Comparison of anesthesia with sevofl urane-N2O and midazolam-remifentanil in low-birth-weight premature infants undergoing diode laser photocoagulation

Aim: The present study aimed to compare anesthesia with sevofl urane-N2O and midazolam-remifentanil in terms of hemodynamic parameters and safety in low-birth-weight (LBW) premature infants undergoing diode laser photocoagulation (DLP) for retinopathy of prematurity (ROP). Materials and methods: A total of 91 infants undergoing DLP for ROP were enrolled in this study. All of the infants were established with LBW ( 2000 g) and were preterm (gestational age of 32 weeks; age range: 0-28 days). The infants were intubated in the neonatal intensive care unit (NICU) and were randomly divided into 2 groups. For Group 1 (n = 47), anesthesia was induced with 45% O2 + 55% N2O + 3%-5% sevoflurane to which 1 μg kg^–1 fentanyl was added, and it was then maintained with 45% O2 + 55% N2O + 1%-3% sevoflurane. For Group 2 (n = 44), anesthesia was induced with 0.1 mg kg–1 midazolam + 2 μg kg–1 remifentanil, and it was then maintained with a concomitant infusion of 0.1-0.2 mg kg^–1 h^–1 midazolam + 0.125-0.2 μg kg^–1 min^–1 remifentanil. Hemodynamic data, perioperative complications, and extubation time were recorded. The patients were transported to the NICU in the postoperative period without being extubated. Results: No signifi cant differences were observed between the groups in terms of demographic data, perioperative complications, and extubation time. Heart rate values were significantly lower in both groups at different measurement times with respect to baseline values. Mean arterial pressure values were significantly higher in Group 1 only at 60 min in comparison to Group 2. Conclusion: Anesthesia with sevoflurane + O2 + N2O and with remifentanil + midazolam were established to be safe anesthetic approaches for LBW premature infants.