Sedative Preference of Families for Lumbar Punctures in Children With Acute Leukemia: Propofol Alone or Propofol and Fentanyl

Abstract

Propofol is a common sedative/anesthetic used for invasive procedures in children with cancer. The purpose of this study was to determine whether families of children with acute leukemia prefer propofol alone or propofol plus fentanyl for lumbar puncture (LP) sedation. We conducted a randomized, placebo controlled, double blind, crossover study. Each patient was studied twice, once with propofol/placebo and once with propofol/fentanyl. Data collected included the modified Yale Preoperative Anxiety Score (M-YPAS) at baseline and after placebo or fentanyl, Induction Compliance Checklist, recovery excitement, recovery time, and adverse events. After the study, families were asked which sedative regimen they preferred for future LPs. Twenty-two patients received 44 LP sedations: propofol 22, propofol/fentanyl 22. The average age was 6.4+/-4.2 years (mean+/-SD). There were no significant differences between groups in M-YPAS, Induction Compliance Checklist or recovery excitement. Adverse events occurred in 11/22 patients (50%) propofol and 4/22 (18.2%) propofol/fentanyl (P=0.0196). Average recovery time (mean+/-SD) was 36.86+/-17.1 minutes propofol versus 26.36+/-16.4 minutes propofol/fentanyl (P=0.047). Sixteen families (72.7%) chose propofol with fentanyl for future LP sedations (P=0.05). In conclusion, most families prefer propofol and fentanyl for LPs. Propofol with fentanyl was also associated with fewer adverse events and faster recovery.

Propofol-fentanyl versus propofol alone for lumbar puncture sedation in children with acute hematologic malignancies: Propofol dosing and adverse events

“…Adverse events occurred in 11 of the 22 patients (50%) receiving propofol and placebo compared to 4 of the 22 patients (18.2%) receiving propofol with fentanyl 17 (P = 0.02). (Table 1).…”

“…We have previously described the lower overall incidence of adverse events, faster recovery and family preference with this combination. 17 In terms of total propofol requirements and incidence of adverse events, the combination of propofol and fentanyl proved superior to propofol alone. To our knowledge this is the first randomized, controlled study to relate propofol dosing to adverse events in pediatric oncology patients receiving procedural sedation.…”

“…We have previously we reported overall fewer adverse events with the combination of propofol and fentanyl. 17 …”

Sedation and regional anesthesia

“…Sedation is nowadays frequently used in the pediatric population. The combination propofol/fentanyl has been compared with propofol alone for lumbar puncture in children with acute hematologic malignancies [16,17]. The trials were prospective, randomized, double blinded and crossover.…”

Managing Painful Procedures in Children With Cancer

“…The addition of an analgesic agent such as fentanyl can result in lower propofol doses (median 3.1 mg/ kg vs. 4.6 mg/kg), fewer adverse effects (18% vs. 50%), and a shorter recovery period (37 min vs. 26 min). [53][54][55] When remifentanil, an ultra-short-acting opioid, was used in combination with propofol in 80 children undergoing BMAs, it allowed for an overall propofol dose reduction and decreased time to discharge, but it increased the risk of respiratory depression. 56 Whether used alone or in combination, propofol can cause apnea, hypotension, and airway obstruction.…”