(683) Procedural Sedation Performed by PICU Physicians for Children Undergoing Daily Radiation Therapy

Introduction: In the US, cancer is the third leading cause of death in children. Radiation therapy targets tumor tissue and requires patients to lay still, which often necessitates procedural sedation in children. These sedations are unique in that patients must be sedated daily during a defined treatment course. This study's objective was to evaluate the efficacy and safety of repeated sedations for radiation therapy performed by pediatric critical care physicians.

Methods: We performed a single-center, retrospective case series of children who received sedation for radiation therapy (proton beam, non-proton beam, simulation) by pediatric critical care physicians over 4.5-years (2018 to 2022). The primary outcome was the success rate of sedation; secondary outcomes included type of medication, dosing, development of tolerance, and complications requiring intervention.

Results: In our sample, 55 patients underwent 1174 sedation instances (mean 19.8 sedations per patient). Patients were 66% male; mean age was 4.7 years (SD 3.4); mean weight was 20.2 kg (SD 11.9). The median ASA was 2 (range 2 to 3). All patients had either a brain tumor (49.1%) or a solid tumor that was non-mediastinal (50.9%). 5.5% of patients were on a home ventilator prior to the sedation. 79.3% of sedations were for proton beam radiation, 16.3% were for non-proton beam, and 4.4% were for simulation for future radiation. The success rate of sedations was 99.8% (1172/1174). All sedations included propofol as a first agent with a mean bolus 3.3 mg/kg (SD 1.4) and a mean drip rate 148.7 mcg/kg/min (SD 39.7). 4.4% of sedations required a second agent (ketamine or dexmedetomidine). A generalized linear model showed no significant effect of repeated sedations with regards to the medication amount received (p=0.97). 0.2% of sedations had laryngospasm. No patients required bag-mask ventilation, intubation, or chest compressions. No patients died.

Conclusions: Pediatric critical care physicians can perform procedural sedation for radiation therapy with propofol successfully and safely, even with repeated daily sedations on the same patient. Patients did not require increased doses of propofol with repeated sedations.