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Intraoperative radiation therapy (IORT) is a relatively new mode of cancer treatment which is being used with increasing frequency. IORT presents several challenges to the anesthesiologist, including (1) patients who are debilitated from their disease or chemotherapy, (2) operations involving major tumor resections, (3) intraoperative interdepartmental transport of patients, and (4) remote monitoring of patients during electron beam therapy. This report discusses the anesthetic management of ten children undergoing IORT. With adequate preparation and interdepartmental communication, complications can be avoided during these challenging cases.

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