Safety and efficacy of two protocols for sedation in pediatric oncology procedures

Abstract

<jats:title>Abstract</jats:title><jats:p>Invasive procedures, such as the lumbar puncture, can cause anxiety and pain in children undergoing treatment for acute lymphoblastic leukemia (ALL). We investigated the safety and efficacy of two different protocols for pain relief in 20 children with ALL undergoing lumbar puncture. Protocol A was composed of an association between propofol and alfentanil. Protocol B consisted in the combination of propofol and ketamine. Vital and behavioural parameters, sedation and pain scores were recorded at different times during and after the procedure. All patients showed a satisfactory sedation and analgesia. We found a statistically significant difference of vital parameters between protocol A and protocol B, while there were no significative differences between sedation scores and the other parameters evaluated. Patients in protocol A showed a higher incidence of major side effects, such as respiratory depression. Our results show that both protocols are effective to obtain a good sedation and analgesia in children with ALL undergoing lumbar puncture, but the association between propofol and ketamine appears more safe due to the lower incidence of side effects.</jats:p>

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

“…The use of preprocedural opioids is strongly associated with an increased risk of an adverse event regardless of the sedation drug used [17]. A study conducted by Crea et al compared the incidence of adverse effects caused by propofol and alfentanil with propofol and ketamine, and their study findings suggested that although there are some adverse effects associated with propofol and ketamine, their use is much safer than the other combination and recommended its use in these patients [18].…”

Sedation for middle ear surgery: prospective clinical trial comparing propofol and midazolam

“…Propofol induces dose-dependent cardiovascular and respiratory depression [7]. The rapid titrability, brief pharmacologic effect, and maintenance of spontaneous ventilation make intravenous propofol a suitable agent for conscious sedation during MES when patient cooperation is necessary (e.g., for evaluation of hearing).…”

The Safety and Efficacy ff Propofol Combinations with Ketamine or Fentanyl in Lumbar Puncture Application in Children with Haematological Diseases: A Prospective, Randomised, Double-Blinded Study

“…A similar study compared groups that received propofol and ketamine or propofol and alfentanil and the need for additional propofol was less in the ketamine group. [6] These results show that the ketamine-propofol combination provides more effective sedation. The authors did not find a significant difference between the groups despite a longer time to awakening in the group administered ketamine.…”

“…The authors did not find a significant difference between the groups despite a longer time to awakening in the group administered ketamine. [6] Tian and his friends found the longest recovey period to be 5 minutes in their studies which had the subject of children who were diagnosed with leukemia and who were administered fentanyl propofol combination for sedation. [12] In our study, there is no difference with regard to recovery time which is 5.1 minutes for the group F and 5.5 minutes for group K.…”

“…Two minutes after propofol was administered, the physician was allowed to perform the procedure if the Ramsey Sedation Score was 5 or 6. [4][5][6] If the patient was agitated and moved during the procedure, an additional dose of iv 1 mg kg¯¹ propofol was administered with a slow push. Subsequent additional doses were administered in the same way until satisfactory sedation was obtained.…”