Anesthesiological aspects of surgical correction of retinopathy of prematurity

Anesthesia for extremely preterm infants is the «new» modern problem in anesthesiology and demands special preparation for anesthesiologists, equipment and medicines. These little patients have usually bronchopulmonary dysplasia, intraventricular hemorrhages, periventricular leukomalakia, metabolic disorders, hypoglycemia; it is extremely important to ensure safety of respiratory tract during general anesthesia with endotracheal intubation. Hyperoxia should be avoided (development of retinopathy, lipid peroxidation).
Hemodynamic stability must be maintained (prevention of IVH, cerebral ischemia, development of periventricular infiltration, disorders of autoregulation of cerebral circulation);
Prevention of hypothermia, hypoglycemia during the surgery is extremely important.
Due to the risk of apnea development, surveillance should be ensured.
The incidence of apnea is higher when used opioids, sedatives, hypoglycemia, hypothermia, anemia (timely correction is needed).
It should be remembered that premature babies feel pain more than full–term newborns and infants. In this category of patients, assessment of the effect and dosage of opioids is difficult, their duration of action is variable, and especially careful monitoring is required after surgery. A minimum of 12 hours of observation after surgery is required. In children under one year of age, the risk of anesthetic complications is higher than in other age groups.
Opioids have a narrower therapeutic window (from analgesia to respiratory depression) in preterm infants compared to term infants.
Retinopathy of prematurity (ROP) develops in 30% of all premature infants weighing less than 1500 grams at birth, leading in some cases to retrolental fibroplasia; fibrovascular strands leading to retinal detachment (traction), this is important until approximately 34 weeks of gestation; fluctuations in SpO2 are significant for ROP formation.

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