García-Aroca Miguel A, Fernández-de Miguel José M, Franceschi María Aymerich-de, Fernández-Vaquero Miguel A, Meléndez-Salinas Diego A, Piñero-Merino María, Álvarez-Avello José M
Department of Anesthesia and Intensive Care, Clínica Universidad de Navarra, Madrid, Spain.
Paediatr Anaesth. 2023 Nov;33(11):946-954. doi: 10.1111/pan.14739. Epub 2023 Aug 1.
Proton beam therapy is an oncological treatment, argued to be an appropriate tumor irradiation technique for childhood solid tumors. Due to its duration and the need for immobility, many children require anesthesia for proton therapy sessions. As not many centers in the world provide this therapy, there is little published research about pediatric anesthesia for these cases, and the available data suggest a preference for intravenous anesthesia or combined intravenous and inhalation anesthesia. We conducted this study with the aim of describing and analyzing the inhalation anesthetic management of children undergoing proton therapy at our medical center, comparing our results with studies that have followed different anesthetic protocols.
We reviewed two major databases (Web of Science and Scopus) to find papers that had addressed, to date, anesthesia for pediatric proton therapy. To describe our anesthetic management, we included all pediatric patients treated with proton therapy under anesthesia in our center between June 2020 and August 2021. The characteristics of the patients, their diagnoses, treatments, airway management, drugs administered, duration of induction, and recovery from anesthesia, and adverse effects where all recorded. All anesthesiologists followed a strict anesthetic protocol based only on inhalational anesthesia with sevoflurane delivered via laryngeal mask airway.
Of the total of 1082 papers found in Web of Science and Scopus on pediatric proton therapy, 11 have addressed its anesthetic management, using intravenous or combined intravenous and inhalation anesthesia. Between June 2020 and August 2021, 31 children were anesthetized in our center to receive proton therapy under inhalational anesthesia (total number of sessions: 873). The mean anesthesia induction time was 4.1 min (SD = 0.7, 95% CI [3.9, 4.4]). The mean anesthesia recovery time was 13.8 min (SD = 4.1, 95% CI [12.3, 15.3]). The percentage of non-serious adverse effects was 0.7% (Clopper-Pearson 95% CI [0.3, 1.5]). The percentage of serious adverse effects was 0.1% (Clopper-Pearson 95% CI [0, 0.6]), without statistically significant difference with other published works with different anesthetic approaches.
Inhalation anesthesia without any intravenous management for pediatric proton therapy is, in our experience, an effective technique with a complication rate similar to other anesthetic approaches.
质子束治疗是一种肿瘤治疗方法，被认为是治疗儿童实体瘤的一种合适的肿瘤照射技术。由于治疗时间长且需要患儿保持不动，许多儿童在质子治疗过程中需要麻醉。由于世界上提供这种治疗的中心不多，关于此类病例的儿科麻醉的已发表研究很少，现有数据表明倾向于静脉麻醉或静脉与吸入联合麻醉。我们开展这项研究的目的是描述和分析在我们医疗中心接受质子治疗的儿童的吸入麻醉管理，并将我们的结果与采用不同麻醉方案的研究进行比较。
我们检索了两个主要数据库（科学网和Scopus），以查找迄今为止涉及儿科质子治疗麻醉的论文。为了描述我们的麻醉管理，我们纳入了2020年6月至2021年8月期间在我们中心接受质子治疗且处于麻醉状态下的所有儿科患者。记录了患者的特征、诊断、治疗、气道管理、使用的药物、诱导时间、麻醉苏醒时间以及不良反应。所有麻醉医生都遵循严格的麻醉方案，仅采用通过喉罩气道给予七氟烷的吸入麻醉。
在科学网和Scopus上总共找到的1082篇关于儿科质子治疗的论文中，有11篇涉及了其麻醉管理，采用的是静脉麻醉或静脉与吸入联合麻醉。2020年6月至2021年8月期间，我们中心有31名儿童在吸入麻醉下接受质子治疗（总治疗次数：873次）。平均麻醉诱导时间为4.1分钟（标准差=0.7，95%置信区间[3.9, 4.4]）。平均麻醉苏醒时间为13.8分钟（标准差=4.1，95%置信区间[12.3, 15.3]）。非严重不良反应的发生率为0.7%（克洛珀-皮尔逊95%置信区间[0.3, 1.5]）。严重不良反应的发生率为0.1%（克洛珀-皮尔逊95%置信区间[0, 0.6]），与其他采用不同麻醉方法发表的研究相比，无统计学显著差异。
根据我们的经验，儿科质子治疗采用无任何静脉管理的吸入麻醉是一种有效的技术，并发症发生率与其他麻醉方法相似。
