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    When is anesthesia needed in proton therapy in children?
  • A critical aspect of proton therapy in children is to keep them in a fixed position to ensure that the proton beam is precisely applied to the target tissue. For adults, an immobilization device can help to maintain the right position, and reduce the likelihood of movement during treatment. However, children find it very hard to keep still during treatment. Therefore, children aged less than 6 or 7 years generally need anesthesia during proton therapy.
    At the National Cancer Center, about 40% of children who receive proton therapy need anesthesia. This is similar to other hospitals in other countries, where anesthesia is needed in about 50% of children. We endeavor to anesthetize patients for the shortest time possible and use methods that allow the quickest recovery, to avoid limiting daily activities after each treatment. Furthermore, because patients are anesthetized every day for 6-7 weeks during the treatment course, anesthesia is limited to avoid the development of tolerance or resistance to the anesthetic agent.
    Concerns over anesthesia
  • The main concern of parents is that their children are anesthetized every day, possibly for several weeks. They worry about whether it could harm their childĄ¯s memory or intelligence, or whether drug use could become habitual. To our knowledge, there are no retrospective studies showing that intelligence is affected by long-term anesthesia. Several prospective studies are currently underway in the USA to confirm the absence of long-term effects of anesthesia in children. Based on the studies reported to date and clinical experience, it seems that anesthesia does not have an adverse effect on intelligence. Furthermore, propofol, the main anesthetic drug, is not used again once the treatments are completed, which means it is very unlikely for patients to develop drug resistance.
    Some patients have allergies to some anesthetic drugs. It has been proposed that the risk of allergy is greater in children with allergy to eggs, but there is no consensus on this issue. In such children, extra care should be taken and, before inducing anesthesia, any allergies should be described to the anesthesiologists during consultation and in questionnaires.
    Experience of the National Cancer Center and its Pediatric Anesthesia Team
  • So far, 1,600 anesthetic procedures have been performed during proton therapy at the National Cancer Center. According to our statistics, the average age of the children who needed anesthesia was about 3-4 years. Anesthesia lasted about 40 minutes in each child and recovery took about 30-60 minutes. Because there were no anesthesia-related complications, treatment under anesthesia is considered safe.
    To induce deeper sleep than usual, which facilitates uninterrupted treatment, and to allow quick recovery, highly experienced anesthesiologists are required. We always use devices to monitor patients from induction to recovery, and our team of experienced anesthesiologists is able to promptly respond to emergencies.
    Proton therapy and the anesthetic process
  • To help reduce anxiety in children, they enter the treatment room with their parents, who remain with their child while anesthesia is induced. Because no one other than the patient is allowed to be in the treatment room during proton therapy, the patientĄ¯s anesthetic state, respiratory condition, and heartbeat are monitored from the treatment control room. After each session of proton therapy is completed, the patient is transferred to a recovery room next to the treatment room. Anesthetists monitor the patient until he/she has fully recovered.
    Things that a patientĄ¯s family must know before anesthesia
  • The patient should fast before undergoing proton therapy with anesthesia. The time for fasting depends on the age of the patient. Infants aged 6 months or younger should not consume any solid food or any drink with solid ingredients (including milk, powered milk, or breast milk) for 4-6 hours before anesthesia. Children aged 6 months to 3 years must fast for 6 hours. Children aged over 3 years must fast for at least for 6-8 hours. However, if necessary, it is possible to drink water until 2 hours before anesthesia.
    Throughout anesthesia, extra care should be taken to avoid upper airway infection or pneumonia. As airway infections, including the common cold, increase secretion from the nose or throat, the risk of aspiration pneumonia during anesthesia also increases.
    Body temperature can also decrease during anesthesia. Therefore, we suggest children wear a warm beanie or are covered by a thin blanket to maintain their body temperature.
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