妇科近距离放射治疗手术的镇痛和麻醉实践模式以及对女性手术经验的潜在影响:全国调查。
Analgesia and Anesthesia Practice Patterns for Gynecologic Brachytherapy Procedures and Potential Impact on Women's Procedural Experience: A National Survey.
发表日期:2024 Jul 25
作者:
Amanda Rivera, Dulce M Barrios, Emma Herbach, Jenna M Kahn, Vonetta M Williams, Keyur J Mehta, Aaron Wolfson, Lorraine Portelance, Mitchell Kamrava
来源:
Int J Radiat Oncol
摘要:
旨在确定美国目前妇科近距离放射治疗 (BT) 手术中镇痛 (AG) 和麻醉 (AS) 的实践模式。根据 5 名近距离治疗师的专业知识创建的 27 项调查以电子方式分发给 90 个美国放射肿瘤学学术项目,并在社交媒体上公布媒体以及 2023 年 6 月至 10 月期间的两次全国会议上。收到了 41 份回复 (46%)。 54% 的人为女性,66% 为白人,85% 为非西班牙裔/拉丁裔。 49% 的人仅使用 BT 套件/- CT 模拟器,39% 的人使用手术室/- BT 套件或 CT 模拟器或其他位置,10% 的人仅使用 CT 模拟室,2% 的人使用临床检查室。 34% 的患者仅使用全身麻醉 (GA) 进行腔内 BT (n=41),20% 的患者仅使用清醒镇静 (CS),10% 的患者仅使用口服镇痛 (OA),9% 的患者仅使用脊髓或硬膜外镇痛,27% 的患者使用联合麻醉。在进行混合 BT 的患者 (n=25) 中,40% 单独使用 GA,16% 单独使用 CS,12% 单独使用硬膜外或脊髓 AS,4% 单独使用 OA,28% 联合使用。对于模板间质性 BT (n=25),44% 的人单独使用 GA,48% 的人单独使用硬膜外麻醉或与其他 AS 联合使用,8% 的人单独使用 CS。 22% 的受访者仅在施药器放置期间提供 AG 或 AS,而 32% 的受访者在放置、计划、治疗和移除期间提供。不使用 CS 或 GA 的最常见原因是缺乏麻醉资源和临床医生的偏好。 73% 的人认为患者在接受 BT 治疗后会出现创伤后应激障碍 (PTSD) 症状。然而,68% 的人报告没有使用技术来缓解 BT 相关的情绪困扰。许多美国近距离治疗师报告使用 GA、CS 或硬膜外 AS,但 10% 的人仅使用 OA,22% 的人仅在施药器放置期间提供 AG/AS。此外,大多数受访者认为 BT 后可能会出现 PTSD 症状,但很少有人提供任何干预措施。 AS 资源和临床医生的偏好应以扩大更高质量的护理为目标。版权所有 © 2024。由 Elsevier Inc. 出版。
To determine the current U.S. practice patterns of analgesia (AG) and anesthesia (AS) for gynecologic brachytherapy (BT) procedures.A 27-item survey created with expertise from five brachytherapists was distributed electronically to 90 U.S. Radiation Oncology academic programs and publicized on social media and at two national meetings during June-October 2023.Forty-one responses were received (46%). Fifty-four percent identified as female, 66% Caucasian and 85% non-Hispanic/Latino ethnicity. Forty nine percent utilize a BT suite +/- CT simulator alone, 39% the operating room +/- BT suite or CT simulator or other location, 10% CT simulation room alone, and 2% clinic exam room. Thirty four percent utilize general anesthesia alone (GA) for intracavitary BT (n=41), 20% conscious sedation (CS) alone, 10% oral analgesia (OA) alone, and 9% spinal or epidural AS alone, and 27% combination. Among those performing hybrid BT (n=25), 40% use GA alone, 16% use CS alone, 12% epidural or spinal AS alone, and 4% OA alone, and 28% combination. For template interstitial BT (n=25), 44% use GA alone, 48% epidural alone or in combination with other AS, and 8% CS alone. Twenty-two percent of respondents provide AG or AS during applicator placement only, while 32% provide it during placement, planning, treatment, and removal. The most common reasons for not using CS or GA were lack of anesthesia resources and clinician preference. Seventy-three percent reported the belief that patients suffer from post-traumatic stress disorder (PTSD) symptoms after BT. However, 68% reported not using techniques to alleviate BT related emotional distress.Many U.S. brachytherapists report using GA, CS or epidural AS, yet 10% are using only OA and 22% offer AG/AS only during applicator placement. Furthermore, a majority of respondents believe PTSD symptoms can occur after BT, but few offer any intervention. AS resources and clinician preference should be targeted for expansion of higher quality care.Copyright © 2024. Published by Elsevier Inc.