К вопросу о выборе оптимального способа анестезиологического пособия при лазеркоагуляции сетчатки у младенцев с ретинопатией недоношенных

Abstract

Purpose. To evaluate the method of anesthesia used in the Kaluga branch of the Fyodorov Eye Microsurgery Federal State Institution for retinal laser photocoagulation in premature infants with retinopathy of prematurity. Materials and methods. The data of children diagnosed with retinopathy of prematurity was analyzed for the period 2017– 2019. These children underwent retinal laser photocoagulation under general anesthesia at the Kaluga branch of the Fyodorov Eye Microsurgery Federal State Institution. As an anesthetic aid, inhalation monoanesthesia with sevoflurane by the method of «bolus» induction was carried out starting from 6–8 vol% with a Mapleson circuit filled with a gas-narcotic mixture of oxygen and air. Induction with using a face mask with reaching the surface level of the surgical stage of anesthesia was fixed by 4–5 minutes. Then, for better airway patency, the laryngeal mask was fixed. Results. With «bolus» induction, the surgical stage of anesthesia occurred within 3–4 minutes. The patient was in the optimal anesthetic condition for laser surgery during the entire surgical process. The eyeballs had a fixed central position, muscle tone was reduced, breathing was even, and there was no reaction to pain stimulus. No significant changes in the heart rate were revealed when monitoring the parameters of the state of the cardiovascular system during induction was being performed. In children with profound prematurity, a slight increase in heart rate was determined (10–15%) in the intraoperative period. The heart rate returned to its original values at the end of anesthesia. The exit from the narcotic state was characterized by smoothness and was carried out immediately after the elimination of the anesthetic within 4–8 minutes. Severe complications from vital systems and pronounced changes in behavioral reactions were not observed, in the immediate postoperative period. Conclusion. The use of this technology makes it possible to provide high-quality anesthetic treatment for premature infants during laser treatment of ROP, minimize the negative impact of anesthesia on the patient's body and optimize the work of an anesthesiologist. Key words: retinopathy of prematurity, retinal laser photocoagulation, anesthetic aid, sevoflurane, Mapleson's contour, laryngeal mask.