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Abstract
Aims Following a baseline audit in 2005, we altered the medication regime for achieving sedation and paralysis in babies undergoing treatment for Retinopathy of Prematurity (ROP). The aim of this study was to assess the impact of that change on the duration of post procedure ventilation.
Methods On a large tertiary NICU, babies undergoing treatment for ROP previously had sedation/analgaesia with fentanyl and muscle relaxation using pancuronium. In 2013 the medication regime was changed to the shorter acting agents Remifentanyl and Vecuronium. An audit of practice had been performed in 2005. This included a measurement of post procedure ventilation. We performed a further audit following the change in policy to compare time to extubation in two cohorts of babies treated before and after this change in policy. A standard set of clinical and demographic data were collected from the electronic patient record for analysis. The times to extubation were compared and the difference was assessed for statistical significance using Mann-Whitney U testing.
Results The first cohort included 18 babies treated between 2002 and 2005. These babies received pancuronium and fentanyl. The second cohort included 23 babies treated between May 2013 and December 2014. These babies received vecuronium and remifentanil. There were no statistically significant differences in the demographic variables of the two groups or their need for pre-operative respiratory support. There was a statistically significant reduction in the duration of post procedure ventilation from a median (interquartile range) of 13.5 (10 to 23.75) hours in cohort 1 to 7(3 to 14) hours in cohort 2 (p < 0.05) (Table 1). There were no differences in any other clinical outcome between the two groups and no adverse events associated with the use of either combination.
Conclusion Use of remifentanil and vecuronium for sedation and paralysis of neonates during ROP surgery was found to be safe and was associated with a statistically significant reduction in time to post-procedure extubation when compared to the use of fentanyl and pancuronium.