Retinoblastoma is the most common eye neoplasm in children. It accounts for 2.5% to 4% of all Pediatric tumours, with an incidence in the USA and Europe of 2 to 5 cases per million [1]. It carries a significant hereditary component [2], with an autosomal dominant inheritance pattern associated with the RB1 gene mutation, which could lead to visual impairment in more than one family member. Until '90, the treatment of RB was based on enucleation and radiotherapy, which eventually evolved into systemic chemotherapy. To generate a more localized treatment to prevent systemic adverse reactions while preserving the eye, novel treatments have emerged, such as the Super-Selective Intra-Arterial Chemotherapy of the Ophthalmic Artery (SOAC) [3]. Unlike systemic chemotherapy, this super selective treatment requires the patients to be under general anaesthesia. Here we present two cases of patients with RB treated with SOAC and presented severe cardiovascular adverse events.

A 5-year-old male patient with left congenital retinoblastoma is admitted for a second chemotherapy session of SOAC. Previous clinical history included bronchiolitis and SOAC with Melphalan without any complications. The anaesthesia induction was done with sevoflurane 4% and O2 , and anaesthesia maintenance with sevoflurane and remifentanil, in addition to atropine 0.1 mg IV. After canalization of the ophthalmic artery, the patient presented a sudden decrease of pulmonary distention, hypoxemia (SaO2 30%), and bradycardia that soon converted into pulseless electrical activity. Code blue was activated, and CPR maneuvers were executed, including 10 µcg/kg of adrenaline and cardiac massage during 3 min. The patient returns to spontaneous circulation, and the chemoembolization was changed from super selective to non-selective chemotherapy in the internal carotid artery. The patient was transferred to the paediatric ICU. With favourable evolution, it was extubated at 24 hours post-surgery and discharged without any neurological deficit three days after.