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Deep sedation with propofol in preschool children undergoing radiation therapy
G Scheiber1, F C Ribeiro, H Karpienski
1Department of Anaesthesiology, University Hospital, Essen, Germany.
Insights
Sedative anesthesia using propofol effectively immobilizes pediatric oncology patients for radiation therapy. This method, involving continuous propofol infusion, offers a safe alternative to general anesthesia with no significant complications.
Area of Science:
- Pediatric Oncology
- Anesthesiology
Background:
- Immobilization for pediatric radiation therapy typically requires general anesthesia.
- General anesthesia involves intubation and controlled ventilation, posing potential risks for young patients.
Purpose of the Study:
- To evaluate the efficacy and safety of sedative anesthesia with propofol for immobilizing pediatric oncology patients during radiation therapy.
- To present a clinical report on the use of propofol-based sedative anesthesia as an alternative to general anesthesia.
Main Methods:
- A clinical report detailing 155 anesthetic procedures in 11 pediatric oncology patients (mean age 30 months).
- Propofol was administered for induction (3.6 mg/kg) followed by continuous infusion (7.4 mg/kg/h) for maintenance.
- Patients underwent radiation therapy for 7-33 consecutive days, with anesthesia duration averaging 18 minutes.
Main Results:
- No clinically significant complications related to respiration, circulation, or neurology were observed.
- One transient episode of desaturation was managed successfully with suctioning and repositioning.
- Children recovered spontaneously, opening eyes in 4 minutes and discharging in approximately 30 minutes post-anesthesia.
Conclusions:
- Sedative anesthesia with propofol is an effective and safe method for immobilizing pediatric patients during radiation therapy.
- This approach avoids the need for intubation and controlled ventilation associated with general anesthesia.
- Propofol-based sedative anesthesia offers a favorable alternative, with rapid recovery and no observed adverse effects.
Abstract:
Immobilization of children undergoing radiation therapy always requires anaesthesia. Deep sedation with continuous infusion of propofol and spontaneous breathing, (we call it ¿sedative anaesthesia'), may be an alternative to general anaesthesia with intubation and controlled ventilation. This clinical report deals with 155 anaesthetics performed in 11 consecutive paediatric oncology patients, mean age 30 months (range 19-42), who required radiation therapy for from seven to 33 consecutive days. Mean duration of anaesthesia was 18 ( +/- 11) mins. For induction, a loading dose of 3.6 (SD +/- 0.59) mg.kg-1 propofol was administered immediately followed by a continuous infusion of 7.4 ( +/- 2.2) mg.kg-1.h-1 for maintenance of anaesthesia. There were no complications of clinical importance involving respiration, circulation or neurology, except for one short episode of transient desaturation, which was managed by suctioning and changing head position. Children opened their eyes spontaneously four ( +/- 3.7) min after discontinuing the propofol infusion and could be discharged about 30 mins later. Tachyphylaxis or unpleasant side effects during and after anesthesia have not been observed. Sedative anaesthesia with propofol seems to be an excellent method to immobilize paediatric patients during radiotherapeutic procedures.