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Multidisciplinary Strategies for Tailored Anesthesia Management in Children Undergoing Radiotherapy
Salvatore Palmese1, Renato Gammaldi1, Alessandro Vittori2
1Department of Anesthesia and Intensive Care, AOU "San Giovanni di Dio e Ruggi d'Aragona", 84131 Salerno, Italy.
Insights
Pediatric radiotherapy requires careful anesthetic management due to repeated sedation needs. This review covers anesthetic strategies, safety, and multidisciplinary care for children undergoing radiation therapy.
Area of Science:
- Pediatric Anesthesiology
- Radiation Oncology
- Pediatric Oncology
Background:
- Radiotherapy is vital for pediatric cancers but presents anesthetic challenges in children.
- Children often need repeated sedation or general anesthesia for immobility and to reduce distress during lengthy treatments.
Purpose of the Study:
- To review current evidence on anesthetic strategies for pediatric radiotherapy.
- To focus on clinical indications, pharmacology, safety, and organizational aspects of pediatric anesthesia during radiation therapy.
Main Methods:
- Narrative review of current evidence.
- Discussion of sedation and anesthesia techniques in non-operating room anesthesia (NORA) settings.
- Examination of pharmacological agents like midazolam, propofol, ketamine, and dexmedetomidine.
Main Results:
- Anesthetic management requires attention to cumulative effects, airway challenges in remote settings, and potential complications.
- Individualized, protocol-driven management, rapid recovery, and continuous monitoring are highlighted.
- Non-pharmacological and audiovisual techniques may reduce anesthesia needs.
Conclusions:
- A multidisciplinary approach is essential for optimizing safety, adherence, and care quality.
- Tailored anesthetic management with standardized protocols and pediatric expertise is crucial for balancing efficacy and safety.
Abstract:
Although radiotherapy is a cornerstone in the management of several pediatric malignancies, its administration in children poses unique anesthetic challenges. Unlike adults, pediatric patients, particularly younger children, often require repeated sedation or general anesthesia to ensure immobility and reduce psychological distress during daily treatment sessions that may extend over several weeks. This narrative review summarizes current evidence on anesthetic strategies for children undergoing radiotherapy, focusing on clinical indications, pharmacological approaches, safety considerations, and organizational aspects. We discuss the main sedation and anesthesia techniques used in non-operating room anesthesia (NORA) settings, including deep sedation with midazolam, propofol, ketamine, and dexmedetomidine, as well as general anesthesia with laryngeal mask airway management. Particular attention is given to the cumulative effects of repeated anesthetic exposure, airway management challenges in remote radiation environments, and the risk of respiratory and hemodynamic complications. The review also highlights the importance of individualized, protocol-driven management, rapid recovery strategies, and continuous remote monitoring systems. Non-pharmacological interventions and audiovisual-assisted techniques are also discussed as potential strategies to reduce anesthesia requirements in selected patients. A multidisciplinary approach involving anesthesiologists, radiation oncologists, nurses, psychologists, and technical staff is essential to optimize safety, treatment adherence, and overall quality of care. Tailored anesthetic management, supported by standardized protocols and specialized pediatric expertise, remains crucial to balancing procedural efficacy with short- and long-term safety in this vulnerable population.
