Anaesthesia for paediatric radiotherapy: A narrative review.
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INTRODUCTION: Radiotherapy is currently used in approximately one-third of children with cancer. Treatments are typically received as weekday outpatient appointments over 3-6 weeks. The treatment is painless but requires a still, co-operative patient who can lie alone in set positions, facilitated by the use of immobilisation devices, for up to 1 h. METHODS: We conducted a literature search to identify relevant articles relating to radiotherapy treatment. Key search terms included: 'radiotherapy'; 'proton beam'; 'photon'; 'sedation'; 'anaesthesia'; and 'paediatric'. The abstracts of identified articles were assessed for relevance and their references reviewed for further relevant publications. RESULTS: The requirement for anaesthesia is almost exclusively limited to younger children, who are committed to daily anaesthetics over the duration of their treatment course. Centres tend to adopt a primary anaesthetic technique of either general anaesthesia using a supraglottic airway device or deep sedation, with spontaneous ventilation maintained. A full variety of anaesthetic drugs has been used with insufficient evidence to support a standardised primary approach but an apparent global trend towards propofol by infusion for sedation. Children may become acutely unwell during their treatment course and systems for escalation of clinical care in this event are vital. Distance from the patient for staff radiation shielding, patient positioning for treatment delivery and the use of immobilisation devices may provide additional access challenges in the event of an emergency. DISCUSSION: The requirement for anaesthesia for paediatric radiotherapy is typically confined to younger children. Patients may be unwell, with several specific considerations related to their cancer diagnosis and the impact of various treatments including surgery and chemotherapy, in addition to the radiotherapy. A multidisciplinary team approach to all aspects of care is imperative in this group of high-risk patients.