Safe anesthesia for radiotherapy in pediatric oncology: St. Jude Children's Research Hospital Experience, 2004-2006.
OBJECTIVE
To determine the incidence of anesthesia-related complications in children undergoing radiotherapy and the associated risk factors.


METHODS
We retrospectively investigated the incidence and types of anesthesia-related complications and examined their association with age, weight, oncology diagnosis, type of anesthetic (propofol vs. propofol and adjuncts), total propofol dose, anesthetic duration, type of radiotherapy procedure (simulation vs. radiotherapy) and patient position (prone vs. supine).


RESULTS
Between July 2004 and June 2006, propofol was used in 3,833 procedures (3,611 radiotherapy sessions and 222 simulations) in 177 patients. Complications occurred during 49 anesthetic sessions (1.3%). On univariate analysis, four factors were significantly associated with the risk of complications: procedure duration (p <0.001), total propofol dose (p <0.001), use of adjunct agents (vs. propofol alone; p = 0.029), and simulation (vs. radiotherapy; p = 0.014). Patient position (prone vs. supine) was not significantly associated with the frequency of complications (odds ratio, 0.71; 95% confidence interval, 0.33-1.53; p = 0.38). On multivariate analysis, the procedure duration (p <0.0001) and total propofol dose (p < or =0.03) were the most significant risk factors after adjustment for age, weight, anesthetic type, and procedure type. We found no evidence of the development of tolerance to propofol.


CONCLUSIONS
The rate of anesthesia-related complications was low (1.3%) in our study. The significant risk factors were procedure duration, total propofol dose, the use of adjunct agents with propofol, and simulation (vs. radiotherapy).
Anghelescu
Doralina L
DL
Division of Anesthesiology, St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA. doralina.anghelescu@stjude.org
Burgoyne
Laura L
LL
Liu
Wei
W
Hankins
Gisele M
GM
Cheng
Cheng
C
Beckham
Penny A
PA
Shearer
Jack
J
Norris
Angela L
AL
Kun
Larry E
LE
Bikhazi
George B
GB
D000759:Adjuvants, Anesthesia / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D000758:Anesthesia / Q000009:adverse effects*; D000777:Anesthetics / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D011187:Posture; D015742:Propofol / Q000009:adverse effects; D011878:Radiotherapy; D012189:Retrospective Studies; D012307:Risk Factors; D013714:Tennessee; D013997:Time Factors
D000759:Adjuvants, Anesthesia; D000777:Anesthetics; D015742:Propofol