Rb Fast Facts
Introduction to Rb
Global Incidence
Signs and Symptoms
Referral and Diagnosis
Staging Systems
Exam Under
Anaesthetic
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Follow Up and Prognosis
RB1 Genetics
Glossary Of Terms
Although an EUA is carried out in the oprtating room, it is not in itself a treatment. EUA is used to thoroughly check the retinas of a young child, confirm diagnosis, assess the extent of retinoblastoma and response to treatment.
During the EUA, ultrasound, retinal photographs and drawings are used to map the size, shape, and location of each tumour in each eye.
If there is a risk that retinoblastoma has spread beyond the eye(s), a sample of fluid bathing the brain and a bone marrow aspirate and/or biopsy may be taken durin an EUA for microscopic examination.
Focal therapies (such as laser and cryotherapy) are also carried out during an EUA, but any necessary surgical procedures should only be performed after they have been discussed with the child's parents, and consent has been obtained.
Repeated EUAs are necessary to monitor and treat children with retinoblastoma, and may be carried out as frequently as every 2-3 weeks during and immediately after treatment.
EUA is usually done on an outpatient basis. Children must not eat before the procedure as this can cause dangerous complications during the general anaesthetic. Most hospitals instruct that food should not be consumed after midnight on the morning of the scheduled EUA. This includes all solid and thick liquid foods, milk, juice with pulp.and formula.
Clear fluids can be given upto 2 hours before the EUA. This included water, apple juice, uncarbonated soft drinks, jelly, ice lollies and clear broth. Many hospitals also consider breast milk to be a clear liquid, but some instruct that breasfeeding should stop 3 hours before the general anaesthetic.
Withholding food is extremely important, but can be particularly hard for infants and young children.
Don't eat or drink whilst in the company of a child who is nil-by-mouth in preparation for an EUA. Providing some favourite activities to divert attention away from thoughts of food can also help. Many parents help their older child to choose a favourite meal to be enjoyed as a post-EUA treat. Giving children reasons for not allowing food will help them to understand what is happening and why.
Eye drops are necessary to dilate the pupil, and these will be given before the anaesthetic is administered. The eye drops sting for up to 30 seconds, and may cause the child some distress. Lots of reassurance while the eye drops are administered can be very helpful, as can simple explanation for the older child, such as “the drops will hurt a bit, but the hurt will go away very quickly”.
The general anaesthetic can be administered in several different ways.
Mask: this is the standard approach for babies and very young children. The mask is placed over the mouth and nose, and the drugs are inhaled.
IV injection: this route can be used if the child already has an IV canula inserted. Older children may prefer to let the anaesthetist insert a canula as this may be less distressing for them than the mask. If the IV option fails, it is always possible to use the mask.
Central Veinous Catheter: CVCs (port-a-cath, broviac or PICC) are used in many developed countries to administer chemotherapy, and it may be possible to use the CVC for anaesthetic administration.
Many hospitals allow a parent to remain with their child until she is asleep, and this can be particularly therapeutic if the child is very young or distressed. Other hospitals will only allow parents as far as the Theatre anti-room. Some hospitals have set procedures whilst at others, such decisions rest with the attending physicians.
During the EUA, the child's breathing and heart rate are closely monitored by the anaesthetist, and she may be intubated to manage breathing. This involves inserting a flexible tube into the throat, which will be removed once the procedure is complete.
An average EUA lasts about 45minutes, after which the child will be taken to Recovery until she is fully conscious.
Upon waking, some children experience confusion, irritability and/or distress. Though this is normal, certain anaesthetic agents may cause or amplify the symptoms. The anaesthetist should discuss with parents any potential effects of individual drugs before their administration.
Although a child may cry following EUA, it is unlikely that she is experiencing any physical pain as painkillers will be administered in the operating room after any potentially painful treatments. Crying is actually thought to aid the removal of remaining anaesthesia from the body, and thus speed up the recovery process.
Drowsiness may remain after an EUA. Children may sleep for an hour or more, and this is totally normal.
Child often wake up feeling hungry, particularly if the EUA has been delayed. It is usually preferable to begin with clear liquids and build up from there. Infants may be given breast milk as usual.
Children will usually be ready to go home several hours after the EUA. However, infants under 8 weeks old may be required to stay in hospital overnight.
The doctor should discuss the findings of the EUA with the parents immediately after the EUA or before the end of the day’s clinic, and set a date for the next EUA of office exam during this discussion.
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