ROP Surgery without Intubation

ROP Surgery without Intubation

Woodhead DD, Lambert DK, Molloy DA, et al. Avoiding endotracheal intubation of neonates undergoing laser surgery for retinopathy of prematurity. J Perinatol (Apr 2007);27: 209-213. Full Text | PDF

Objective: Respiratory support of neonates during and following laser surgery for retinopathy of prematurity (ROP) is commonly accomplished using endotracheal intubation and mechanical ventilation. However, most patients undergoing ROP surgery have been weaned off mechanical ventilation days or weeks before the surgery. When they are electively re-intubated for ROP surgery, it can be difficult to extubate them postoperatively. One of the three level III neonatal intensive care units (NICUs) in the Intermountain Healthcare system initiated a program of using nasopharyngeal prongs, rather than endotracheal intubation, for respiratory support during ROP surgery.

Methods: We performed an historic cohort analysis of all neonates undergoing ROP surgery during their NICU stay at the three level III NICU's between 1 January 2002 and 31 March 2006. Data collected included birth weight, gestational age at delivery and corrected gestational age at ROP surgery, whether or not they were intubated in the days immediately preceding the ROP surgery, whether or not they were electively intubated for the ROP surgery, the respiratory modality used during and the 3 days following ROP surgery, and all blood gas determinations and respiratory charges during this period.

Results: Fifty-four patients underwent ROP surgery during this period. All 23 from NICUs 'A' and 'B' had endotracheal intubation for surgery, while in NICU 'C' 24 were managed using nasopharyngeal prongs. The day following surgery, 77% (23/30) of those who had been intubated for surgery remained intubated and on mechanical ventilation, whereas only one (4%) of those not intubated for surgery was intubated in the postoperative period (P<0.001). On day 3 following surgery, 50% (15/30) of those intubated for surgery remained intubated and on mechanical ventilation, whereas none of those not intubated for surgery were intubated (P<0.001). Management with nasopharyngeal prongs did not result in higher PCO₂s, or lower pH values, during or after surgery. Respiratory charges for the 3 days following surgery were $1762±678 (mean±s.d.)/patient among those intubated versus $357±352/patient for those managed with nasopharyngeal prongs (P<0.001).

Conclusions: Neonates undergoing laser surgery for ROP can often be supported intraoperatively and postoperatively using nasopharyngeal prongs, thus avoiding the need for endotracheal intubation.

Comments: Nasal prong ventilation appears to be an effective alternative to intubation for Laser ROP surgery that can have significant cost savings and clinical benefits. The article did not discuss the type of anesthesia / sedation used during the procedures. ABK

Date: 19 May 2007
Time: 05:48:29

Thank you for this very interesting note. I would be very interested to know which narcose or which analgesia you used during the operation in the patients on nasal prongs? Thank you in advance for your answer!

UserName: Romaine Arlettaz, consultant
Institution: clinic for neonatology, university hospital, Zurich, Switzerland
telephone: +41 44 255 35 82
email: Romaine.Arlettaz@usz.ch

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