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F Molle, D Lepore, M Sammartino, M Pagliara, G Ferro, MG Bocci; Influence of Different Anaesthetic Techniques on Postoperative Course of Threshold ROP . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1242.
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Purpose:To evaluate the effects of different anaesthetic techniques in the immediate postoperative behaviour of ROP Methods:from Jan «97 to Dec ’00 16 children underwent surgical treatment for threshold ROP in the neonatal intensive care unit at the Catholic University Hospital in Rome. All babies were inborn. The mean BW was 706.5grams (range 440-990gr) and the mean GA was 26,7 weeks (range 24-30w). In 5 babies (groupA) anaesthesia was induced with Halothane (1.5%-2%) and oxygen in facial mask and maintained with Halothane (0.8-1.5%), oxygen and air and Vecuromium Bromide (0.08mg/Kg). In 6 babies (groupB) 3.5-4% Sevofluorane was used for induction and 2.5-3% Sevofluorane and Atracurium (0.5mg/Kg) for maintenance. Both group A and B babies received Atropine 0.01mg/Kg at the induction time. Five babies (group C) were anaesthetised using continuous infusion of Remifentanil (0.75-1mg/Kg/min) that started 1 hour before surgery. Infusion was increased up to 3-5mg/Kg/min if needed A Midazolam bolus (0.25mg/Kg) was administered at the surgery start. Non-invasive blood pressure (NIBP), Heart Rate (HR), Percutaneous CO2 and O2 and respiratory rate were continuously monitored. All babies from group A underwent cryotherapy as well as 4 from group B. Remaining 2 babies from group B and all from group C underwent diode laser photocoagulation. Babies were examined 24 hours after surgery to observed reduction of retinal vessels dilatation and congestion (plus disease). Results:three babies from group A showed an increased congestion at the posterior pole, while the remaining 2 showed no changes. All babies anaesthetised with Sevofluorane showed a worsening of plus disease. Two cases form group C there was a marked reduction of vessels congestion, in 1 case plus disease was unchanged and in the remaining 2 there was a slight increase. Conclusion:: the use of Remifentanil could ensure a cardio respiratory stability during surgery for threshold ROP. Although many variables could affect our observation, it seems that this technique improves the course of posterior pole congestion in the 24 hours after surgery
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