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Twice-daily anesthesia in infants receiving hyperfractionated irradiation
L Menache1, P J Eifel, D L Kennamer
1Department of Radiation Therapy, University of Texas Medical Branch, Galveston 77550.
Insights
Hyperfractionated radiation therapy is safe for infants requiring anesthesia. Sodium thiopental enables rapid recovery, allowing adequate nutrition through oral feedings alone.
Area of Science:
- Pediatric Oncology
- Anesthesiology
- Radiation Oncology
Background:
- Infants undergoing radiation therapy often require general anesthesia for immobilization.
- Maintaining adequate nutrition during treatment is crucial for pediatric patients.
Observation:
- Four infants (6-30 months) received twice-daily radiation therapy under general anesthesia.
- Sodium thiopental was used for anesthesia, with rapid recovery observed after the second dose.
- Children were able to resume oral feedings shortly after anesthesia, maintaining their weight throughout treatment.
Findings:
- Hyperfractionated radiation therapy can be safely administered to infants using sodium thiopental anesthesia.
- Rapid recovery from sodium thiopental allowed for consistent oral nutrition, eliminating the need for parenteral support.
- No radiation-related treatment breaks occurred, and anesthetic complications were minimal.
Implications:
- Sodium thiopental is a suitable anesthetic for pediatric radiation therapy due to its short duration and rapid recovery.
- This approach facilitates uninterrupted treatment and adequate nutritional support in young cancer patients.
- Safe and effective radiation delivery in infants can be achieved with appropriate anesthetic management.
Abstract:
Four children ranging in age from 6-30 months were treated with twice-daily (BID) radiation therapy under general anesthesia with a 5-6 hr treatment interval. Anesthesia was accomplished with sodium thiopental administered intravenously (IV) by bolus injection. This as followed by continuous drip infusion of sodium thiopental in a few instances where more prolonged anesthesia was required. Children received an initial formula feeding 6 hr before their first treatment and were subsequently kept NPO (nothing by mouth) until they recovered from their second anesthesia. Recovery from thiopental was rapid and children were ready for a normal feeding within 1-1 1/2 hr of the second treatment. No parenteral feedings were required in any of these patients. Children maintained their weight during courses of radiation therapy which ranged between 19 and 43 elapsed days. There were no radiation-related treatment breaks. One child experienced two hypotensive episodes during anesthesia which responded rapidly to intravenous atropine. No other anesthetic complications occurred. This experience demonstrates that hyperfractionated radiation therapy can be safely delivered in infants requiring general anesthesia for immobilization. We feel that sodium thiopental is the anesthetic of choice in this setting because of the short duration of action and consequently rapid post-anesthesia recovery which makes it possible to achieve adequate nutrition with oral feedings alone.