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Anaesthesia for radiotherapy in paediatric oncology-a retrospective observational study in an Asian population
Lydia W Li1, Gail Wy Chua2, Koh Wenjun3
1Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Anaesthesia & Intensive Care, Changi General Hospital, Singapore; Duke-NUS Medical School, Singapore.
Insights
Pediatric radiotherapy often requires anesthesia or sedation due to immobilization devices. The need for anesthesia significantly decreases with age, with younger children (under 3) requiring it more frequently than older children (over 7).
Area of Science:
- Oncology
- Anesthesiology
- Pediatrics
Background:
- Immobilization is crucial for pediatric radiotherapy near critical organs.
- External beam radiotherapy is painless, but immobilization devices can cause distress in children.
- Anesthesia or sedation is often unavoidable for pediatric patients undergoing radiotherapy.
Purpose of the Study:
- To evaluate the demographics, methods, and outcomes of pediatric radiotherapy patients in an Asian context.
- To analyze factors associated with the need for anesthesia during pediatric radiotherapy.
- To provide insights into anesthetic practices for pediatric radiotherapy in the region.
Main Methods:
- Retrospective observational study at a tertiary hospital.
- Data collected on patient demographics, oncology diagnosis, radiotherapy details, and anesthetic management.
- Statistical analysis, including multivariable modeling, to assess factors influencing anesthesia use.
Main Results:
- 434 pediatric patients underwent 10,357 radiotherapy sessions between 2006 and 2017.
- General anesthesia or sedation was required in 11.8% of sessions.
- Anesthesia need was age-dependent: all patients under 3 years required it, while rarely needed in those over 7 years. Inhalational agents were more prevalent than intravenous agents.
Conclusions:
- This is the first retrospective review in the country on pediatric patients receiving anesthesia during radiotherapy.
- The requirement for anesthesia decreases with age, consistent with existing literature.
- The reported complication rate during anesthesia sessions was low, indicating high standards of safety.
Background:
Immobilisation in radiotherapy treatment is especially important as many paediatric tumours are located near critical organs. Although the external beam radiotherapy treatment process itself is painless, the immobilization devices used may cause anxiety and discomfort in children who are too young to understand and co-operate. Hence, anaesthesia or sedation is unavoidable in such cases. This descriptive study aims to evaluate the demographics, methods and outcomes of paediatric radiotherapy patients in our Asian context.
Methods:
This is a single-institution, retrospective observational study in a tertiary hospital with more than a decade of experience in paediatric radiotherapy. Data collected include age, gender, race, ASA status, oncology diagnosis, site of radiotherapy, position of patient during procedure, need for sedation or anaesthesia, anaesthetic drugs used, airway devices, use of premedications, use of antiemetics, and incidence and type of complications. We also analysed the association between various factors (e.g., age, radiotherapy treatment site) and usage of anaesthesia. Statistical analysis was carried out using a multivariable model.
Results:
Between January 2006 and December 2017, 434 paediatric patients underwent radiotherapy, with a total of 10,357 discrete radiotherapy sessions. In 1,276 radiotherapy sessions (11.8%) either general anaesthesia or sedation was required. The need for anaesthesia was highly age-dependent-all patients under 3 years of age required anaesthesia, whereas anaesthesia was rarely needed in patients above 7 years of age. Our institution had a higher prevalence of inhalational agent usage as opposed to intravenous agent usage. Complication rate was relatively low.
Conclusions:
This is the first retrospective review performed in our country on paediatric patients receiving anaesthesia during radiotherapy, evaluating patients' demographic data, and type of anaesthesia and radiotherapy techniques used. We found that patients' requirement for anaesthesia decreases in an age-dependent fashion, in line with existing literature. Our reported complication rate during anaesthesia sessions was low, testament to the high standards and safety of our techniques.
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