Propofol and fentanyl for laser photocoagulation in non-intubated preterm infants with retinopathy of prematurity

Abstract Objectives Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder of preterm infants, characterized by disrupted retinal vascular development and abnormal neovascularization that result from preterm birth and supplemental oxygen exposure. It is a leading cause of preventable childhood blindness. Laser photocoagulation is a common treatment, but there is no evidence-based consensus on the most appropriate sedation method for this procedure. This study aimed to determine if deep sedation with propofol and fentanyl during laser photocoagulation for ROP is safe and effective while minimizing the side effects of general anesthesia in a vulnerable population. Methods We retrospectively analyzed preterm infants in the neonatal intensive care unit at a tertiary care medical center who underwent deep sedation with propofol and fentanyl administered by pediatric intensivists during retinal ablation for ROP. The primary outcome was change in vital signs from pre- to post-procedure; secondary outcomes were adverse events, including death, apnea, and emergent airway intervention. Results Nine preterm infants were identified. Gestational age ranged from 22 to 28 weeks, and median weight at the time of the procedure was 4,000 g (range 1,860–6,500). Median sedation time was 117 min (range 85–188). Vital signs remained stable from pre- to post-procedure (p>0.05 for all). Three patients experienced adverse events: one apnea and two emergent airway interventions. No patient required intubation or mechanical ventilation, and photocoagulation was completed in all cases. Conclusions Deep sedation with propofol and fentanyl may be effective to control pain during retinal ablation for treatment of ROP for patients with low pre-operative risk. Prospective studies should be conducted to further assess efficacy and safety and to improve the standard of care.