LAUSR

BACKGROUND At our institution, a multi-faceted approach is used to reduce general anesthetic (GA) use for children receiving photon radiation therapy (RT), as standard-of-care treatment. The purpose of this study was to evaluate the effectiveness of our methods. METHODS Patients treated as part of the paediatric radiotherapy program from 2010-2018 were retrospectively reviewed. GA use was defined as need for intravenous propofol or inhaled gaseous anaesthetic for at least one simulation or RT session. Methods to reduce GA use included: presence of a dedicated paediatric nurse for procedural preparation, audio-visual distraction (television during RT), and two-way audio communication with caregivers. RESULTS There were 779 unique patients who received RT over 14 163 fractions of radiation. GA utilization was 90% in those under age 3, 28% in those age 3-6, 1% in those age 7-11, and <1% in those ≥12 years of age. Four years of age is a cutoff age at which the majority of patients switch from needing GA (56.6% for those aged 3) to not needing GA (29.8% for those aged 4). Younger age, use of total body irradiation, and craniospinal irradiation were independently associated with requiring GA. CONCLUSIONS Using methods designed to reduce GA use, most children aged 4 years or older were able receive RT awake. Our GA rates compare favourably to other literature reports; thus, pediatric RT centres should consider adopting specific interventions to reduce GA use.