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 27th 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.
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All data generated or analyzed during this study are included in this article and its supplementary material files. Further enquiries can be directed to the corresponding author. This article is part of a thesis for the requirements of the postgraduate program “Medical Research Methodology in Medicine and Health Sciences” of the Aristotle University of Thessaloniki , available in: (http://ikee.lib.auth.gr/record/338708/files/GRI-2022-34613.pdf).
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We would like to thank Professor D.G.Goulis and I. Doundoulakis who very kindly contributed to this systematic review.
The authors declare no competing interests.
An ethics statement is not applicable because this study is based exclusively on published literature.
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Gavriilidou, A., Seliniotaki, A.K., Arvanitaki, Z. et al. Safety profile of anesthetic modalities during laser treatment for retinopathy of prematurity: a systematic review. J Perinatol (2023). https://doi.org/10.1038/s41372-023-01622-7