Major Article
Quantity and duration of exposure to general anesthesia for pediatric patients with retinoblastoma

https://doi.org/10.1016/j.jaapos.2022.07.013Get rights and content

Purpose

To quantify the duration of anesthesia required for optimal management of retinoblastoma (Rb), stratified by clinical factors.

Methods

The medical records of Rb patients treated at Phoenix Children’s Hospital between January 2011 and January 2022 were reviewed retrospectively. Demographic, tumor, and treatment data were collected. Anesthesia time was recorded for procedures requiring general anesthesia, including intra-arterial chemotherapy (IAC), enucleation, brainstem auditory evoked response testing (BAER), port placement, magnetic resonance imaging (MRI), and examination under anesthesia (EUA). Descriptive statistics were used to summarize patient and clinical characteristics.

Results

Total anesthesia time was 48,991 minutes for 610 procedures in 43 patients. The median follow-up time was 36 months (range, 12-114 months). Average anesthetic durations per exposure were 274, 152, 81.8, 62.5, 60.7, and 45 minutes for IAC, enucleation, BAER, port placement, MRI, and EUA, respectively. Patients with bilateral Rb underwent a median of 1,659 minutes of total anesthesia, compared with 397 minutes for those with unilateral disease. In patients with unilateral Rb, median total anesthesia time was 2,651, 1681, 312, 397 minutes for International Classification of Retinoblastoma grades B, C, D, and E tumors, respectively. Patients who received IAC as their primary treatment had the highest median anesthesia duration (2,100 minutes), followed by systemic chemo (654 minutes) and enucleation (289 minutes).

Conclusions

Treatment of Rb requires prolonged and repeated exposure to general anesthesia. Future studies are required to determine the potential effects of these childhood anesthetic exposures.

Section snippets

Subjects and Methods

This study was approved by the Phoenix Children Hospital Institutional Review Board. The medical records of pediatric patients undergoing treatment of Rb from January 2011 to February 2022 at Phoenix Children’s Hospital were retrospectively reviewed. Patients who received a portion of their oncologic or ophthalmologic care outside of our institution and patients lost to follow-up were excluded. The following data were extracted from record: patient demographics, family history of Rb, presenting

Results

A total of 43 patients were included; demographics and clinical characteristics are summarized in eSupplement 1 (available at jaapos.org). Almost all patients in the study (95%) were diagnosed with retinoblastoma at <4 years of age, at a median age of 20 months (range, 1-134 months) in children with unilateral disease, and a median of 6 months (range, 0-11 months) in children with bilateral disease.

Total general anesthesia time was 48,991 minutes (816.5 hours) for 610 procedures in the 43

Discussion

During neuronal development and synaptogenesis, N-methyl-D-aspartate (NMDA) glutamate blockade or γ-aminobutyric acidA (GABAA) activation via anesthetic agents can interfere with dendritic development and promote apoptotic degeneration of immature neurons.19 Other possible causes for the purported effects of lengthy anesthesia include impaired growth factor signaling, neuroinflammation, oxidative stress, and epigenetic modification.20 Although studies analyzing the neurodevelopmental

References (21)

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Presented as a poster at the 47th Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus, Scottsdale, Arizona, March 23-27, 2022.

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