Inhalational general anesthesia with spontaneous respiration for laser in ex-preterm infants with retinopathy of...

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].

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.

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.

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.

https://youtu.be/UURZrz_b7_o.