Should nitrous oxide ever be used in oncology patients receiving methotrexate therapy?

Forster, Victoria J.; Bell, Graham; Halsey, Christina

doi:10.1111/pan.13760

Cited by 5 publications

(7 citation statements)

References 56 publications

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“…However, healthy pediatric patients undergoing spinal interventions for up to 8 h did not develop any evidence of megaloblastic anemia 37 . Obviously, children with cancer are of special concern because of the possible interaction (additive effects) between N 2 O and certain chemotherapeutic agents 38 . Their bone marrow is more fragile (immunosuppression, anemia) and some chemotherapies are neurotoxic (e.g., vincristine).…”

Section: Discussionmentioning

confidence: 99%

Inhalation anesthesia without any intravenous management for pediatric proton beam therapy

García‐Aroca,

Fernández‐de Miguel,

Franceschi

et al. 2023

Pediatric Anesthesia

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IntroductionProton 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.MethodsWe 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.ResultsOf 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.ConclusionInhalation 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.

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Section: Discussionmentioning

confidence: 99%

Inhalation anesthesia without any intravenous management for pediatric proton beam therapy

García‐Aroca,

Fernández‐de Miguel,

Franceschi

et al. 2023

Pediatric Anesthesia

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“…For some children who prefer this, nitrous oxide can be a good alternative with few side effects to general anesthesia for minor procedures. 30 However, due to the risk of interactions, 31 the use of nitrous oxide in lumbar punctures in pediatric oncology is limited since many chemotherapy regimens include intrathecal administration of methotrexate followed by intravenous high-dose methotrexate, which may be potentiated by nitrous oxide. 31 More nurses and physicians reported that children with cancer experience moderate-to-severe pain.…”

Section: Discussionmentioning

confidence: 99%

“…30 However, due to the risk of interactions, 31 the use of nitrous oxide in lumbar punctures in pediatric oncology is limited since many chemotherapy regimens include intrathecal administration of methotrexate followed by intravenous high-dose methotrexate, which may be potentiated by nitrous oxide. 31 More nurses and physicians reported that children with cancer experience moderate-to-severe pain. However, there were fewer nurses and physicians who believed that more effective treatment of pain was possible.…”

Section: Discussionmentioning

confidence: 99%

“…For some children who prefer this, nitrous oxide can be a good alternative with few side effects to general anesthesia for minor procedures. 30 However, due to the risk of interactions, 31 the use of nitrous oxide in lumbar punctures in pediatric oncology is limited since many chemotherapy regimens include intrathecal administration of methotrexate followed by intravenous high‐dose methotrexate, which may be potentiated by nitrous oxide. 31 …”

Section: Discussionmentioning

confidence: 99%

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Pain in pediatric oncology—A Swedish nationwide follow‐up study among nurses and physicians

Kamsvåg,

Arvidson,

et al. 2023

Paediatric and Neonatal Pain

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To examine nurses' and physicians' assessments of pain in children with cancer, and to identify the methods in use to diagnose, evaluate, and treat pain. In addition, to examine whether/how the healthcare professionals' assessment and management of pain has changed compared to 1995 and identify the needs for training. The study has a descriptive and comparative design. 363 nurses and physicians working with children with cancer in Sweden were invited to participate in April 2017. Participants answered an updated version of a questionnaire used in 1995 by Ljungman et al. focusing on the healthcare professionals’ experience of pain among their patients, their pain treatment strategies, and need for training. 120 nurses and 65 physicians participated. Fifty percent of nurses and 55% of physicians answered that moderate‐to‐severe pain was experienced often or very often by children with cancer. Methods recommended in international guidelines to diagnose, evaluate, and treat pain were generally followed. Compared with findings from 1995 by Ljungman et al., nurses, and physicians assessed that moderate‐to‐severe pain was seen more often. The greatest need for training was reported for pharmacology, different routes for administration of opioids, treatment with nitrous oxide, and nonpharmacological interventions. Nurses and physicians assessed that moderate‐to‐severe pain is often present in children with cancer. More time to treat pain in the department and training in certain areas seem to be needed to improve pain management.

