Abstract
Background:
There is no consensus on the mode of anesthesia for laser in ex-preterm infants with retinopathy of prematurity (ROP).[1,2] It is technically difficult to perform laser under topical anesthesia, particularly in large infants. Conventional general anesthesia (GA) with endotracheal intubation appears appropriate; however, it has high cardio-respiratory complications.[3]
Purpose:
This video describes a method of inhalational GA with spontaneous respiration using sevoflurane at low concentration with laryngeal mask airway (LMA) in ex-preterm infants undergoing laser for ROP.
Synopsis:
Evaluation and correction of anemia remain the most important preoperative consideration. The procedure of GA includes induction with 2–5% sevoflurane followed by insertion of LMA and maintenance with 1.5–3% sevoflurane in combination with nitrous oxide. In case of intraoperative apnea, the inhalational agents are discontinued, and if spontaneous respiration is not restored in 20 seconds, then manual ventilation with flow-inflated bag is started. Following the laser, inhalational agents are stopped, and the LMA is removed after recovery of protective reflexes.
Highlights:
Use of benzodiazepines, opioids, skeletal muscle relaxants, and endotracheal intubation with mechanical ventilation can be avoided as far as possible.[4] Induction and titration of GA can be better achieved with inhalational anesthetic agents (sevoflurane). An appropriately placed laryngeal mask airway (LMA) with spontaneous respiration or pressure-assisted ventilation not only provides airway control but also helps to minimize the cardio-respiratory complications associated with endotracheal intubation during and after the laser.[5] Under appropriate resource settings, laser for severe ROP can be safely performed under GA using sevoflurane and LMA.
Video Link:
Keywords: General anesthesia, laryngeal mask airway, laser, preterm infants, retinopathy of prematurity, sevoflurane
Authors contributions
Concept, design, definition of intellectual content: AT, ABS, AA, DA, RVA, ABG; Literature search clinical studies, data acquisition, data analysis: AT, ABS, AA, ABG; Statistical analysis: ABS, AA, ABG; Manuscript preparation, manuscript editing, and manuscript review: AT, ABS, AA, DA, RVA, ABG. The manuscript has been read and approved by all the authors. The requirements for authorship, as stated above, have been met, and all authors believe that this manuscript represents honest work.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his/her consent for his/her images and other clinical information to be reported in the journal. The patient understands that their names and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Acknowledgment
Dr. Renu Sinha (Professor of Anesthesiology, AIIMS, New Delhi); Dr. Satya (Ekta Institute of Child Health, Raipur); Mr. Shailendra Patnaik – Video editing (ISD, MGM Eye Institute).
Funding Statement
Nil.
References
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