Analysis of severe intraoperative cardiorespiratory changes during intra-arterial chemotherapy for retinoblastoma

PURPOSE: To determine the incidence and characteristics of severe cardiorespiratory events during intra-arterial chemotherapy (IAC) for retinoblastoma and to evaluate a potential association with the COVID-19 pandemic. METHODS: This single-center retrospective observational study included 108 children who underwent 280 IAC procedures between January 2017 and May 2024. Severe cardiorespiratory events were defined by acute oxygen desaturation accompanied by increased peak airway pressure, reduced tidal volume, bradycardia, or hypotension. Patient demographics, procedural details, and periprocedural outcomes were extracted from anesthesia and radiology records. A multivariable generalized linear mixed model with a logit link was used to assess associations with severe cardiorespiratory events while accounting for repeated procedures within patients. RESULTS: Severe cardiorespiratory events occurred in 18 procedures (6.4%) among 15 patients, increasing from 3 procedures (2.2%) before the COVID-19 pandemic to 15 procedures (10.5%) during or after the COVID-19 pandemic (P=0.011). Procedures performed during or after the pandemic were associated with higher odds of severe cardiorespiratory events (OR 7.1, 95% CI 1.6 to 31.8). Most events occurred during the second or subsequent IAC sessions. Management included manual ventilation, increased oxygen delivery, propofol bolus, and deepening of anesthesia. No procedures were interrupted due to severe cardiorespiratory events. CONCLUSION: Severe cardiorespiratory events during IAC were more frequent during and after the COVID-19 pandemic, often presenting as bronchospasm-like events. All events were managed successfully without procedural interruption. Given the retrospective design and the lack of individual SARS-CoV-2 infection data, these findings should be considered hypothesis-generating and require confirmation in larger prospective multicenter studies.