Department of Ophthalmology, 424 General Military Hospital, Thessaloniki, Greece.
School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
J Perinatol. 2023 Jun;43(6):685-693. doi: 10.1038/s41372-023-01622-7. Epub 2023 Jan 28.
To determine the anesthetic approach with the least adverse events and better cardiorespiratory stability profile, used in infants undergoing laser photocoagulation for retinopathy of prematurity.
A systematic review was conducted. PubMed, Scopus, and Cochrane Library were searched until 27 October 2021. Reference lists of relevant studies, and abstract books of international annual meetings of pediatric Οphthalmology for the years 2020 and 2021 were also looked at, as well as Clinical trials registry ( https://clinicaltrials.gov/ ).
Overall 18 primary studies (3 randomized controlled trials, 3 cohorts, 12 case series) were included, investigating different anesthetic modalities. Cardiopulmonary instability was more common, and hypothermia was less common in the sedation groups of pentazocine/midazolam and fentanyl/midazolam, compared to the general anesthesia group of air/oxygen/sevoflurane (AOS). Cardiorespiratory instability was also more common in sedation with propofol/ketamine compared to general anesthesia with AOS, while postoperative mechanical ventilation was more frequently needed in the latter. Αpnea, need for supplemental oxygen and cardiorespiratory instability was more frequent in infants receiving fentanyl as opposed to ketamine. Fentanyl compared to morphine presented no differences in safety parameters. Finally, topical anesthesia showed the greatest instability with a higher mean postoperative cardiorespiratory index, compared to both sedation and general anesthesia. Episodes of life-threatening events were reported after topical anesthesia, while hypothermia and oliguria presented less often after topical, compared to general anesthesia and sedation.
Significant heterogeneity among studies precludes direct comparisons and generalizability of the results. No specific anesthetic modality for treatment of ROP with laser photocoagulation was shown to be superior in terms of safety. Well-designed studies are required to establish the optimal anesthetic approach, considering that laser photocoagulation still remains one of the main therapeutic modalities for ROP.
确定在接受早产儿视网膜病变激光光凝治疗的婴儿中，具有最少不良事件和更好的心肺稳定性的麻醉方法。
进行了系统评价。检索了 PubMed、Scopus 和 Cochrane Library，检索截至 2021 年 10 月 27 日。还查阅了相关研究的参考文献列表，以及 2020 年和 2021 年国际小儿眼科年会的摘要集，以及临床试验注册中心（https://clinicaltrials.gov/）。
共纳入 18 项原始研究（3 项随机对照试验、3 项队列研究、12 项病例系列研究），研究了不同的麻醉方式。与空气/氧气/七氟醚（AOS）全身麻醉组相比，戊乙奎醚/咪达唑仑和芬太尼/咪达唑仑镇静组的心肺不稳定更常见，低体温更少。与 AOS 全身麻醉相比，丙泊酚/氯胺酮镇静组的心肺不稳定也更常见，而后者术后更需要机械通气。与 AOS 全身麻醉相比，接受芬太尼的婴儿发生呼吸暂停、需要补充氧气和心肺不稳定的情况更频繁。与氯胺酮相比，芬太尼在安全性参数方面没有差异。最后，与镇静和全身麻醉相比，局部麻醉的不稳定程度最高，术后心肺指数更高。与全身麻醉和镇静相比，局部麻醉后报告了危及生命的事件发作，而局部麻醉后低体温和少尿的情况较少。
研究之间存在显著的异质性，因此无法直接比较和推广结果。没有一种特定的麻醉方法在治疗 ROP 激光光凝方面被证明是安全的。需要进行精心设计的研究，以确定最佳的麻醉方法，因为激光光凝仍然是 ROP 的主要治疗方法之一。
