Minimizing Anaesthesia Use in Paediatric Radiation Therapy

Abstract

Although generally safe, anaesthesia in paediatric radiation therapy (RT) is costly and cumbersome. At our institution, a multi-faceted approach to reduce anaesthesia utilization is in place as standard-of-care treatment. The goal of this study was to evaluate the effectiveness of our approach by measuring general anaesthesia (GA) rates across all age categories and to compare with published GA rates in the literature. Paediatric patients aged ≤18 treated with RT from 2014-2018 were retrospectively reviewed. GA use was defined as need for intravenous propofol or inhaled gaseous anaesthetic for at least one CT simulation or treatment session. The following methods were used to reduce GA utilization: presence of a dedicated paediatric nurse for procedural preparation, comfort objects (stuffed animal and blanket), and audio-visual distraction (television). Comparison of GA rates across age categories was done using the chi-square trend test. Multivariable logistic regression was used to identify clinical or disease factors associated with GA use. There were 377 unique patients who received RT over 6 411 fractions of radiation. 939 sessions of GA were administered. The median age of patients was 9.8 years (range, 0-18). Among all patients, 68 (18%) required some or all RT fractions under GA. GA utilization was 100% in those under age 3, 37.5% in those age 3-6, 1% in those age 7-12, and 1% in those ≥12 years of age (p<0.0001). The GA rate between age 5-13 was 2%. No child between age 6-9 required GA. Age was the sole predictor of GA use, with each year increase in age resulting in 2.9-fold decreased odds of requiring any GA (odds ratio 0.344, 95% confidence interval 0.25-0.47, p<0.0001). Body site, diagnosis, treatment technique (including IMRT, VMAT, 3DCRT or total body irradiation), use of craniospinal irradiation, year of treatment, and method of immobilization were not predictive of GA use. Our institutional rates of GA use are low in the age 3-6 category (37.5% vs. 79-95% in the literature) and age 5-12 category (2% vs. 47% in the literature). Our methods of preparing and treating children with RT successfully minimize GA use and may be considered for adoption by other cancer centres.