Anaesthesia modalities during laser photocoagulation for retinopathy of prematurity: a retrospective, longitudinal study.

OBJECTIVES: Laser photocoagulation surgery is a routine treatment for threshold retinopathy of prematurity (ROP). However, little is known about which anaesthesia protocols provide efficient pain control while minimising exposure risk to vulnerable infants. In this study, therefore, we assessed the efficacy and tolerability of multiple anaesthesia techniques used on premature infants during laser therapy. DESIGN AND MAIN OUTCOME MEASURES: Anaesthesia modalities consisted of topical eye drops anaesthesia, general anaesthesia and intravenous fentanyl sedation with mechanical ventilation. Laser treatment efficacy and detailed operative information were retrospectively and consecutively analysed. Cardiorespiratory stability was assessed and compared. The Neonatal Pain Agitation and Sedation Scale (N-PASS) was used to evaluate tolerability in infants that underwent intravenous fentanyl sedation. RESULTS: 97 cases of prematurity were included in this study. In 94/97 (96.9%) cases, vascular proliferation regressed. In the topical anaesthesia groups, the ophthalmologist needed 12-16 min more to complete the treatment. During the 3 postoperative days, topical anaesthesia demonstrated the greatest instability; 4/31 (12.90%) infants in this group suffered from life threatening events requiring resuscitation. The only instability observed in general anaesthesia and fentanyl sedation was attributed to difficulty in extubating within 24 hours after surgery. During laser therapy, the N-PASS score increased to 1.8 in the fentanyl sedation group. CONCLUSIONS: Topical anaesthesia was associated with more cardiorespiratory instability during ROP laser treatment. While general anaesthesia and fentanyl sedation had similar postoperative cardiorespiratory results, the latter demonstrated acceptable pain stress control. However, the difficulty of weaning off mechanical ventilation in some cases after surgery needs to be addressed in future studies.

[Clinical study of astragalus's preventing the recurrence of asthma in children].

OBJECTIVE: To study the clinical efficacy of astragalus's preventing the recurrence and regulatory effects on Th1/Th2 cytokines in asthmatic children during the remission stage. METHODS: Ninety asthmatic children during the remission stage were assigned to the astragalus treatment group (Group A), the hormone treatment group (Group B), and the combined group of astragalus and hormone treatment (Group C), 30 in each. Thirty healthy children were set up as the control group. The changes of peak expiratory flow rate (PEFR) before and after treatment and the recurrence times during the one-year follow-up were observed. Peripheral serum contents of immunoreactive fibronectin-gamma (IFN-gamma) and interleukin-4 (IL-4) were detected before and after treatment using ELISA. RESULTS: The total effective rate was higher in Group B (73.3%) than in Group A (66.7%), but with no statistical difference between the two groups (P>0.05). It was highest in Group C (96.7%), showing significant difference from the other two groups (P<0.05). The levels of PEFR and IFN-gamma significantly increased and IL-4 obviously decreased in the three groups after treatment (P<0.05). No statistical difference of PEFR, IFN-gamma, or IL-4 existed in the three groups before treatment (P>0.05). Statistical difference of PEFR, IFN-gamma, or IL-4 existed between Group C and Group B after treatment (P<0.05). CONCLUSIONS: Astragalus played a role in preventing the recurrence of asthma. The combination of astragalus and hormones showed better effects.