ABSTRACT
BACKGROUND: Immobilisation in radiotherapy treatment is especially important as many paediatric tumours are located near critical organs. Although the external beam radiotherapy treatment process itself is painless, the immobilization devices used may cause anxiety and discomfort in children who are too young to understand and co-operate. Hence, anaesthesia or sedation is unavoidable in such cases. This descriptive study aims to evaluate the demographics, methods and outcomes of paediatric radiotherapy patients in our Asian context. METHODS: This is a single-institution, retrospective observational study in a tertiary hospital with more than a decade of experience in paediatric radiotherapy. Data collected include age, gender, race, ASA status, oncology diagnosis, site of radiotherapy, position of patient during procedure, need for sedation or anaesthesia, anaesthetic drugs used, airway devices, use of premedications, use of antiemetics, and incidence and type of complications. We also analysed the association between various factors (e.g., age, radiotherapy treatment site) and usage of anaesthesia. Statistical analysis was carried out using a multivariable model. RESULTS: Between January 2006 and December 2017, 434 paediatric patients underwent radiotherapy, with a total of 10,357 discrete radiotherapy sessions. In 1,276 radiotherapy sessions (11.8%) either general anaesthesia or sedation was required. The need for anaesthesia was highly age-dependent-all patients under 3 years of age required anaesthesia, whereas anaesthesia was rarely needed in patients above 7 years of age. Our institution had a higher prevalence of inhalational agent usage as opposed to intravenous agent usage. Complication rate was relatively low. CONCLUSIONS: This is the first retrospective review performed in our country on paediatric patients receiving anaesthesia during radiotherapy, evaluating patients' demographic data, and type of anaesthesia and radiotherapy techniques used. We found that patients' requirement for anaesthesia decreases in an age-dependent fashion, in line with existing literature. Our reported complication rate during anaesthesia sessions was low, testament to the high standards and safety of our techniques.
Subject(s)
Anesthesia, General , Neoplasms , Radiation Oncology , Asian People , Child , Child, Preschool , Humans , Immobilization , Medical Oncology , Neoplasms/radiotherapy , Pediatrics , Retrospective StudiesABSTRACT
Background@#Trigeminal neuralgia is a debilitating craniofacial pain syndrome that is characterized by paroxysms of intense, short-lived electric shock-like pains in the trigeminal nerve distribution. Recently, the presence of triggers has become one of the key diagnostic criteria in the 3rd edition of the International Classification of Headache Disorders. Light touch is the most common trigger, however other nonmechanical triggers, such as cold weather and certain foods, have been thought to provoke trigeminal neuralgia anecdotally. We aimed to characterize the prevalence and characteristics of these atypical triggers. @*Methods@#We conducted a retrospective, cross-sectional study of atypical triggers in trigeminal neuralgia patients seen in a tertiary pain clinic in Singapore. Patients were recruited via clinic records, and study data were identified from physician documentation. @*Results@#A total of 60 patients met the inclusion criteria. Weather triggers were observed in 12 patients (20%), of which five patients (8%) reported strong winds, 4 patients (7%) reported cold temperatures, and 3 patients (5%) reported cold winds as triggers. Fifteen patients (25%) had a specific food trigger, of which 10 patients (17%) reported hard or tough food, 5 patients (8%) reported hot/cold food, 4 patients (7%) reported spicy food, and 2 patients (3%) reported sweet food as triggers. @*Conclusions@#Although trigeminal neuralgia is most commonly triggered by mechanical stimuli, atypical triggers such as cold temperatures and certain foods are seen in a significant proportion of patients. These atypical triggers may share a common pathway of sensory afferent Aδ fiber activation.
ABSTRACT
Background@#Trigeminal neuralgia is a debilitating craniofacial pain syndrome that is characterized by paroxysms of intense, short-lived electric shock-like pains in the trigeminal nerve distribution. Recently, the presence of triggers has become one of the key diagnostic criteria in the 3rd edition of the International Classification of Headache Disorders. Light touch is the most common trigger, however other nonmechanical triggers, such as cold weather and certain foods, have been thought to provoke trigeminal neuralgia anecdotally. We aimed to characterize the prevalence and characteristics of these atypical triggers. @*Methods@#We conducted a retrospective, cross-sectional study of atypical triggers in trigeminal neuralgia patients seen in a tertiary pain clinic in Singapore. Patients were recruited via clinic records, and study data were identified from physician documentation. @*Results@#A total of 60 patients met the inclusion criteria. Weather triggers were observed in 12 patients (20%), of which five patients (8%) reported strong winds, 4 patients (7%) reported cold temperatures, and 3 patients (5%) reported cold winds as triggers. Fifteen patients (25%) had a specific food trigger, of which 10 patients (17%) reported hard or tough food, 5 patients (8%) reported hot/cold food, 4 patients (7%) reported spicy food, and 2 patients (3%) reported sweet food as triggers. @*Conclusions@#Although trigeminal neuralgia is most commonly triggered by mechanical stimuli, atypical triggers such as cold temperatures and certain foods are seen in a significant proportion of patients. These atypical triggers may share a common pathway of sensory afferent Aδ fiber activation.
