General anesthesia in infants during surgical laser treatment of retinopathy of prematurity in ophthalmological clinic

Abstract

Retinopathy of prematurity (ROP) is the main cause of blindness in extremely premature infants. The frequency of ROP in different countries varies from 9 to 46.9% cases among children born prematurely, and from 69 to 90% cases among children born with extremely low birth weight. Laser coagulation (LC) of retina is the most effective way to treatment of active stage of ROP with high operational and anesthetic risk for the child. Purpose. Comparative analysis of safety of general anesthesia (GA) with halothane and sevoflurane with using face mask and Mapleson breathing circuit in children with ROP at LC of retina. Material and methods. In the period from 2008 to 2017 LC of retina at ROP with GA was performed in 284 children born prematurely at 24-34 weeks of gestation. 2 groups were formed of these, depending on the used anesthetic: the 1 st group ( n = 167) halothane was used at concentration of 0.3 vol%, in the 2 nd group ( n = 117) – sevoflurane at concentration of 1-1.5 vol%. Criteria of adequacy of GA: sleep, lacking of motor reactions of child, eye movements at introduction of blepharostat, at optical lens installation on cornea and at applying first coagulates. Results. In 68 children of the 1st group (40.7%) negative reactions appeared in the form of respiratory depression, bradycardia, prolongation of awakening, delayed apnea, since halothane can cause depression of respiratory center and inhibit functions of respiratory musculature. In the 2 nd group, negative reactions were observed in 14 children (11.9%), since sevoflurane is more manageable, promotes rapid awakening and low risk of depressive influence on functions of the child's body. Conclusion. The optimal anesthetic for LC of retina in premature infants is sevoflurane in low concentrations when using face mask and Mapleson breathing circuit.