Safety and Efficacy of Procedural Sedation and Analgesia in Pediatric Oncology Patients

Aslam, Saba Laila; Haque, Anwar Ul; Jamil, Muhammad Tariq; Ariff, Madiha; Nasir, Saad

doi:10.7759/cureus.7442

Cited by 9 publications

(19 citation statements)

References 24 publications

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“…Lipid emulsions have been used to lower lidocaine plasma levels in the event of toxicity [ 36 ]. The studies described here suggest that initiating a lidocaine infusion requires dose titrations and close monitoring for side effects [ 37 , 38 ]. Table 3 summarizes dosing considerations and pharmacokinetics for intravenous lidocaine that have been described in both adult and pediatric literature [ 22 , 23 , 24 , 25 , 26 , 32 , 35 , 36 , 37 , 38 , 39 ].…”

Section: Systemic Lidocaine Infusionsmentioning

confidence: 99%

Systemic Lidocaine Infusions for Pediatric Patients with Cancer-Related Pain

2022

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Pediatric patients with cancer experience significant distress from both treatment and cancer-related pain. Careful selection of an analgesic regimen should be based upon individual patient factors, including the level of pain, response to therapy, and physiologic profile. Refractory pain is a therapeutic dilemma frequently encountered in the pediatric cancer setting. Systemic lidocaine infusions have been described as both safe and efficacious, as prior studies show patients reporting decreased pain scores and improved quality of life after lidocaine treatment. Given the favorable side effect profile of lidocaine, it has the potential to be considered for analgesia in the setting of refractory pain. This review discusses the use of systemic lidocaine infusions for analgesia in pediatric oncology patients with cancer-related pain.

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Section: Systemic Lidocaine Infusionsmentioning

confidence: 99%

Systemic Lidocaine Infusions for Pediatric Patients with Cancer-Related Pain

2022

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“…Sedation for diagnostic procedures is generally safe, rarely associated with major complications or serious adverse events, such as apnea, hypotension, laryngospasm, and bradycardia. Medical history, physical examination, current medical therapy, sedative to be used, type, and length of the procedure always need to be carefully evaluated to minimize procedure-associated risks [ 14 ].…”

Section: Preoperative Assessmentmentioning

confidence: 99%

Anesthesia in Children with Neuroblastoma, Perioperative and Operative Management

et al. 2021

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Neuroblastoma (NB) is the most common extracranial, solid, pediatric malignancy and, despite the constant progress of treatment and development of innovative therapies, remains a complex, challenging disease causing major morbidity and mortality in children. There is significant variability in the management of neuroblastoma, partially due to the heterogeneity of the clinical and biological behavior, and partially secondary to the different approaches between treating institutions. Anesthesia takes an integral part in the multidisciplinary care of patients with NB, from diagnosis to surgery and pain control. This paper aims to review and discuss the critical steps of the perioperative and operative management of children undergoing surgery for neuroblastoma. Anesthesia and analgesia largely depend on tumor location, surgical approach, and extension of the surgical dissection. Attention should be paid to the physio-pathological changes on cardiovascular, gastrointestinal, and immune systems induced by the tumor or by chemotherapy. At the time of surgery meticulous patient preparation needs to be carried out to optimize intraoperative monitoring and minimize the risk of complications. The cross-sectional role of anesthesia in cancer care requires effective communication between all members of the multidisciplinary team.

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“…There is scarce data on the safety and utility of propofol infusions in the pediatric intensive care setting [8].…”

Section: Introductionmentioning

confidence: 99%

“…There is scarce data on the safety and utility of propofol infusions in the pediatric intensive care setting [ 8 ]. Given that propofol usage may be beneficial in this setting, further investigation is warranted.…”

Section: Introductionunclassified

Propofol in the Pediatric Intensive Care Unit, a Safe and Effective Agent in Reducing Pain and Sedation Infusions: A Single-Center Retrospective Study

Uppuluri¹,

Villarreal²,

Dorsey³

et al. 2022

Cureus

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IntroductionPropofol has long been used as an anesthetic agent during pediatric surgery. Its use in pediatric intensive care units has been largely controversial. A beneficial use of propofol is to facilitate weaning of other pain and sedation infusions such as opiates and benzodiazepines. However, some have advocated to not use propofol due to fear of possible adverse effects including propofol infusion syndrome and hemodynamic instability. The purpose of this study was to determine both the safety of propofol infusions in critically ill pediatric patients, as well as the change in the requirement of other pain and sedation infusions by use of a propofol infusion. MethodsSingle-center, retrospective data (January 2011 to January 2020) was obtained manually using a studyspecific data extraction tool created for electronic medical records. The data obtained included variables of interest that measured physiological parameters and pain/sedation infusion (morphine, fentanyl, hydromorphone, midazolam, and dexmedetomidine) rates during three time periods: before propofol initiation, immediately after discontinuation, and four hours after discontinuation. The physiological parameters were then compared to the pain and sedation infusion rates using paired Wilcoxon signed-rank tests. ResultsThere was a total of 33 patients with an average age of 11.1 years who were given a median initial propofol infusion of 50 mcg/kg/min with a peak dose of 75 mcg/kg/min over an average of eight hours. Age had a weak and insignificant correlation with initial rate and duration and a moderate and significant correlation with peak rate and duration. Physiological parameters did not vary at any time point measured. There was a significant reduction in other pain and sedation infusions after discontinuation of propofol. ConclusionPropofol infusions are hemodynamically tolerated and the majority of patients who are on other pain and sedation infusions tolerate complete discontinuation of these infusions following propofol discontinuation.

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Safety and Efficacy of Procedural Sedation and Analgesia in Pediatric Oncology Patients

Cited by 9 publications

References 24 publications

Systemic Lidocaine Infusions for Pediatric Patients with Cancer-Related Pain

Systemic Lidocaine Infusions for Pediatric Patients with Cancer-Related Pain

Anesthesia in Children with Neuroblastoma, Perioperative and Operative Management

Propofol in the Pediatric Intensive Care Unit, a Safe and Effective Agent in Reducing Pain and Sedation Infusions: A Single-Center Retrospective Study

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