The Neurologic Complications Associated with Anesthesia in Pediatrics Treated with Radiotherapy Under Anesthesia

Background: Children with brain tumors experience potential neurologic complications when are treated with radiotherapy, especially if done frequently under anesthesia. Objectives: This study aimed to evaluate the neurologic complications associated with anesthesia in pediatrics treated with radiotherapy under anesthesia. Methods: This cross-sectional study consisted of 133 pediatric patients with a brain tumor who needed anesthesia for performing radiotherapy and were referred to Omid Charity Hospital and Imam Khomeini University Hospital from 2014 to 2020 by the census. Statistical values less than 0.05 were considered significant (P < 0.05). Results: The patients were in range of 1 - 8 years, and the number of 3,208 anesthesia inductions were conducted for daily radiotherapy. Major complications such as stroke, arrhythmia, tachyphylaxis, and aspiration were not observed. There was a significant relationship between the tumor side, anesthesia, and neurologic complications (P < 0.05). No significant differences were found between demographic data (age, sex, and weight) (P > 0.05). Conclusions: Anesthesia complications in this study were slight and insignificant. Some were either due to the tumor effect on other vital organs or prior exposure to radiotherapy and chemotherapy. Thus, for providing safe anesthesia, considering the tumor effect on body organs and neurologic complications caused by it can be a great help to reduce anesthesia complications in pediatrics under radiotherapy.

Prevalence of Anesthesia Complications in Orthopedic Surgeries and its Related Factors

Background: The duration of surgery in orthopedic surgeries is often longer than one hour. Therefore, these patients are at further risk of complications induced by general anesthesia. The present study aimed to determine the prevalence of anesthesia complications in orthopedic surgeries and its related factors. Methods: This cross-sectional study was performed on 400 patients undergoing orthopedic surgery in Shahid Beheshti Hospital of Kashan Province, Iran, in 2020. The study subjects were recruited by convenience sampling method. We included those who similarly underwent general anesthesia for elective surgery and were transferred to Post-Anesthesia Care Unit (PACU). The research instruments included a demographic questionnaire and a checklist for recording complications (shivering, pain, nausea, vomiting, & vital signs). The necessary data were recorded after the patient was admitted to the PACU, as well as half an hour and one hour later. The obtained data were analyzed using the Chi-squared test, Independent Samples t-test, one-way Analysis of Variance (ANOVA), Pearson correlation coefficient, and logistic regression analysis in SPSS v. 16. Results: The present research results suggested that the most and least frequent complications were vomiting (91.8%) and changes in blood pressure (5%), respectively. Gender was significantly associated with pain, nausea, and hypertension (P<0.05). The Pearson correlation coefficient data indicated a significant relationship between the duration of anesthesia and the mean scores of shivering, pain, nausea, tachycardia, and tachypnea (P<0.05). There was also a significant relationship between the types of surgery and shivering, pain, blood pressure, and nausea (P<0.05). Pulse rate was significantly associated with complete intravenous anesthesia and the duration of anesthesia (P<0.05). Conclusion: The relatively high incidence of post-anesthesia complications in orthopedic surgeries indicates the significance of employing skilled personnel as well as using adequate monitoring equipment at the PACU. Such measures help to decrease mortality and morbidity among patients, also save on hospital costs.

Regional Anesthesia Complications

This chapter reviews peripheral nerve anatomy and common complications associated with regional anesthesia.

Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries

Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Compared with neuraxial anesthesia, general anesthesia for cesarean delivery is associated with increased risk of maternal adverse events. Reducing avoidable general anesthetics for cesarean delivery may improve safety of obstetric anesthesia care. This study examined adverse events, trends, and factors associated with potentially avoidable general anesthetics for cesarean delivery. Methods This retrospective study analyzed cesarean delivery cases without a recorded indication for general anesthesia or contraindication to neuraxial anesthesia in New York State hospitals, 2003 to 2014. Adverse events included anesthesia complications (systemic, neuraxial-related, and drug-related), surgical site infection, venous thromboembolism, and the composite of death or cardiac arrest. Anesthesia complications were defined as severe if associated with death, organ failure, or prolonged hospital stay. Results During the study period, 466,014 cesarean deliveries without a recorded indication for general anesthesia or contraindication to neuraxial anesthesia were analyzed; 26,431 were completed with general anesthesia (5.7%). The proportion of avoidable general anesthetics decreased from 5.6% in 2003 to 2004 to 4.8% in 2013 to 2014 (14% reduction; P &lt; 0.001). Avoidable general anesthetics were associated with significantly increased risk of anesthesia complications (adjusted odds ratio, 1.6; 95% CI, 1.4 to 1.9), severe complications (adjusted odds ratio, 2.9; 95% CI, 1.6 to 5.2), surgical site infection (adjusted odds ratio, 1.7; 95% CI, 1.5 to 2.1), and venous thromboembolism (adjusted odds ratio, 1.9; 95% CI, 1.3 to 3.0), but not of death or cardiac arrest. Labor neuraxial analgesia rate was one of the most actionable hospital-level factors associated with avoidable general anesthetics. Relative to hospitals with a rate greater than or equal to 75%, the adjusted odds ratio of avoidable general anesthetics increased to 1.3 (95% CI, 1.2 to 1.4), 1.6 (95% CI, 1.5 to 1.7), and 3.2 (95% CI, 3.0 to 3.5) as the rate decreased to 50 to 74.9%, 25 to 49.9%, and less than 25%, respectively. Conclusions Compared with neuraxial anesthesia, avoidable general anesthetics are associated with increased risk of adverse maternal outcomes.

Regional Anesthesia Complications

This chapter reviews peripheral nerve anatomy and common complications associated with regional anesthesia.

Propofol-based balanced anesthesia is safer in pediatric radiotherapy

Backround and purpose To investigate the incidence of complications related to propofol-based anesthesia and the factors associated with complications in children with radiotherapy. Materials and methods Patients who underwent anesthesia for external beam radiotherapy between May 2013 and November 2017 were included in the study. We assessed the age/weight, sex, oncologic diagnosis, type of radiotherapy procedure, duration of anesthesia, applied agents, and complications related to anesthesia. Complications were evaluated between group I (only propofol group) and group II (propofol plus adjuvant drugs) as respiratory and cardiac. Results In 130 patients, sedation was given for 1376 radiotherapy procedures. Of these, 1274 (1140 radiation treatment sessions and 134 computed tomography simulations) in 126 patients were propofol-based and were included in the analysis. Although respiratory complications are the most common in both groups, there were no episodes of laryngospasm, broncospasm, and no use of advanced airway intervention. The rate of complication was significantly higher in only propofol anesthesia group than in patients treated with propofol plus adjuvant drugs. In the multivariate analysis, we found three factors that were significantly associated with the risk of complications: total dose of propofol (mg/kg) (p < 0.001), anesthesia with propofol alone (as compared to propofol plus adjunct agents) (p = 0.001), and diagnosis of neuroblastoma (as compared to other diagnosis) (p = 0.043). Conclusion Propofol-based anesthesia is preferred in order to minimize the rate of complications in radiotherapy anesthesia applications. The use of non-opioid adjuvants in combination with propofol to achieve a balanced anesthesia will also reduce the complications that may be encountered.