Radiation Therapy

One of the black boxes of medicine, even to doctors, is radiation oncology. Physicians know more or less what all their colleagues do, except for the elusive radiation oncologists. We send our cancer patients to get radiation without knowing exactly what it entails. For the first time, I saw external beam radiation rooms and machines as I had to provide anesthesia to children for treatments. Although the therapy is not painful, it requires the patient to stay quite still while a loud machine whirls about them. Teenagers and adults can tolerate the treatment, but children often need general anesthesia for the five or ten minutes while the cancer is zapped. It's not difficult since the patients all have indwelling vascular access ports for their chemotherapy. But it is an interesting environment because it is so remote. After inducing anesthesia, we leave the room and monitor the patient with video cameras while the room is irradiated. Because treatments recur daily for weeks, patients get very resistant to propofol and require sky-high doses. Conversely though, the anesthesia is easy because we simply repeat what worked in the past. Overall, it is a different facet of anesthesia for me to learn, and it was interesting to see the inner workings of one aspect of radiation oncology.

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