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BACKGROUND: Anesthesia during pediatric external beam radiation therapy poses a challenge, as radiotherapy rooms are not designed for the administration of anesthesia. AIMS: We conducted a retrospective cohort study of children who underwent radiation therapy to describe the anesthetic approach and assess anesthetic-related complications. MATERIALS AND METHODS: Data of all, who underwent radiation therapy under general anesthesia between November 2019 and January 2021, were recorded. Data were obtained from medical records, including demographic characteristics and information, regarding the anesthetic procedure and its associated complications. We describe our protocols for preoperative assessment, anesthetic procedures, and postanesthetic discharge evaluation. RESULTS: Over the reporting period, 739 sessions of general anesthesia were performed. The mean number of radiation therapy rounds per patient was 23.5 sessions. Anesthetic induction was accomplished by sevoflurane inhalation in 639 sessions (86.4%) and intravenous propofol in the remaining 13.6%. General anesthesia was maintained with sevoflurane in all cases. Anesthesia-related complications occurred in 118 sessions (15.7%). The most frequent was nausea in 48 (6.4%) cases, followed by hypotension in 38 (5.1%). Airway-related complications occurred at a low frequency (2.3%), and all were resolved successfully with positive pressure ventilation. No patient hospitalizations were required because of any anesthetic complications. CONCLUSIONS: Inhalation anesthesia is reliable and safe for pediatric patients undergoing radiation therapy.
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Background: Reported data suggest that 4.2 million deaths will occur within 30 days of surgery worldwide each year, half of which are in low- and middle-income countries. Postoperative complications are a leading cause of long-term morbidity and mortality. Patients who survive and leave the hospital after surgical complications regularly experience reductions in long-term survival and functional independence, resulting in increased costs. With a high volume of surgery performed, there is a growing perception of the substantial impact of even minor enhancements in perioperative care. The Latin American Surgical Outcomes Study (LASOS) is an international, multicentre, prospective cohort study of adults submitted to in-patient surgery in Latin America aiming to provide detailed data describing postoperative complications and surgical mortality. Methods: LASOS is a 7 day cohort study of adults undergoing surgery in Latin America. Details of preoperative risk factors, intraoperative care, and postoperative outcomes will be collected. The primary outcome will be in-hospital postoperative complications of any cause. Secondary outcomes include in-hospital all-cause mortality, duration of hospital stay after surgery, and admission to a critical care unit within 30 days after surgery during the index hospitalisation. Results: The LASOS results will be published in peer-reviewed journals, reported and presented at international meetings, and widely disseminated to patients and public in participating countries via mainstream and social media. Conclusions: The LASOS may augment our understanding of postoperative complications and surgial mortality in Latin America. Clinical trial registration: NCT05169164.
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The importance of preoperative anesthetic evaluation in a cancer patient is indispensable. Enables the anesthesiologist and surgical team to realize whether the clinical status can be optimized or if a specific perioperative approach is required. However, with proper evaluation, the goal of prompt surgical therapy should be kept in mind. In cancer patients, the diagnostic approach is not far from the usual preoperative evaluation performed on any surgical patient, which focuses on medical comorbidities and current functional capacity. Nevertheless, in these patients, it becomes relevant to recognize the mass anatomical location, the compromise of adjacent structures, and the mass effects that the tumor may be causing. Also, it is essential to assess the nutritional status and patients' metabolic or neurohormonal consequences. On the other hand, the oncological disease itself or its associated therapies may trigger secondary organic repercussions that impact anesthetic management and perioperative care. All of which deserves meticulous surgical planning. Acknowledging these factors will enable us to face cancer surgery better, understand and reduce perioperative risks, and promote accelerated recovery.
La importancia de la evaluación preoperatoria anestésica en un paciente oncológico es relevante a la hora de detectar y conocer condiciones que puedan ser optimizadas o que requieran un manejo específico durante el perioperatorio, sin que esto retrase la oportuna entrega de la terapia definitiva, sea ésta cirugía, quimioterapia o radioterapia. Si bien este enfrentamiento no dista mucho de la evaluación preoperatoria habitual que se realiza a cualquier paciente quirúrgico, hay que dar relevancia en conocer el estado funcional actual y al estado nutricional con el que se presenta el paciente, así como sus condiciones médicas asociadas. También es importante los efectos de masa que puede estar provocando el tumor, su ubicación anatómica, el compromiso de otras estructuras y su funcionalidad, si es que la tiene. Por efecto de la propia enfermedad oncológica o de las terapias médicas y quirúrgicas, pueden presentarse alteraciones hematológicas y metabólicas importantes, que requieren manejos específicos y compensaciones previas, así como las repercusiones orgánicas e interacciones anestésicas que pueden tener las terapias neo- adyuvantes para una correcta y meticulosa planificación quirúrgica. El conocer estos factores nos posibilitará enfrentarnos de mejor manera a la cirugía oncológica, conocer y disminuir los riesgos perioperatorios, y favorecer una recuperación acelerada con menor tasa de complicaciones.