Standardized anesthetic protocol in pediatric Radiotherapy: A retrospective analysis of clinical efficacy and outcomes

Background and purpose: Radiotherapy plays a critical role in the treatment of pediatric cancers; however, the need for absolute immobilization during treatment necessitates the use of general anesthesia or deep sedation. Materials and methods: In this retrospective observational study conducted at Salerno University Hospital between 2022 and 2024, we evaluated a standardized anesthetic protocol based on the exclusive use of a laryngeal mask airway (LMA) in pediatric patients undergoing radiotherapy. Data were collected from 420 anesthesia sessions performed in 22 patients under 14 years of age with solid or hematological tumors. The protocol involved premedication with midazolam when indicated, induction with either intravenous propofol (administered in 77.3 % of sessions with a mean dose of 1.64 mg/kg) or inhalational sevoflurane (in 22.7 % of sessions), and maintenance with sevoflurane at a mean minimum alveolar concentration of 2.2. Continuous monitoring of vital parameters was ensured via advanced remote systems, while airway management was successfully maintained with LMA in all sessions. Results: The overall complication rate was low (1.9%), with laryngospasm (0.95%), postoperative delirium (0.71%), and a single episode of tachycardia/hypotension (0.24%) observed; importantly, no major adverse events occurred. The median time to awakening was 3 min, and full recovery in the post-anesthesia care unit was achieved within 35 min. Conclusion: These findings suggest that the standardized anesthetic protocol is both safe and effective, ensuring rapid recovery and minimal complications, thereby optimizing the management of pediatric radiotherapy sessions.