456 - The use of laryngeal mask airway reduces postoperative ventilatory need in preterm infants undergoing ROP laser treatment

Poster Number: 456
Publication Number: 456.228

Sarolta Trinh, Semmelweis University, Budapest, Budapest, Hungary; Gyula Tövisházi, Semmelweis University, Budapest, Budapest, Hungary; Lóránt Kátai, Division of Neonatology, 1st Department of Pediatrics, Budapest, Budapest, Hungary; Erika Maka, Semmelweis University, Dept.of Ophthalmology, Budapest, Budapest, Hungary; Vera Balog, Semmelweis University, Budapest, Budapest, Hungary; Miklós Szabó, Division of Neonatology Ist Dept. of Pediatrics Semmelweis University, Budapest, Budapest, Hungary; Agnes Jermendy, Semmelweis University, Budapest, Budapest, Hungary; Balázs Hauser, Semmelweis University, Dept. of Aneshtesia and Intensive Therapy, Budapest, Budapest, Hungary

Background: The gold standard treatment of retinopathy of prematurity (ROP) is laser photocoagulation (LPC) under general anesthesia with endotracheal intubation (ETT). Most patients undergoing LPC have a history of difficulties with weaning from mechanical ventilation, thus reintubation has a high risk for postoperative need for ventilatory support. However, there is progressively more evidence that laryngeal mask airway (LMA) may provide a safe alternative.

Objective: To assess the need for postoperative invasive ventilation (PIV) in extremely low birth weight infants undergoing general anesthesia for ROP LPC with LMA versus ETT.

Design/Methods: In this retrospective cohort study premature infants undergoing LPC between 2014-2019 at the 1st Department of Pediatrics, Semmelweis University, Budapest were enrolled. General anesthesia was induced and maintained by sevoflurane inhalation. Patients were allocated to Group LMA (n=144) and Group ETT (n=34) at the beginning of anesthesia. The choice of airway management strategy was at the discretion of the anesthetist. LMA was converted to ETT if necessary, at any time during anesthesia. Outcome was defined as need for PIV. Data is given in median [IQR], data analysis was carried out with nonparametric tests and logistic regression with a p< 0.05.

Results: Patients gestational age was 26 [25;27] weeks, while birth weight was 780 [660;970] g. LPC took place on week 36 [34;38] of postmenstrual age. At the time of LPC, body weight of patients in Group LMA was significantly higher than those in Group ETT (2090 [1780;2600] g versus 1350 [1230;1610] g, p< 0.0001). 26 infants from Group LMA were converted to ETT during LPC; however, 15 of them were extubated at the end of the procedure. Upon discharge from the operating room, 8% (11/144) of Group LMA and 71% (24/34) of Group ETT required PIV (p=0.0004). Multiple logistic regression adjusted for body weight revealed that the use of ETT significantly raised the odds of need of PIV (OR 3.8 [95%CI: 1.1-14.8]). Furthermore, a larger birth weight decreases (OR 0.04 [95%CI: 0.01-0.23]), while a history of longer mechanical ventilatory support increases the odds of PIV (OR 1.06 [95%CI: 1.03-1.11]).Conclusion(s): There was a reduced need of PIV in patients who received LMA compared to ETT during anesthetic management for LPC. Our data suggests that the routine use of LMA may reduce perioperative pulmonary complications of neonatal anesthesia in vulnerable preterm infants undergoing ROP LPC.