Fortney J T, Halperin E C, Hertz C M, Schulman S R
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
Int J Radiat Oncol Biol Phys. 1999 Jun 1;44(3):587-91. doi: 10.1016/s0360-3016(99)00058-9.
For very young patients, anesthesia is often required for radiotherapy. This results in multiple exposures to anesthetic agents over a short period of time. We report a consecutive series of children anesthetized for external beam radiation therapy (EBRT).
Five hundred twelve children < or = 16 years old received EBRT from January 1983 to February 1996. Patient demographics, diagnosis, anesthesia techniques, monitoring, airway management, complications, and outcome were recorded for the patients requiring anesthesia.
One hundred twenty-three of the 512 children (24%) required 141 courses of EBRT with anesthesia. Anesthetized patients ranged in age from 20 days to 11 years (mean 2.6 +/- 1.8 ). The frequency of a child receiving EBRT and requiring anesthesia by age cohort was: < or = 1 year (96%), 1-2 years (93%), 2-3 years (80%), 3-4 years (51%), 4-5 years (36%), 5-6 years (13%), 6-7 years (11%), and 7-16 years (0.7%). Diagnoses included: primary CNS tumor (28%), retinoblastoma (27%), neuroblastoma (20%), acute leukemia (9%), rhabdomyosarcoma (6%), and Wilms' tumor (4%). Sixty-three percent of the patients had been exposed to chemotherapy prior to EBRT. The mean number of anesthesia sessions per patient was 22 +/- 16. Seventy-eight percent of the treatment courses were once daily and 22% were twice daily. Anesthesia techniques included: short-acting barbiturate induction + inhalation maintenance (21%), inhalation only (20%), ketamine (19%), propofol only (12%), propofol induction + inhalation maintenance (7%), ketamine induction + inhalation maintenance (6%), ketamine or short-acting barbiturate induction + inhalation maintenance (6%). Monitoring techniques included: EKG (95%), O2 saturation (93%), fraction of inspired O2 (57%), and end-tidal CO2 (55%). Sixty-four percent of patients had central venous access. Eleven of the 74 children with a central line developed sepsis (15%): 6 of the 11 were anesthetized with propofol (55%), 4 with a short-acting barbiturate induction plus inhalation maintenance (36%), and 1 with inhalation alone (9%). Eight of the 11 (73%) received prior chemotherapy.
Anesthesia was generally necessary at < or = 3 years, and rarely required at > 5 years of age. Sepsis associated with frequent use of the central venous access line was seen in 15% of the patients with these lines.
对于非常年幼的患者，放疗通常需要麻醉。这导致在短时间内多次接触麻醉剂。我们报告了一系列连续接受体外放射治疗（EBRT）麻醉的儿童病例。
1983年1月至1996年2月期间，512名年龄小于或等于16岁的儿童接受了EBRT治疗。记录了需要麻醉的患者的人口统计学资料、诊断、麻醉技术、监测、气道管理、并发症及治疗结果。
512名儿童中有123名（24%）需要接受141个疗程的EBRT麻醉。接受麻醉的患者年龄范围为20天至11岁（平均2.6±1.8岁）。按年龄组划分接受EBRT且需要麻醉的儿童比例为：小于或等于1岁（96%），1 - 2岁（93%），2 - 3岁（80%），3 - 4岁（51%），4 - 5岁（36%），5 - 6岁（13%），6 - 7岁（11%），7 - 16岁（0.7%）。诊断包括：原发性中枢神经系统肿瘤（28%）、视网膜母细胞瘤（27%）、神经母细胞瘤（20%）、急性白血病（9%）、横纹肌肉瘤（6%）和肾母细胞瘤（4%）。63%的患者在接受EBRT之前曾接受过化疗。每位患者的平均麻醉次数为22±16次。78%的治疗疗程为每日一次，22%为每日两次。麻醉技术包括：短效巴比妥类药物诱导+吸入维持（21%）、单纯吸入（20%）、氯胺酮（19%）、单纯丙泊酚（12%）、丙泊酚诱导+吸入维持（7%）、氯胺酮诱导+吸入维持（6%）、氯胺酮或短效巴比妥类药物诱导+吸入维持（6%）。监测技术包括：心电图（95%）、血氧饱和度（93%）、吸入氧分数（57%）和呼气末二氧化碳（55%）。64%的患者有中心静脉通路。74名有中心静脉导管的儿童中有11名发生败血症（15%）：11名中的6名使用丙泊酚麻醉（55%），4名使用短效巴比妥类药物诱导加吸入维持麻醉（36%），1名单纯使用吸入麻醉（9%）。11名中的8名（73%）之前接受过化疗。
一般3岁及以下儿童放疗通常需要麻醉，5岁以上则很少需要。在有中心静脉通路的患者中，15%出现了与频繁使用中心静脉导管相关的败血症。
