Morbidity and mortality of deep sedation in outpatient bone marrow biopsy

Abstract

Deep sedation is being provided at an increasing rate for patients undergoing bone marrow biopsy and aspiration (BMBA). The aim of this study was to establish the safety of deep sedation used for adults undergoing BMBA. A nonrandomized database analysis and retrospective review of patient records from January 1997 to December 2000 was performed; 5,811 patients were identified as having undergone their first outpatient BMBA. Outcome measures included 30-day mortality and same-day hospital admission; surrogate measures included need for a surgical procedure or receipt of red blood cells within the 48 hr following the BMBA. Patients who received intravenously administered midazolam, fentanyl, and propofol for maintenance of deep sedation plus infiltration of a local anesthetic (n = 2,604; 45%) comprised the deep sedation group; those who received infiltration of a local anesthetic but no intravenous sedation or analgesia (n = 3,207; 55%) comprised the local anesthesia group. Patients in the deep sedation group compared to those in the local anesthesia group were less likely to die within 30 days (0.69% vs. 1.34%, P = 0.018) and less likely to receive red blood cells (1.27% vs. 2.25%, P = 0.006). No other differences between the groups were found. Although the study was retrospective and nonrandomized, the results suggest that the use of deep sedation for outpatient BMBA is as safe as using local anesthesia. Am.

Oral administration of analgesia and anxiolysis for pain associated with bone marrow biopsy

“…Used with permission. Copyright, Mosby The widespread acceptance of conscious sedation in BMAB is limited by several factors: (1) The prolonged recovery after sedation may be cumbersome and time consuming for physicians and nurses in a busy clinic; (2) no conclusive data are available to establish its effectiveness in inducing a significant reduction of pain level; (3) it increases the cost of the procedure; (4) although generally safe [2], it can potentially lead to clinical complications if given by inexperienced personnel; since sedation is a continuum, patients receiving conscious sedation may progress to deep sedation and may require actions for a "rescue response". It is not always possible to predict how an individual patient will respond to conscious sedation, and physicians are expected to be ready in rescuing patients who enter a state of deep sedation.…”

“…Medical literature provides only scarce data about the degree of pain experienced by patients undergoing this procedure, and little is known about the factors that can modify their perception of pain [1][2][3][4][5][6].…”

Procedural Care for Adult Bone Marrow Aspiration and Biopsy

“…2,3,6,21 One of the most significant consequences of experiencing pain during the procedure is that patients are likely to have raised anxiety about further BMABs. 5,10,22 Painful procedures can engender anger, mistrust, a sense of loss of control, and heightened feelings of hopelessness. 9 Indeed, research by Johnson and associates 3 indicates that all patients who have experienced prior biopsies report significantly more pain, regardless of whether sedatives are used.…”

Bedside Anesthesia for Painful Procedures in Onco-Hematology

“…[3][4][5] Although these procedures can also be stressful for adults, experience in adults is limited in the literature. 6 Based on the results of this investigation, effective, inexpensive, and safe interventions are available to reduce pain and distress in patients with nonsolid tumors undergoing repeated painful procedures. It is clear that greater advocacy is needed for painful procedures, if the most effective treatment options are to be made available to all patients in the near future.…”