The Abramson Cancer Center of the University of Pennsylvania
Before Treatment and the Day of Treatment
About General Anesthesia
Depending on the situation, some younger children may need to have general anesthesia before each radiation treatment. The amount of anesthesia given is just enough to let your child sleep and remain still during their treatment. The anesthesia will be given by the anesthesia team from CHOP, which is led by a CHOP staff pediatric anesthesiologist. While the team may change from day to day, the anesthesia plan for your child is developed by the team and they stay in close communication about your child's care. This team is a specially trained group, who are dedicated to caring for children with cancer.
Before your child comes for radiation, a line, also called an intravenous catheter will need to be placed, or their port accessed. Medications will be given through the line or port.
Your CHOP Anesthesia Team
This team is made up of doctors and staff from CHOP. All have special training in giving anesthesia to children and adolescents. Members of your anesthesia team may include:
Pediatric Anesthesiologist: A doctor who has received advanced education in giving anesthesia to children and adolescents.
Pediatric Nurse Anesthetist: These nurses have received advanced education in giving anesthesia and work closely with the anesthesiologist.
Senior anesthesia resident/fellow: A doctor with anesthesia training who is closely supervised by the pediatric anesthesiologist.
Post Anesthesia Care Nurses: Nurses who have received special training in the care of pediatric patients receiving anesthesia.
Here are a few very important things for you to do:
Before every treatment it is VERY important that your child follow the feeding instructions exactly. Your doctor or nurse from CHOP will give you a separate sheet of instructions about feeding the day before and the morning of treatment. If your child eats or drinks on the morning of treatment, we will need to postpone the treatment.
Do not use lotions or creams anywhere on the skin for 4 hours before the scheduled treatment.
Bring a few helpful items, depending on your child's age: Your stroller, a favorite blanket, drink in a sippy cup, and snack to be given once the treatment is completed are all helpful. Anything else that will be a comfort to your child, such a favorite toy, book or DVD is fine to bring.
On the morning of treatment, it's important to let your anesthesia team know about any medications your child has received at home.
The Morning of Treatment
If your Child is sick on the morning of treatment: If your childhas a fever, cold, vomiting, or does not look well, please call theCHOP Oncology triage nurse at 215.590.2299. Sometimes it isbetter that your child not have treatment that day. The decision togo ahead with treatment will be made by the anesthesiologist afterdiscussion with your oncologist. It may be better to wait a day ortwo.Waiting a day or two will not effect your child's overalltreatment.
If you are running late: We understand that this is a difficult timeand how hard it can be to come into the hospital so early. Childrenwho need general anesthesia are always scheduled first thing in themorning. This way, you can be "in-and-out" and your child will notmiss breakfast. If you are running late or miss your appointment,treatment will be postponed to the next day. Postponing a treatmentfor a day will not affect the overall treatment and its ability todestroy the cancer.
Although everyone's situation is different, this is generally what will happen during your treatment visit:
When you arrive at the radiation oncology department, you willstop at the front desk in the main waiting room and then continueon to the front desk of the children's waiting area in order to beregistered.
Each day of treatment, your child's vital signs (temperature, bloodpressure, pulse, oxygen, and breathing) will be checked.
If your child has a port-a-cath, it will be accessed on Mondays. Theport will remain accessed all week. If your child does not have acentral line then an intravenous catheter will need to be placed.
You will be able to hold your child while the medication is given. Itwill be a comfort to your child for them to fall asleep with youthere. The Anesthesia team will monitor your child the entire time,until they are awake.
You will be able to go with your child to the treatment room. Weask that you wait in the waiting room during treatment due to theamount of radiation being given. No one is allowed in thetreatment room while treatments are beinggiven, except your child. This is becausethese treatments are very different fromX-rays and other procedures where youwere allowed to stay with your child.
What Happens In the Treatment Room
For conventional radiation treatment, the actual treatment takes about 5 to 10 minutes. Intensity modulated radiation treatment (IMRT) takes about 20 to 30 minutes. On most days you will spend up to 1 ½ hours in the Department on the day of treatment.
Depending on the treatment being given, this is generally what will happen during treatment:
Once in the treatment room, your child will be positioned on the treatment table. The therapist will go to the console area. This area is right outside the treatment room. After checking all the settings, the technican will turn on the machine.
Throughout the treatment, the therapist will watch your child on a TV monitor.
The anesthesiologist and a nurse anesthetist or anesthesia fellow will carefully monitor your child on the TV screen.
Depending on the treatment machine, the therapist may put special shields (or blocks) between the machine and other parts of the body to help protect normal tissues and organs.
The radiation therapist controls the movement of the machine and checks to be sure it is working properly.
Even though the effects of radiation are powerful, your child will not become permanently radioactive. External radiation treatment affects cells only for a moment.
Once a week, images (X-ray, CT scans) will be taken to ensure proper treatment positioning. These images will also be taken if there is a change in the treatment field or plan. The images will be taken during the radiation treatment. They are used only to make sure the position and treatment are correct. They are not used to measure the response to the radiation.
If you have questions about anything that happens in the treatment room, ask your therapist to explain.
Once the treatment is completed, the anesthesia team will notify you and you will be reunited with your child in the recovery room.
Your child may be sleepy and a little cranky when they wake up. This is normal. If your child is asleep, please do not try to wake your child. It is best to let your child become fully awake on their own. Having a favorite blanket, juice or snack can be helpful in making the wake up time a little easier.
Once your child is fully awake, you will be discharged from the radiation oncology department.