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General Anesthesia for Pediatric Radiation Therapy in the Era of COVID-19
Michael J LaRiviere1,2, Yash B Shah1,2,3, Elizabeth R Cummings1,2
1Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
This study shows that a new protocol for pediatric radiation therapy (RT) under general anesthesia (GA) during COVID-19 successfully managed patients, maintaining high treatment volumes without increasing infection risk or toxicity.
Area of Science:
- Pediatric Oncology
- Radiation Therapy
- Anesthesiology
- Infectious Disease Control
Background:
- Managing pediatric patients requiring daily general anesthesia (GA) for radiation therapy (RT) during the COVID-19 pandemic presents significant challenges.
- These challenges include the aerosolizing nature of GA procedures, potential cardiopulmonary complications in infected patients, and the need to protect immunocompromised oncology patients and staff in a busy clinic.
Purpose of the Study:
- To develop and implement an institutional protocol for COVID-19 testing and protection measures for pediatric patients, caregivers, and staff undergoing RT with GA.
- To determine if this protocol could safely facilitate treatment, minimize COVID-19 transmission, and maintain pre-pandemic patient volumes.
Main Methods:
- An institutional protocol was developed, including mandatory COVID-19 testing before treatment and thrice-weekly during treatment.
- Patients testing positive for COVID-19 received RT as the last end-of-day appointment.
- GA induction and recovery occurred in a negative pressure room, with separate teams for in-room and out-of-room patient management.
Main Results:
- Eighty courses of RT under GA were administered to 78 pediatric patients, an increase from the previous year.
- Two patients (2.6%) tested positive for COVID-19; both were asymptomatic and completed treatment without complications.
- No patient developed cardiopulmonary symptoms complicating anesthesia or experienced grade 3+ acute radiation toxicity.
Conclusions:
- Multidisciplinary planning effectively mitigated COVID-19 risks associated with pediatric RT under GA.
- High patient volumes were maintained without widespread infection.
- The protocol ensured that treatment toxicity from GA or RT did not increase.
Purpose:
Managing pediatric patients requiring daily general anesthesia (GA) for radiation therapy (RT) in the setting of COVID-19 is complex, owing to the aerosolizing nature of GA procedures, the risk of cardiopulmonary complications for infected patients, and the treatment of immunocompromised oncology patients in a busy, densely populated radiation oncology clinic.
Methods And Materials:
We developed an institutional protocol to define procedures for COVID-19 testing and protection of patients, caregivers, and staff, hypothesizing that this protocol would allow patients requiring GA to be safely treated, minimizing COVID-19 transmission risk to both patients and staff, and at the same time maintaining pre-COVID-19 patient volumes. All patients underwent COVID-19 testing before their first treatment and thrice weekly during treatment. For patients who tested positive for COVID-19, RT was delivered in the last end-of-day treatment appointment. A negative pressure room was used for GA induction and recovery, and separate physician/nurse teams were designated for in-room versus out-of-room patient management.
Results:
Seventy-eight pediatric patients received RT under GA, versus 69 over the same prior year timeframe, and 2 patients received 2 courses of RT under GA, for a total of 80 courses. The mean age was 4.9 years (range, 0.5-19.0 years) and 41 of 78 (52.6%) were male. Two patients (2.6%) received 2 courses of RT under GA, establishing a total of 80 courses. The mean number of treatment fractions was 22.2 (range, 1-40). Two of 78 patients (2.6%) tested positive for COVID-19; both were asymptomatic. Both patients completed treatment as prescribed. Neither patient developed cardiopulmonary symptoms complicating anesthesia, and neither patient experienced grade 3+ acute radiation toxicity.
Conclusions:
With careful multidisciplinary planning to mitigate COVID-19 risk, pediatric RT with GA was carried out for a large patient volume without widespread infection and without increased toxic effects from either GA or RT.
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