Anesthesia management of selective ophthalmic intra-arterial chemotherapy for retinoblastoma / 上海交通大学学报（医学版）

ABSTRACT

Objective: To investigate the safety of treatment with ophthalmic artery cannulation for intra-arterial chemotherapy (IAC) in children with retinoblastoma (RB) during general anesthesia. Methods: A total of 60 children with RB who underwent ocular artery interventional chemotherapy under general anesthesia in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from September 2015 to August 2018 were collected. Induction of anesthesia was performed with rapid induction of endotracheal intubation with midazolam, fentanyl, propofol and rocuronium. Sevoflurane and oxygen were administered for maintenance of general anesthesia, with intermittent injection of rocuronium and fentanyl. Intraoperative continuous monitoring of hemodynamic parameters, respiratory parameters (EtCO2, oxygen saturation and inspiratory peak pressure) and sevoflurane minimum alveolar concentration (MAC) was performed, and intraoperative pulmonary compliance, hypoxemia, hypotension and other cardiopulmonary adverse events were observed and recorded. Results: Over a 3-year period, 185 treatment sessions were performed in 60 patients. Thirty-two cardiopulmonary adverse events were observed in 20 patients, and the incidence rate was 17.2%, mainly including severe decrease in lung compliance, hypoxemia and arterial hypotension. All severe decreases in lung compliance occurred within 1 or 2 minutes after catheter insertion in the ophthalmic artery. After active treatment with propofol, phenylephrine and epinephrine, no death and permanent sequelae occured. Conclusion: An appreciable incidence of trigeminocardiac reflex to intra-ophthalmic artery infusion of chemotherapy in patients with RB is found. Both interventionalists and anesthesiologists should be aware of this potential event and be prepared to provide immediate resuscitative measures.