Jewish tradition, glucose gel aid in treating ROP

NEW YORK — Ancient Jewish tradition combined with modern science may improve anesthesia options for infants undergoing laser therapy for retinopathy of prematurity, a speaker here said.

Khaled A, Tawansy, MD, explained the innovation here at the American Society of Retina Specialists meeting.

He said anesthesia options for laser treatment of infants with ROP currently include general inhalation, sedation, topical anesthesia or no anesthesia. When no anesthesia is used, 25% of infants require CPR during the procedure, Dr. Tawansy noted. But opiates and other pain medications are also responsible for respiratory distress in these fragile patients, he added.

Dr. Tawansy and colleagues turned to the Jewish tradition of giving infants a drop of wine prior to a circumcision. Oral sugars, Dr. Tawansy noted, activate an aggressive suckling response, which in turn creates a state of anesthesia and analgesia.

Forty neonates, born at a gestational age of 22 to 28 weeks and treated at 32 to 39 weeks, underwent 450 to 1,400 laser burns in each eye, with settings of 200 to 500 mw for 300 to 500 ms.

The infants had to demonstrate a vigorous suckling response and be clinically stable for at least 48 hours. They were kept fasting for 5 hours and then given an oral pacifier coated with glucose gel and oral acetaminophen (15 mg/kg).

Dr. Tawansy noted that 38 of the 40 patients had a significant anesthetic response to the pacifier while two had a moderate response. None of patients developed respiratory repression or required mechanical ventilation during treatment, he said.