title: Repetitive pediatric anesthesia in a non-hospital setting.
abstract: OBJECTIVE
  Repetitive sedation/anesthesia (S/A) for children receiving fractionated radiation therapy requires induction and recovery daily for several weeks. In the vast majority of cases, this is accomplished in an academic center with direct access to pediatric faculty and facilities in case of an emergency. Proton radiation therapy centers are more frequently free-standing facilities at some distance from specialized pediatric care. This poses a potential dilemma in the case of children requiring anesthesia.
  
  
  METHODS
  The records of the Indiana University Health Proton Therapy Center were reviewed for patients requiring anesthesia during proton beam therapy (PBT) between June 1, 2008, and April 12, 2012.
  
  
  RESULTS
  A total of 138 children received daily anesthesia during this period. A median of 30 fractions (range, 1-49) was delivered over a median of 43 days (range, 1-74) for a total of 4045 sedation/anesthesia procedures. Three events (0.0074%) occurred, 1 fall from a gurney during anesthesia recovery and 2 aspiration events requiring emergency department evaluation. All 3 children did well. One aspiration patient needed admission to the hospital and mechanical ventilation support. The other patient returned the next day for treatment without issue. The patient who fell was not injured. No patient required cessation of therapy.
  
  
  CONCLUSIONS
  This is the largest reported series of repetitive pediatric anesthesia in radiation therapy, and the only available data from the proton environment. Strict adherence to rigorous protocols and a well-trained team can safely deliver daily sedation/anesthesia in free-standing proton centers.
authors.affiliation: Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA. jbuchsba@iupui.edu
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Buchsbaum
authors.forename: Kevin P
authors.initials: KP
authors.lastname: McMullen
authors.forename: James G
authors.initials: JG
authors.lastname: Douglas
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Jackson
authors.forename: R Victor
authors.initials: RV
authors.lastname: Simoneaux
authors.forename: Matthew
authors.initials: M
authors.lastname: Hines
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bratton
authors.forename: John
authors.initials: J
authors.lastname: Kerstiens
authors.forename: Peter A S
authors.initials: PA
authors.lastname: Johnstone
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000293:Adolescent; D000554:Ambulatory Care Facilities; D000758:Anesthesia / Q000379:methods / Q000706:statistics & numerical data*; D000762:Anesthesia Recovery Period; D002648:Child; D002675:Child, Preschool; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007196:Indiana; D007223:Infant; D008297:Male; D061214:Patient Safety; D061766:Proton Therapy / Q000379:methods / Q000706:statistics & numerical data*; D053120:Respiratory Aspiration / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors