Stephanie M Ntoukas1, Tatiana Ritchie1, Susan Awrey2, David C Hodgson2, Normand Laperriere2, Ryan Yee1, Vijay Ramaswamy3, Barbara-Ann Millar1, Nathan Becker1, Derek S Tsang4. 1. Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. 2. Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada. 3. Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada. 4. Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: derek.tsang@rmp.uhn.ca.
Abstract
PURPOSE: At our institution, a multifaceted approach is used to reduce general anesthetic (GA) use for children receiving photon radiation therapy (RT) as standard-of-care treatment. The purpose of this study was to evaluate the effectiveness of our methods. METHODS AND MATERIALS: Patients treated as part of the pediatric radiation therapy program from 2010 to 2018 were retrospectively reviewed. GA use was defined as need for intravenous propofol or inhaled gaseous anesthetic for at least 1 simulation or RT session. Methods to reduce GA use included presence of a dedicated pediatric nurse for procedural preparation, audiovisual distraction (television during RT), and 2-way audio communication with caregivers. RESULTS: There were 779 unique patients who received RT over 14 163 fractions of radiation. GA utilization was 90% in those under age 3, 28% in those age 3 to 6, 1% in those age 7 to 11, and <1% in those ≥12 years of age. Four years of age is a cutoff age at which the majority of patients switch from needing GA (56.6% for those aged 3) to not needing GA (29.8% for those aged 4). Younger age, use of total body irradiation, and craniospinal irradiation were independently associated with requiring GA. CONCLUSIONS: Using methods designed to reduce GA use, most children aged 4 years or older were able receive RT awake. Our GA rates compare favorably to other literature reports; thus, pediatric RT centers should consider adopting specific interventions to reduce GA use.
PURPOSE: At our institution, a multifaceted approach is used to reduce general anesthetic (GA) use for children receiving photon radiation therapy (RT) as standard-of-care treatment. The purpose of this study was to evaluate the effectiveness of our methods. METHODS AND MATERIALS: Patients treated as part of the pediatric radiation therapy program from 2010 to 2018 were retrospectively reviewed. GA use was defined as need for intravenous propofol or inhaled gaseous anesthetic for at least 1 simulation or RT session. Methods to reduce GA use included presence of a dedicated pediatric nurse for procedural preparation, audiovisual distraction (television during RT), and 2-way audio communication with caregivers. RESULTS: There were 779 unique patients who received RT over 14 163 fractions of radiation. GA utilization was 90% in those under age 3, 28% in those age 3 to 6, 1% in those age 7 to 11, and <1% in those ≥12 years of age. Four years of age is a cutoff age at which the majority of patients switch from needing GA (56.6% for those aged 3) to not needing GA (29.8% for those aged 4). Younger age, use of total body irradiation, and craniospinal irradiation were independently associated with requiring GA. CONCLUSIONS: Using methods designed to reduce GA use, most children aged 4 years or older were able receive RT awake. Our GA rates compare favorably to other literature reports; thus, pediatric RT centers should consider adopting specific interventions to reduce GA use.
Authors: Paulina M Gutkin; Sarah S Donaldson; Lawrie Skinner; Michelle Callejas; Jaclyn Cimino; Jacob Lore; Karl Bush; Susan M Hiniker Journal: Adv Radiat Oncol Date: 2020-12-10
Authors: Douglas E Holt; Susan M Hiniker; John A Kalapurakal; John C Breneman; Jay C Shiao; Nicole Boik; Benjamin T Cooper; Paige L Dorn; Matthew D Hall; Natalie Logie; John T Lucas; Iain J MacEwan; Adam C Olson; Joshua D Palmer; Samir Patel; Luke E Pater; Stephanie Surgener; Derek S Tsang; Jennifer H Vogel; Alyssa Wojcik; Cheng-Chia Wu; Sarah A Milgrom Journal: Int J Radiat Oncol Biol Phys Date: 2020-09-12 Impact factor: 8.013