General Anesthesia for Pediatric Radiation Oncology

Younger children, children with medically complex cases (posterior fossa syndrome, autism, etc.), or children with significant anxiety often require general anesthesia during each radiation treatment. This is necessary to keep them still during their treatments.

Who gives the anesthesia?

The anesthesia will be given by a pediatric anesthesiologist and/or a certified registered nurse anesthetist (CRNA), and a nurse. The team may rotate on a daily basis, but the team is in constant communication about your child’s treatment plan. 

Your care team includes:

• Pediatric Anesthesiologist: A doctor who has received advanced education in giving anesthesia to children and adolescents.
• Pediatric Certified Registered Nurse Anesthetists: Nurses who have received advanced education in giving anesthesia and work closely with the anesthesiologist. 
• Post-Anesthesia Care Nurse: Nurses who have received special training in the care of pediatric patients receiving anesthesia. They also have experience with pediatric patients with cancer. 
• Operating Room Technician: They prepare the room prior to treatment with general anesthesia equipment and ensure all necessary supplies are ready for use. 

How is general anesthesia given?

A central line, IV (intravenous) catheter, or port-a-cath is used to give medications. A central line or IV is most often used, but some patients will be given inhaled anesthesia (called mask inductions). 

If your child is receiving general anesthesia, it is important to follow all of the instructions given to you by the care team. Some of these may start several hours or the night before treatment. Some important things to remember:

• It is important to follow the feeding instructions exactly as they are outlined. You will receive these from the care team in advance. If your child eats or drinks the morning of treatment, you must let your care team know right away. The child’s treatment may be moved to a different time or be canceled. This is for the safety of your child. 
• Do not use lotions or creams on your child’s skin for the 4 hours before their scheduled treatment time unless advised by the radiation oncologist.
• Pack some items that your child will find comforting such as a favorite stuffed animal, blanket, book, or toy. You may want to pack a bag with snacks and drinks for your child after their treatment is complete because they may be hungry and/or thirsty.

The Morning of Treatment

• Let your care team know if your child has received any medications at home the morning of or the night before treatment.
• If your child has a temperature, cold, vomiting, or does not look well, let your anesthesia care team know right away. The anesthesiologist and the radiation oncologist will determine if it is safe for your child to have radiation that day. In certain cases, it is best to cancel treatment for the day. This means the treatment will be added to the end of the treatment schedule, all missed or canceled appointments should be made up. 
• If you are running late, please call your anesthesia care team to let them know. General anesthesia is almost always scheduled early morning or afternoon. We understand that it can be hard to make it to the hospital early in the morning. 

What to Expect During Treatment

Although everyone’s situation is different, this is generally what will happen during your treatment visit:

• When you arrive for treatment, you will stop at the front desk to check-in for your appointment. Many oncology departments have a dedicated waiting room for pediatric patients, but if yours does not you can sit wherever you are comfortable. 
• When it is your turn for treatment the nurses will get you from the waiting room and check your child’s vital signs (weight, temperature, blood pressure, oxygen, and breathing). 
• If your child has a port, it will likely be accessed on Mondays and remain accessed until after treatment on Friday. If your child does not have a central line, then an intravenous catheter will need to be placed. 
• Often times children are put under anesthesia in an induction room, this is different than the treatment room. Once the child is asleep, they are transported via stretcher into the treatment room. 
• Every oncology department has different rules about if you can be with your child while the anesthesia is given. Most departments allow you to hold your child because it is comforting to them. As soon as the medicine is given, you will be asked to leave the induction room. The anesthesia team will monitor your child the entire time they are asleep.
• If you want to see the treatment room where your child will be receiving treatment, ask the nurses to show it to you. 
• Each day you will be asked to wait in the waiting room during the treatment. No one can be in the treatment room during treatment. Once your child is awake, after treatment, you will be able to join your child in the recovery room. 
• The anesthesia care team will monitor your child during treatment along with the radiation therapists. 
• Your child may be sleepy or wake up cranky after anesthesia. This is normal. Once your child is awake, they can eat and drink like normal. You will be able to leave the department shortly after your child wakes up. 

The rules for pediatric general anesthesia vary from department to department so it is important to be familiar with your oncology department's rules. If you have any questions or concerns, please don’t hesitate to talk to the care team.