Risk factors for the development of severe forms of trigeminocardial reflex during selective intraoperative chemotherapy in children with retinoblastoma

Introduction. Retinoblastoma is the most common primary intraocular tumor of childhood. Among available treatment strategies, selective intra-arterial and intravitreal chemotherapy represent the most effective approaches for targeted drug delivery directly to the tumor. However, potentially life-threatening complications may occur during anesthetic management, particularly the trigeminocardiac reflex.

The objective was to evaluate the incidence of cardiorespiratory events in patients undergoing selective intra-arterial chemotherapy for retinoblastoma and to identify risk factors for their occurrence.

Materials and methods. We conducted a single-center retrospective cohort study including 214 pediatric patients (622 procedures) with retinoblastoma between 2018 and 2023. Generalized estimating equations were used to identify the risk factors for adverse events. Cardiorespiratory events were recorded, and both clinical and procedural characteristics potentially associated with these events were analyzed. Patients were accompanied during anesthesiological care and data was recorded for analysis by anesthesiologists from the department of anesthesiology and intensive care of the Research Institute of Pediatric Oncology.

Results. The overall incidence of trigeminocardiac reflex (TCR) was 50% across all procedures, with variable severity. Every fifth selective intra-arterial chemotherapy session (in 21% of cases) was complicated by severe TCR. The highest incidence of TCR (24.4%) was observed during the second selective intra-arterial chemotherapy session, affecting nearly every fourth patient. Younger age ( > 24 months) and lower body weight ( > 12.5 kg) were identified as risk factors for the development of severe TCR.

Conclusions. TCR with cardiorespiratory disorders during selective intra-arterial chemotherapy in childrenwith retinoblastoma occurin 20-25% of cases. These complications require timely diagnosis and treatment to prevent further deterioration of the condition with the development of an adverse outcome.

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