PhD Scientific Days 2022

Clinical Medicine V. (Poster discussion will take place in the Aula during the Coffee Break)

The Use Of Laryngeal Mask Airway Reduces Postoperative Ventilatory Need In Preterm Infants Undergoing ROP Laser Treatment

Text of the abstract

Introduction: There is no protocol for anesthetic care of infants with retinopathy of prematurity undergoing laser photocoagulation (LPC). Patients can undergo sedation, topical anesthesia, or general anesthesia with endotracheal intubation (ETT). Most patients undergoing LPC have a history of difficulties with weaning from mechanical ventilation (MV), thus reintubation has a high risk for postoperative invasive ventilation (PIV). However, there is evidence that laryngeal mask airway (LMA) may provide a safe alternative.

Aims: To assess the need for PIV in preterm infants undergoing general anesthesia for retinopathy of prematurity LPC with laryngeal mask airway versus endotracheal intubation.

Method: In this retrospective cohort study premature infants undergoing LPC between 2014-2021 at the 1st Department of Pediatrics, Semmelweis University, Budapest were enrolled. Patients were allocated to Group LMA (n=224) and Group ETT (n=47) at the beginning of general anesthesia. The choice of airway management was at the discretion of the anesthesiologist. Some cases required conversion from LMA to ETT during anesthesia. Outcome was defined as need for PIV. Data is given in median [IQR], data analysis was carried out with nonparametric tests and logistic regression with a p<0.05.

Results: Patients gestational age was 26 [25;28] weeks, while birth weight was 790 [650;990] g. LPC took place on week 37 [35;39] of postmenstrual age. At the time of LPC, body weight of patients in Group LMA was significantly higher than those in Group ETT (2110 [1800;2780] g versus 1350 [1230;1610] g, p<0.0001). After the LPC 92% (n= 206) of Group LMA and 26% (n=12) of Group ETT left the operating room without any ventilatory support, while the rest of the patients required PIV. Multiple logistic regression adjusted for body weight revealed that the use of ETT significantly raised the odds of need of PIV (OR 4,80 [95%CI: 1,67-14,50]). Furthermore, a larger birth weight decreases (with every 100 g OR 0,74 [95%CI: 0,63-0,84]), while a history of longer MV support increases (with every one day spent on MV OR 1,07 [95%CI: 1,03-1,13]), and comorbidities (OR 2,02 [95%CI: 1,16-3,68]) increases the odds of PIV.

Conclusions: Data suggests that with the use of LMA the need for PIV can be reduced, independently from previous MV and body weight.

Funding: SE 250+