The development of stereotactic radiosurgery has been a major advance in the treatment of intracranial lesions. By using a stereotactic head frame attached to the skull, large doses of radiation can be delivered precisely to the lesion while sparing surrounding tissues. Although adults can usually undergo this procedure with
local anesthesia or
conscious sedation alone, children frequently require
general anesthesia. This report describes our experience with the
anesthetic management of all children who have received this
therapy at our institution since the inception of our stereotactic radiosurgery program in 1986 through June 1993. Sixty-eight radiosurgery procedures were performed in 65 patients.
Anesthesia time averaged 9.2 h (range, 7-15). Twenty-two patients (ages 11-17; mean 14.3) received
local anesthesia alone, two patients (ages 11 and 15) received
local anesthesia plus i.v. sedation, and 44 patients (ages 2-14; mean, 7.3) received
general anesthesia. Four potentially serious
anesthesia-related events occurred; in one child (age 7) receiving
general anesthesia, an endotracheal tube obstruction developed during radiosurgery requiring rapid reintubation while the child was still in the head frame; another (age 7) who was undergoing
chemotherapy and had
neutropenia and
rhinitis had a lobar collapse while intubated, requiring
mechanical ventilation and endotracheal tube suctioning for lung expansion. Another (age 5) with a recent
upper respiratory tract infection had copious endotracheal secretions and
sinusitis (ethmoid and maxillary) noted on initial computed tomography scanning and was given
antibiotics and
decongestants (following nasotracheal extubation), and another (age 15) receiving sedation without endotracheal intubation vomited an undigested meal midway through the procedure while her head was partially immobilized in the head frame.(ABSTRACT TRUNCATED AT 250 WORDS)