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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (1): 195-199. doi: 10.19723/j.issn.1671-167X.2021.01.029

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Different anesthesia management in preterm infants undergoing surgeries for retinopathy of prematurity: A retrospective study

ZHANG Qing-fen,ZHAO Hong(),FENG Yi   

  1. Department of Anesthesiology, Peking University People’s Hospital, Beijing, China,100044, China
  • Received:2019-09-18 Online:2021-02-18 Published:2021-02-07
  • Contact: Hong ZHAO E-mail:rayezhao@outlook.com
  • Supported by:
    Young Scholar Research Grant of Chinese Anesthesiologist Association(2018-Z-02)

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Abstract:

Objective: To evaluate the effect of different anesthesia management on clinical outcomes in former prematurely born infants undergoing surgeries for retinopathy of prematurity (ROP).Methods: In this retrospective study, electronic medical record database was searched for all former prematurely born infants (gestational age<37 weeks and post conceptual age<60 weeks) who received ROP surgery under inhalational general anesthesia between November 2016 and October 2018. The patients were divided into two groups based on anesthesia management: laryngeal mask airway (LMA) insertion without intravenous muscle relaxant injection and with pressure support ventilation (LMA group) or airway secured with endotracheal tube (ETT) with intravenous muscle relaxant injection and pressure controlled ventilation (ETT group). Primary outcomes included perioperative adverse events and complications. Extubation time and length of stay after surgery were also recorded.Results: Sixty eight preterm infants in the LMA group and 100 preterm infants in the ETT group were included. The incidence of adverse events during surgery (including airway management change and desaturation) was similar in LMA group and ETT group (4.4% vs. 1.0%, P =0.364). During the early recovery period after surgery, the incidence of difficult extubation (extubation time >30 min) was significantly lower in LMA group compared with ETT group (4.4% vs.15.0%, RR=0.262, 95%CI:0.073-0.942, P=0.029). The incidence of respiratory events was similar between the two groups (20.6% vs. 27.0%, P =0.342). However, the incidence of apnea was significantly lower in the LMA group than in the ETT group (5.9% vs.19.0%, RR=0.266, 95%CI: 0.086-0.822, P =0.015). No significant difference was observed between the LMA group and ETT group in incidences of cardiovascular events (0% vs. 1.0%, P =1.000) and unplanned admission to neonatal intensive care unit (5.9% vs. 7.0%, P=0.774). No airway spasm, re-intubation, aspiration or regurgitation was observed during early recovery. During late recovery after returning to ward, the incidence of adverse events was also similar between the two groups (0% vs. 2.0%, P =0.241). The median (IQR) extubation time was 6 (5,10) min in LMA group and 10 (6, 19) min in ETT group (P <0.001). The median length of stay after surgery was significantly shortened in LMA group compared with ETT group [20 (17,22) hours vs. 22 (17,68) hours, P =0.002].Conclusion: Compared with endotracheal intubation with intravenous muscle relaxant injection, laryngeal mask airway insertion without muscle relaxant could achieve an early extubation, and reduce the incidence of apnea during early recovery period in former prematurely born infants undergoing ROP surgery.

Key words: Anesthesia management, Pediatric anesthesia, Airway management, Muscle relaxant, Retinopathy

CLC Number: 

  • R614.2

Table 1

Definitions of clinical outcomes and adverse events"

Items Definitions
Airway management change Including airway tool change and/or ventilation mode change
Extubation time Time between end of surgery to extubation
Difficult extubation Extubation time >30 min
Desaturation With SpO2 < 95%
Apnea A pause in breathing >15 s and manual ventilation is required
Bradycardia Heart rate<100/min or 20% fall in heart rate
Length of stay Time between end of surgery to discharge from hospital

Table 2

Demographic and baseline characteristics"

Items LMA group (n=68) ETT group (n=100) P value
Gestational age at birth/weeks, M(Q1,Q3) 30 (28, 32) 30 (29, 31) 0.756
Postconceptual age/weeks, M(Q1,Q3) 45 (42, 47) 45 (42, 50) 0.258
Body weight at birth/kg, M(Q1,Q3) 1.3 (1.2, 1.6) 1.4 (1.2 1.6) 0.445
Body weight at surgery/kg, M(Q1,Q3) 4.0 (3.2, 5.0) 4.5 (3.0, 5.9) 0.568
Male, n(%) 45 (66.2) 75 (75.0) 0.214
ASA Ⅲ, n(%) 68 (100) 100 (100) 1.000
Results of CXR, n(%) 0.214
Normal 45 (66.2) 75 (75.0)
Abnormal 23 (33.8) 25 (25.0)
Hemoglobin level/(g/L), M(Q1,Q3) 106 (91, 114) 108 (96, 11) 0.424
Duration of surgery/min, M(Q1,Q3) 60 (42, 97) 62 (45, 85) 0.891

Table 3

Clinical outcomes and adverse events"

Items LMA group
(n=68)		 ETT group
(n=100)		 P
Intraoperative events, n(%) 3 (4.4) 1 (1.0) 0.364
Body movement 1 (1.5) 0 (0)
Desaturation 0 (0) 1 (1.0)
Airway management change 2 (2.9) 0 (0)
Complications during early recovery, n(%)
Difficult extubation 3 (4.4) 15 (15.0) 0.029
Respiratory complications 14 (20.6) 27 (27.0) 0.342
Apnea 4 (5.9) 19 (19.0) 0.015
Desaturation 10 (14.7) 27 (27.0) 0.059
Bradycardia 0 (0) 1 (1.0) 1.000
NICU admission 4 (5.9) 7 (7.0) 0.774
Events during late recovery, n(%) 0 (0) 2 (2.0) 0.241
Extubation time/min, M(Q1,Q3) 6 (5,10) 10 (6, 19) <0.001
Length of stay/h, M(Q1,Q3) 20 (17, 22) 22 (17, 68) 0.002
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