Sedation and Anesthesia Options for Pediatric Patients in the Radiation Oncology Suite

Abstract

External beam radiation therapy (XRT) has become one of the cornerstones in the management of pediatric oncology cases. While the procedure itself is painless, the anxiety it causes may necessitate the provision of sedation or anesthesia for the patient. This review paper will briefly review the XRT procedure itself so that the anesthesia provider has an understanding of what is occurring during the simulation and treatment phases. We will then examine several currently used regimens for the provision of pediatric sedation in the XRT suite as well as a discussion of when and how general anesthesia should be performed if deemed necessary. Standards of care with respect to patient monitoring will be addressed. We will conclude with a survey of the developing field of radiation-based therapy administered outside of the XRT suite.

Dexmedetomidine for sedation in pediatric patients who received more than 20 sessions of radiation therapy: two cases report

“…Nevertheless, children must be made motionless using anesthesia or sedation during this short procedure. Propofol, ketamine, midazolam, and general anesthesia with sevoflurane have been administered as anesthetics or sedatives to pediatric patients [345]. Adverse effects, including respiratory depression and excessive sedation, may necessitate endotracheal intubation [6].…”

Sedation and anesthesia for the pediatric patient undergoing radiation therapy

“…A linear accelerator accelerates electrons within a vacuum. The electrons are forced to collide with a material such as tungsten, which releases energy in the form of X-rays [6 ]. The linear accelerator focuses this energy to target the tumor or the whole body (total body irradiation) in one or many directions.…”

Recommendations for the treatment of children with radiotherapy in low‐ and middle‐income countries (LMIC): A position paper from the Pediatric Radiation Oncology Society (PROS‐LMIC) and Pediatric Oncology in Developing Countries (PODC) working groups of the International Society of Pediatric Oncology (SIOP)

“…With all proper procedures in place, pediatric sedation/anesthesia will be safe to administer. [42][43][44] (iii) Monitoring of acute and late radiotherapy toxicity…”

“…This person would be responsible for showing the child and parents around the RT suite, explaining equipment and processes, and holding the child's attention during line-insertion, mask-making, etc. With all proper procedures in place, pediatric sedation/anesthesia will be safe to administer [42][43][44]. (iii) Monitoring of acute and late radiotherapy toxicity It is essential to carefully monitor children for acute toxicities during radiotherapy administration.…”