title: Non-invasive anesthesia for children undergoing proton radiation therapy.
abstract: BACKGROUND
  Proton therapy is a newer modality of radiotherapy during which anesthesiologists face specific challenges related to the setup and duration of treatment sessions.
  
  
  OBJECTIVE
  Describe our anesthesia practice for children treated in a standalone proton therapy center, and report on complications encountered during anesthesia.
  
  
  METHODS
  A retrospective review of anesthetic records for patients ⩽18years of age treated with proton therapy at our institution between January 2006 and April 2013 was performed.
  
  
  RESULTS
  A total of 9328 anesthetics were administered to 340 children with a median age of 3.6years (range, 0.4-14.2). The median daily anesthesia time was 47min (range, 15-79). The average time between start of anesthesia to the start of radiotherapy was 7.2min (range, 1-83min). All patients received Total Intravenous Anesthesia (TIVA) with spontaneous ventilation, with 96.7% receiving supplemental oxygen by non-invasive methods. None required daily endotracheal intubation. Two episodes of bradycardia, and one episode each of; seizure, laryngospasm and bronchospasm were identified for a cumulative incidence of 0.05%.
  
  
  CONCLUSIONS
  In this large series of children undergoing proton therapy at a freestanding center, TIVA without daily endotracheal intubation provided a safe, efficient, and less invasive option of anesthetic care.
authors.affiliation: Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, United States. Electronic address: poagyemang@mdanderson.org.
authors.forename: Pascal
authors.initials: P
authors.lastname: Owusu-Agyemang
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, United States.
authors.forename: David
authors.initials: D
authors.lastname: Grosshans
authors.affiliation: Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, United States.
authors.forename: Radha
authors.initials: R
authors.lastname: Arunkumar
authors.affiliation: Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, United States.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rebello
authors.affiliation: Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, United States.
authors.forename: Shannon
authors.initials: S
authors.lastname: Popovich
authors.affiliation: Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, United States.
authors.forename: Acsa
authors.initials: A
authors.lastname: Zavala
authors.affiliation: Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, United States.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Williams
authors.affiliation: Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, United States.
authors.forename: Javier
authors.initials: J
authors.lastname: Ruiz
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, United States.
authors.forename: Mike
authors.initials: M
authors.lastname: Hernandez
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, United States.
authors.forename: Anita
authors.initials: A
authors.lastname: Mahajan
authors.affiliation: Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, United States.
authors.forename: Vivian
authors.initials: V
authors.lastname: Porche
mesh_terms: D000293:Adolescent; D000771:Anesthesia, Intravenous / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000532:radiotherapy*; D061766:Proton Therapy / Q000379:methods*; D012189:Retrospective Studies; D011522:Protons
chemical_list: D011522:Protons
keywords: Anesthesia; Children; Proton radiotherapy