title: Anesthesia complications of pediatric radiation therapy.
abstract: OBJECTIVE
  Complications of anesthesia for pediatric radiation therapy are imperative for both radiation oncologists and anesthesiologists to clinically assess and manage. We performed the first systematic review to date addressing this important issue.
  
  
  METHODS
  A systematic search of PubMed and EMBASE was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were not restricted based on publication date. Nine original investigations were identified, analyzed, and collated for this report.
  
  
  RESULTS
  General anesthesia has proven superior to conscious sedation with regard to maintaining satisfactory procedural sedation while maintaining low respiratory and cardiovascular complication rates. Although agents such as ketamine (complication rates approaching 23%-24%) have been used in the past, other agents such as propofol and volatile anesthetics have lower complication rates because of improved drug side effect profiles (0.01%-3.5%). Most common complications are respiratory-based (eg, airway obstruction, broncho/laryngospasm, desaturation, apnea), followed by those that are cardiovascular-based (eg, tachy/bradycardia, arrhythmias, hypotension) and nausea/vomiting. Though procedure duration and anesthetic dose can be associated with higher complication risks, prior or concurrent chemotherapy does not confer added risks other than neutropenia-related sepsis. Other potential complications include those with vascular access devices, observed in up to 20% to 25%, with peripherally inserted central catheters having the highest rates of vascular complications and port catheters the lowest.
  
  
  CONCLUSIONS
  Rates of anesthetic complications encountered in pediatric radiation therapy are similar, if not lower, than rates reported in controlled operating room settings, implying that anesthesia for pediatric radiation therapy is safe, with low complication rates periprocedurally. Propofol infusion and oxygen delivery via nasal cannula offer the lowest immediate anesthetic complication rates and are hence most recommended for use. Though the long-term neurocognitive consequences of multiple anesthetics in pediatric patients have yet to be clearly defined, health care providers should be cognizant of the potentially serious implications.
authors.affiliation: Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Vivek
authors.initials: V
authors.lastname: Verma
authors.affiliation: Department of Anesthesiology, Omaha Children's Hospital, Omaha, Nebraska.
authors.forename: Amy B
authors.initials: AB
authors.lastname: Beethe
authors.affiliation: Department of Anesthesiology, Omaha Children's Hospital, Omaha, Nebraska.
authors.forename: Michelle
authors.initials: M
authors.lastname: LeRiger
authors.affiliation: Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Rajesh R
authors.initials: RR
authors.lastname: Kulkarni
authors.affiliation: Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Mutian
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska. Electronic address: clin@unmc.edu.
authors.forename: Chi
authors.initials: C
authors.lastname: Lin
mesh_terms: D000758:Anesthesia / Q000009:adverse effects*; D005260:Female; D006801:Humans; D011878:Radiotherapy / Q000009:adverse effects* / Q000379:methods