Owusu-Agyemang Pascal, Tsai January Y, Kapoor Ravish, Van Meter Antoinette, Tan Gee Mei, Peters Sarah, Opitz Lucas, Pedrotti Dino, DeSoto Hernando S, Zavala Acsa M
Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, Houston, USA.
Anesthesiology, Children's Hospital Colorado, Aurora, USA.
Cureus. 2022 Apr 12;14(4):e24075. doi: 10.7759/cureus.24075. eCollection 2022 Apr.
Background Children undergoing cranial or craniospinal radiotherapy may require over 30 treatments within a six-week period. Facilitating these many treatments with the patient under anesthesia presents a significant challenge, and the most preferred anesthetic methods remain unknown. The primary goal of this study was to determine the most preferred anesthetic methods and agents for children undergoing daily cranial or craniospinal radiotherapy. Methods An 83-item web-based survey was developed. An introductory email was sent to 505 physicians and child-life specialists with expertise in pediatric anesthesia and/or affiliated with pediatric radiation oncology departments. Results The response rate was 128/505 (25%) and included specialists from Africa (5, 4%), Asia (18, 14%), Australia/Oceania (5, 4%), Europe (45, 35%), North America (50, 39%), and South America (5, 4%). The 128 respondents included 91 anesthesiologists (71%), 20 physicians who were not anesthesiologists (16%), 14 child life/social education specialists (11%), one radiotherapist, one pediatric radiation nurse, and one non-specified medical professional (all = 2%). Of the 128 respondents, 95 (74%) used anesthesia or sedation to facilitate repetitive cranial or craniospinal radiotherapy. Overall, total intravenous anesthesia without intubation was preferred by 67 of 95 (71%) specialists during one or more forms of radiotherapy. During photon-based radiotherapy, total intravenous anesthesia without intubation was the preferred anesthetic method with the patient in the supine (57/84, 68%) and prone positions (25/40, 63%). Propofol was the most used anesthetic agent for both supine (73/84, 87%) and prone positions (38/40, 95%). For proton radiotherapy, total intravenous anesthesia without intubation was the most preferred anesthetic method for the supine (32/42, 76%) and prone treatment positions (11/18, 61%), and propofol was the most used anesthetic (supine: 40/43, 93%; prone: 16/18, 89%). Conclusions In this survey of 95 specialists responsible for anesthesia or sedation of children undergoing repetitive cranial or craniospinal radiotherapy, propofol-based total intravenous anesthesia without intubation was the preferred anesthetic technique.
接受颅脑或全脑全脊髓放疗的儿童可能需要在六周内接受超过30次治疗。在麻醉状态下为这些儿童进行如此多次治疗带来了重大挑战，目前最优选的麻醉方法仍不明确。本研究的主要目的是确定接受每日颅脑或全脑全脊髓放疗的儿童最优选的麻醉方法和药物。方法：开展了一项基于网络的83项调查。向505名在小儿麻醉方面有专业知识和/或隶属于小儿放射肿瘤学部门的医生和儿童生活专家发送了介绍性电子邮件。结果：回复率为128/505（25%），回复者来自非洲（5人，4%）、亚洲（18人，14%）、澳大利亚/大洋洲（5人，4%）、欧洲（45人，35%）、北美洲（50人，39%）和南美洲（5人，4%）。128名受访者包括91名麻醉医生（71%）、20名非麻醉医生（16%）、14名儿童生活/社会教育专家（11%）、1名放射治疗师、1名小儿放射护士和1名未明确的医疗专业人员（共2%）。在128名受访者中，95人（74%）使用麻醉或镇静来辅助重复的颅脑或全脑全脊髓放疗。总体而言，在一种或多种放疗形式中，95名专家中有67人（71%）更喜欢非插管全静脉麻醉。在基于光子的放疗中，非插管全静脉麻醉是患者仰卧位（57/84，68%）和俯卧位（25/40，63%）时的首选麻醉方法。丙泊酚是仰卧位（73/84，87%）和俯卧位（38/40，95%）时最常用的麻醉药物。对于质子放疗，非插管全静脉麻醉是仰卧位（32/42，76%）和俯卧位治疗体位（11/18，61%）时最优选的麻醉方法，丙泊酚是最常用的麻醉药物（仰卧位：40/43，93%；俯卧位：16/18，89%）。结论：在这项针对95名负责为接受重复颅脑或全脑全脊髓放疗的儿童进行麻醉或镇静的专家的调查中，基于丙泊酚的非插管全静脉麻醉是首选的麻醉技术。
