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Published on: September 3, 2020
Quantity and duration of exposure to general anesthesia for pediatric patients with retinoblastoma
Kerri McInnis-Smith1, Kelsey Chen2, Molly Klanderman3
1Mayo Clinic Alix School of Medicine, Scottsdale, Arizona.
Insights
Retinoblastoma (Rb) management requires significant anesthesia time, with intra-arterial chemotherapy (IAC) needing the most. Bilateral Rb and higher tumor grades increase total anesthesia exposure in children.
Area of Science:
- Ophthalmology
- Pediatric Oncology
- Anesthesiology
Background:
- Retinoblastoma (Rb) is a pediatric eye cancer requiring complex treatments.
- These treatments often necessitate repeated general anesthesia exposures.
- Quantifying anesthesia duration is crucial for understanding treatment burden and potential risks.
Purpose of the Study:
- To quantify the total anesthesia duration for retinoblastoma management.
- To stratify anesthesia time based on clinical factors like disease laterality, tumor grade, and treatment modality.
Main Methods:
- Retrospective review of 43 retinoblastoma patients' medical records from January 2011 to January 2022.
- Collected demographic, tumor, and treatment data, recording anesthesia time for procedures like intra-arterial chemotherapy (IAC), enucleation, and MRI.
- Utilized descriptive statistics to analyze anesthesia durations.
Main Results:
- Total anesthesia time was 48,991 minutes across 610 procedures.
- Average anesthetic durations per procedure: IAC (274 min), enucleation (152 min), BAER (81.8 min), port placement (62.5 min), MRI (60.7 min), EUA (45 min).
- Bilateral Rb patients (1,659 min) required significantly more anesthesia than unilateral (397 min). IAC treatment led to the longest median anesthesia duration (2,100 min).
Conclusions:
- Retinoblastoma treatment involves substantial and repeated exposure to general anesthesia in children.
- Anesthesia duration varies significantly based on disease extent and treatment strategy.
- Further research is needed to assess the long-term effects of these cumulative childhood anesthetic exposures.
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.
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