Background
Safety data for infants under 12 months undergoing anesthesia in clinic settings is limited. Retinoblastoma, the most common pediatric intraocular cancer, often requires general anesthesia for outpatient ophthalmology procedures in a clinic setting.
Methods
This is a retrospective study of 888 anesthesia encounters in 237 infants (< 12 months) undergoing clinic visits at MSKCC (2014–2024) for the diagnosis and localized intraocular treatment of retinoblastoma. The primary outcome was the incidence of anesthesia-related complications requiring readmission within 24 h. Secondary outcomes included anesthesia duration, recovery time, airway management approach, and use of opioid or non-opioid analgesia.
Results
No anesthesia-related readmissions occurred. Median anesthesia duration was 43 min (0–6 months) and 36 min (7–< 12 months); median recovery times were 36 and 25 min, respectively. Laryngeal mask airways were used in 824 (93%) cases.
Conclusions
General anesthesia in outpatient clinic settings can be safe for infants with retinoblastoma undergoing non-narcotic-requiring localized intraocular treatment procedures.
Clinical Implications
What is Already Known
- Pediatric outpatient anesthesia and non-operating room anesthesia (NORA) are generally safe, though infants under 12 months have higher complication risks than older children.
- Laryngeal mask airways reduce respiratory complications compared to endotracheal intubation in infants undergoing minor procedures.
- Limited data exist on the safety of outpatient clinic-based general anesthesia specifically for infants undergoing localized intraocular procedures.
What New Information This Study Adds
- In 888 anesthesia encounters in infants with retinoblastoma, there were zero anesthesia-related readmissions, demonstrating excellent safety in this high-risk age group.
- General anesthesia for localized intraocular procedures can be safely delivered in an outpatient clinic without routine intravenous access (27% of cases) or opioids (0.23% of cases), with short recovery times (mean 37 minutes).
- This largest reported experience of outpatient clinic anesthesia in infants under 12 months supports the safety of this approach for localized, minimally invasive procedures when delivered by specialized teams.