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“…Se debería tener en cuenta los niveles de vitamina B12 en pacientes propensos a tener efectos neurotóxicos por metotrexato 21 . Otros autores como Forster VJ, Bell G, Halsey C. también han hecho referencia a ciertas interacciones entre diversos componentes que pueden inducir riesgo en la salud de los pacientes con leucemia Linfoblástica en tratamiento con metotrexate 22 También Deepa Bhojwani et al señalaron que el metotrexato (MTX) puede causar neurotoxicidad clínica significativa y leucoencefalopatía asintomática. Buscamos identificar factores de riesgo clínicos, farmacocinéticas y genéticos para estas toxicidades relacionadas con el MTX durante la terapia de leucemia linfoblástica aguda (LLA) infantil y proporcionar datos sobre la seguridad de la reexposición intratecal y de dosis altas de MTX en pacientes con neurotoxicidad.…”

Section: Introducción Y Justificacionunclassified

Frecuencia y características clínicas de la neurotoxicidad por metotrexato en pacientes de 0 a 18 años con Leucemia Linfoblástica Aguda en el servicio de oncología pediátrica de una clínica privada en Lima entre los años 2014 y 2019

Farfán¹

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Introducción: La literatura señala que el cáncer más frecuente en la edad infantil es la leucemia. Su origen guarda relación con la aparición de células cancerosas como resultado de transmutación de los glóbulos blancos de la sangre hacia ese estado. Se trata de una categoría de cáncer llamado leucemia linfoblástica aguda (LLA) en la que los linfoblastos, una especie de linfocitos inmaduros no permiten la progresión normal de células en la sangre. En la terapia de tratamiento de la LLA con MTX, un resultado subsiguiente es la neurotoxicidad aguda, subaguda o retardada. Si bien esta última puede demorar meses o años después de que el tratamiento se manifiesta como leucoencefalopatía, los primeros dos tipos generalmente se manifiestan en cuestión de horas o semanas después de iniciado su manejo. Las manifestaciones más comunes agudos o subagudos pueden ser dolores de cabeza, mareos, trastornos del estado de ánimo, convulsiones, síntomas similares a los accidentes cerebrovasculares u otros déficits neurológicos. El objetivo es conocer los factores asociados con la Intoxicación por Metotrexato en pacientes con LLA entre 0 y 18 años en un centro especializado privado en oncología pediátrica, de Lima Metropolitana. Métodos: Se llevará a cabo un estudio de tipo observacional, descriptivo, transversal y retrospectivo. Después de ordenar y clasificar los datos mediante el programa Microsoft Excel 2016, se utilizará el programa estadístico SPSS versión 22.0 para realizar el análisis estadístico. Se empleará estadística descriptiva para expresar los valores de las variables cualitativas en frecuencias absolutas y porcentajes. Para los datos cuantitativos se calcularán medidas de tendencia central, media y mediana y se calculará la desviación estándar para el cálculo del rango de dispersión entre las medias de las variables, observando la probabilidad que el evento Neurotoxicidad por Metotrexato en pacientes de 0 a 18 años con Leucemia Linfoblástica Aguda ocurra…

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Should nitrous oxide ever be used in oncology patients receiving methotrexate therapy?

Cited by 5 publications

References 56 publications

Inhalation anesthesia without any intravenous management for pediatric proton beam therapy

Inhalation anesthesia without any intravenous management for pediatric proton beam therapy

Pain in pediatric oncology—A Swedish nationwide follow‐up study among nurses and physicians

Frecuencia y características clínicas de la neurotoxicidad por metotrexato en pacientes de 0 a 18 años con Leucemia Linfoblástica Aguda en el servicio de oncología pediátrica de una clínica privada en Lima entre los años 2014 y 2019

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