Original Article Propofol-based balanced anesthesia is safer in pediatric radiotherapy _ Ilknur Yıldırım 1 , Ayc ¸a _ IC ¸ elik 2 , Sema B Bay 3 ,O ¨ zge Pasin 4 and Ay¸ se C ¸ Tu ¨tu ¨ ncu ¨ 5 Abstract 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 treat- ment 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 laryn- gospasm, 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 ¼ 0.001), and diagnosis of neuroblastoma (as compared to other diagnosis) (p ¼ 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. Keywords Anesthesia, pediatric radiotherapy, propofol-based anesthesia Date received: 31 July 2018; accepted: 26 December 2018 Introduction Radiotherapy (RT) has been used as the primary treat- ment in childhood malignancies with surgery and/or chemotherapy. 1 By maintaining healthy tissue during RT, it is imperative to provide immobilization to achieve a more accurate radiation dose distribution at the target volume. Especially in children aged 0–5 years, general anesthesia or sedation is used to achieve immobilization during RT. 2 These patients often require repeated anesthesia for up to six weeks and stay in a closed area for 10–40 min, far from the anesthesia team. 3,4 Because of the high energy radiation applied, the patient must be alone during treatment. 1 Department of Anesthesiology, Institute of Oncology, Istanbul University, Istanbul, Turkey 2 Department of Radiation Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey 3 Department of Pediatric Hematology & Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey 4 Istanbul Medical Faculty, Department of Biostatistics, Istanbul University, Istanbul 5 Cerrahpasa Medical Faculty, Department of Anesthesiology, Istanbul University, Istanbul, Turkey Corresponding author: _ Ilknur Yıldırım, Department of Anesthesiology, Institute of Oncology, Istanbul University, Istanbul, Turkey. Email: ilknuryildirim97@yahoo.com J Oncol Pharm Practice 0(0) 1–6 ! The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1078155218825296 journals.sagepub.com/home/opp