术结束时拔管的婴儿发生呼吸暂停和心动过缓的风险较高，对于接受长时间手术的低体重婴儿，应考虑在非工作时间保持插管。
