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. 2025 Jan;97(1):341-347.
doi: 10.1038/s41390-024-03356-4. Epub 2024 Jun 22.

Airway management may influence postoperative ventilation need in preterm infants after laser eye treatment

Sarolta H Trinh  1 , Gyula Tövisházi  2   3 , Lóránt K Kátai  1 , Luca L Bogner  1 , Erika Maka  4 , Vera Balog  1 , Miklós Szabó  1 , Attila J Szabó  1 , János Gál  2 , Ágnes Jermendy #  1 , Balázs Hauser #  5   6
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Airway management may influence postoperative ventilation need in preterm infants after laser eye treatment

Sarolta H Trinh et al. Pediatr Res. 2025 Jan.

Abstract

Background: Retinopathy of prematurity is treated with laser photocoagulation under general anaesthesia with intubation using endotracheal tube (ETT), which carries a risk for postoperative mechanical ventilation (MV). Laryngeal mask airway (LMA) may provide a safe alternative. We assessed the need for postoperative MV in preterm infants who received LMA versus ETT.

Methods: In this single-centre, retrospective cohort study, preterm infants who underwent laser photocoagulation between 2014-2021 were enroled. For airway management, patients received either LMA (n = 224) or ETT (n = 47). The outcome was the rate of postoperative MV.

Results: Patients' age were 37 [35;39] weeks of postmenstrual age, median bodyweight of Group LMA was higher than Group ETT's (2110 [1800;2780] g versus 1350 [1230;1610] g, respectively, p < 0.0001). After laser photocoagulation, 8% of Group LMA and 74% of Group ETT left the operating theatre requiring MV. Multiple logistic regression revealed that the use of LMA and every 100 g increase in bodyweight significantly decreased the odds of mechanical ventilation (OR 0.21 [95% CI 0.07-0.60], and 0.73 [95% CI 0.63-0.84], respectively). Propensity score matching confirmed that LMA decreased the odds of postoperative MV (OR 0.30 [95% CI 0.11-0.70]).

Conclusion: The use of LMA is associated with a reduced need for postoperative MV.

Impact: Using laryngeal mask airway instead of endotracheal tube for airway management in preterm infants undergoing general anaesthesia for laser photocoagulation for treating retinopathy of prematurity could significantly decrease the postoperative need for mechanical ventilation. According to our current understanding, this has been the largest study investigating the effect of laryngeal mask airway during general anaesthesia in preterm infants. Our study suggests that the use of laryngeal mask airway is a viable alternative to intubation in the vulnerable population of preterm infants in need of laser treatment.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Consent for publication: As this was a retrospective study, the requirement for written informed consent was waivered by the Institutional Ethics Committee

Figures

Fig. 1
Fig. 1. Flowchart of the infants included in the study and their outcomes.
ETT endotracheal tube, LMA laryngeal mask airway, LPC laser photocoagulation, MV mechanical ventilation, ROP retinopathy of prematurity.
See this image and copyright information in PMC

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