Acute Cardiorespiratory Instability During Intra-Arterial Chemotherapy for Pediatric Retinoblastoma: A Case Series

Intra-arterial chemotherapy (IAC) is increasingly used for the treatment of pediatric retinoblastoma because of its high efficacy and reduced systemic toxicity. We report a case series of 18 intraoperative cardiorespiratory events occurring during 154 procedures in children undergoing superselective ophthalmic artery catheterization. Events included hypoxemia, bradycardia, hypotension, and decreased pulmonary compliance, often occurring abruptly during the procedure. All episodes were managed successfully with supportive measures, and no patient experienced long-term sequelae. These findings highlight the procedure-specific risk of acute cardiorespiratory instability during pediatric IAC and underscore the importance of vigilant intraoperative monitoring, readiness for rapid intervention, and experienced anesthesia care in nonoperating room settings.