Safety of pediatric peripheral blood stem cell harvest in daycare setting: An institutional experience

Abstract

Introduction: Children serving as a donor for their siblings will require anesthesia or sedation. In view of shortage of time and space in operating room setting, peripheral blood stem cell (PBSC) harvest is performed as a daycare procedure. Aim: This study aims to find out whether performing PBSC harvest in hematology blood collection area as a daycare procedure is safe or not. Settings and Design: This secondary analysis included 164 pediatric PBSC harvest (154 pediatric donors, of which 10 had repeat harvesting done) donors, performed under anesthesia, in the Department of Hematology, between January 2009 and June 2017. Materials and Methods: Donors were examined, informed consent was obtained, and adequate premedications were ensured. Induction was intravenous for cooperative donors or inhalational sevoflurane followed by intravenous maintenance infusion using either face mask or a laryngeal mask airway (LMA). During the procedure, vitals are monitored with a noninvasive monitor. Normal hemodynamics were ensured before transferring the children to the ward. Statistical Analysis: Statistical analysis was performed using SPSS 16.0 statistical software. Descriptive statistics and frequencies were used for the data description. Results: A total of 137 donors (median age of 5 years) were induced with sevoflurane and LMA was used in 84 children and face mask in 53. Twenty-seven children cooperated for intravenous induction. Various combinations of propofol, dexmedetomidine, and ketamine were used with respiratory and hemodynamic stability. The median duration of anesthesia was 250 (165–375) min. The recovery from anesthesia was smooth with a median wake-up time of 20 (5–60) min. Conclusion: This retrospective analysis demonstrates that nonoperating room anesthesia for pediatric age group for PBSC harvest can be safely and successfully accomplished outside the operation room setting by a consultant anesthesiologist.