Sir,

We read with interest the editorial on anaesthesia in retinopathy of prematurity (ROP).1

Hartrey suggests that laser treatment is stressful to the baby and thus requires more than minimal sedation. However, PRP, cataract surgery, and LASIK are all performed on adults with nothing more than topical anaesthesia without pain. Consequently, the neonate receiving treatment under appropriate sedation and analgesia is not being subjected to treatment that could not be tolerated by a conscious adult.

We agree that agents such as morphine and midazolam are associated with respiratory depression. We report our experience with incremental ketamine for ROP treatment.2 Ketamine increases airway tone,3 preserving airway patency and avoiding the need for intubation. It also provides analgesia and bronchodilatation. We feel that this technique may be particularly suited to babies at the highest risk of difficulty weaning from ventilation. We would therefore disagree with Hartrey that all neonates should be electively intubated and ventilated before laser treatment. Nevertheless, the ketamine technique is provided by an experienced paediatric anaesthetist, with resource implications.

We agree that safety of the neonates should remain paramount. While in some units, general anaesthetic may remain the preferred choice of anaesthetic we do not feel that the potential benefits of sedation with ketamine for both clinician and patient should be disregarded.