title: Perioperative management and post-operative course in preterm infants undergoing vitreo-retinal surgery for retinopathy of prematurity: A retrospective study.
abstract: BACKGROUND
  Premature infants scheduled for surgery under general anesthesia are more prone to cardio-respiratory complications. Risk factors include post-conception age (PCA), cardiac and respiratory disease, anemia and opioid administration. This retrospective study evaluates the perioperative management and post-operative course (apnea and bradycardia) in premature infants undergoing surgery for retinopathy of prematurity (ROP).
  
  
  METHODS
  We analyzed the pre-operative data, anesthesia chart and post-operative course of 52 former premature infants for 56 general anesthesia exposures for ROP surgery.
  
  
  RESULTS
  At the time of procedure, median PCA was 51 (36-60) weeks. 71% of the infants were above 46 weeks of PCA. Five infants had cardiac disease and four had a history of convulsion. Four infants had a pre-operative history of apneic spells. The airway was secured with either endotracheal tube (46) or supraglottic device (10). Fentanyl (0.5-1 μg/kg), paracetamol, topical anesthetic drops and/or peribulbar block were administered for analgesia. Extubation was performed in the operating room for 54 cases. Three infants had apnea post-operatively. Seven infants were shifted to neonatal intensive care unit either for observation or due to delayed recovery, persistent apneic spells and pre-existing cardio-respiratory disease.
  
  
  CONCLUSIONS
  In the present study, intravenous paracetamol and topical anesthetics reduced the total intra-operative opioid requirement, which resulted in low incidence of post-operative apnea. Regional anesthesia may be considered in infants with high risk of post-operative apnea. Infants with PCA > 42 weeks and without any co-morbidity can be managed in post-anesthesia care unit.
authors.affiliation: Departments of Anaesthesiology and Intensive Care, Rajendra Prasad Institute of Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Renu
authors.initials: R
authors.lastname: Sinha
authors.affiliation: Departments of Anaesthesiology and Intensive Care, Rajendra Prasad Institute of Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Praveen
authors.initials: P
authors.lastname: Talawar
authors.affiliation: Departments of Anaesthesiology and Intensive Care, Rajendra Prasad Institute of Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Ramachandran
authors.affiliation: Departments of Anaesthesiology and Intensive Care, Rajendra Prasad Institute of Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajvardhan
authors.initials: R
authors.lastname: Azad
authors.affiliation: Departments of Anaesthesiology and Intensive Care, Rajendra Prasad Institute of Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Virender Kumar
authors.initials: VK
authors.lastname: Mohan
keywords: Anesthesia; neonatal intensive care; post-operative apnea; post-operative monitoring; preterm infants; retinopathy of prematurity