Abstract
Premature infants are prone to develop postoperative apnoea. The purpose of the present study was to determine if risk factors could be identified to predict which patients would require postoperative tracheal intubation and lung ventilation. Twenty-five extremely premature infants (birth weight: 811 ± 242 g (mean ± SD) and operation weight: 1585 ± 394 g) needing cryotherapy for retinopathy were studied. After surgery the tracheas were extubated if there was no prolonged apnoea, SaO2 > 85%, and heart rate > 120 bpm. In eight, tracheal extubation in the operating room was unsuccessful. Using multivariate discriminant analysis, four risk factors correlated with the need for pulmonary ventilation — gestational duration, birth weight, postconceptional age, and preoperalive amyophylline treatment for seven days. A scoring system using these factors successfully predicted the need for a tracheal tube after surgery in 92% of patients. It is concluded that the system may be clinically useful in the perioperative care of low-birth-weight infants as it identifies important variables for evaluating postoperative prolonged apnoea.
Résumé
Les prématurés sont susceptibles d’encourir des épisodes d’apnée en période postopératoire. Nous avons voulu en établir les facteurs de risque afin de predire quels prématurés auraient besoin de ventilation mécanique aprés une anesthésia. Nous avons inclu dans l’étude 24 grands prématurés dont le poids moyen à la naissance était de 811 ± 242 gr et de 1585 ± 394 lors de l’intervention. Après leur anesthésie pour cryothérapie rétinienne, nous avons détubé la trochée de ceux qui n’avaient pas d’apnée prolongée et qui maintenaient leur SaO2 à plus de 85% et leur pouls à plus de 120 · min−1. Huit enfants ne purent remplir ces exigences en salle d’opération. L’analyse de multiples variables en a isole quatré qui corrélait avec le besoin de ventilation mécanique: la durée de la gestation, le poids à la naissance, l’ àge postconceptionnel et un traitement à l’aminophylline de plus de sept jours. La combinaison de ces quatre variables permettait de prevoir 92% des cas nécessitant un support ventilatoire en postoperatoire et pourrait ainsi devenir un outil clinique fort utile.
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Tashiro, C., Matsui, Y., Nakano, S. et al. Respiratory outcome in extremely premature infants following ketamine anaesthesia. Can J Anaesth 38, 287–291 (1991). https://doi.org/10.1007/BF03007616
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DOI: https://doi.org/10.1007/BF03007616