Non-invasive anesthesia for children undergoing proton radiation therapy

Background Proton therapy is a newer modality of radiotherapy during which anesthesiologists face specific challenges related to the setup and duration of treatment sessions. Purpose Describe our anesthesia practice for children treated in a standalone proton therapy center, and report on complications encountered during anesthesia. Materials and methods A retrospective review of anesthetic records for patients ≤18 years 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 3.6 years (range, 0.4-14.2). The median daily anesthesia time was 47 min (range, 15-79). The average time between start of anesthesia to the start of radiotherapy was 7.2 min (range, 1-83 min). 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.