PMID- 26769714
OWN - NLM
STAT- MEDLINE
DCOM- 20160401
LR  - 20191210
IS  - 2154-1663 (Print)
IS  - 2154-1671 (Linking)
VI  - 6
IP  - 2
DP  - 2016 Feb
TI  - Complications of Deep Sedation for Individual Procedures (Lumbar Puncture Alone) 
      Versus Combined Procedures (Lumbar Puncture and Bone Marrow Aspirate) in 
      Pediatric Oncology Patients.
PG  - 95-102
LID - 10.1542/hpeds.2015-0065 [doi]
AB  - BACKGROUND AND OBJECTIVES: Pediatric oncology patients frequently undergo 
      procedural sedation. The goal of this study was to determine the safety of 
      combining procedures into a single sedation encounter and to assess if the 
      magnitude of any complication is significant enough to justify separate sedation 
      encounters for multiple procedures. METHODS: This retrospective review included 
      pediatric oncology patients sedated for lumbar puncture alone or combined 
      procedures (lumbar puncture and bone marrow aspirate) from January 2012 to 
      January 2014. Demographic characteristics, medication dosing, procedural success, 
      sedation duration, and adverse events (AEs) with associated required 
      interventions were recorded. Sedation-related complications were separated into 
      serious adverse events (SAEs) and AEs. Data were analyzed by using multivariable 
      modeling. RESULTS: Data from 972 sedation encounters involving 96 patients, each 
      having 1 to 28 encounters (mean+/-SD, 10+/-5), were reviewed. Ninety percent were 
      individual procedures and 10% were combined procedures. Overall, there were few 
      SAEs, and airway obstruction was the most common SAE. Combined procedures 
      required 0.31 mg/kg more propofol (P<.001) and took 1.4 times longer (P<.001) 
      than individual procedures. In addition, when adjusting for possible confounding 
      factors, the odds of having an SAE were 4.8 (95% confidence interval, 
      1.37-16.65); P=.014) times higher for combined procedures. All SAEs and AEs were 
      manageable by the sedation team. CONCLUSIONS: Combining procedures was associated 
      with higher propofol doses, prolonged duration, and a small increase in 
      likelihood of SAEs compared with individual procedures. All AEs fell within the 
      scope of management by the sedation team. Balancing the increased, but 
      manageable, risks versus the advantages of family/patient convenience, enhanced 
      resource utilization, and minimization of potential neurotoxicity from 
      anesthetics supports combining procedures when possible.
CI  - Copyright (c) 2016 by the American Academy of Pediatrics.
FAU - Patel, Meral M
AU  - Patel MM
AD  - Departments of Pediatrics, and mmpate2@emory.edu.
FAU - Kamat, Pradip P
AU  - Kamat PP
AD  - Departments of Pediatrics, and Children's Healthcare of Atlanta, Atlanta, 
      Georgia.
FAU - McCracken, Courtney E
AU  - McCracken CE
AD  - Departments of Pediatrics, and.
FAU - Simon, Harold K
AU  - Simon HK
AD  - Departments of Pediatrics, and Children's Healthcare of Atlanta, Atlanta, Georgia 
      Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia; and.
LA  - eng
PT  - Journal Article
DEP - 20160101
PL  - United States
TA  - Hosp Pediatr
JT  - Hospital pediatrics
JID - 101585349
RN  - 0 (Hypnotics and Sedatives)
RN  - YI7VU623SF (Propofol)
SB  - IM
MH  - Airway Obstruction/*etiology
MH  - Biopsy, Needle/*methods
MH  - Bone Marrow Examination/*methods
MH  - Child
MH  - Child, Preschool
MH  - *Deep Sedation/adverse effects/methods
MH  - Female
MH  - Humans
MH  - Hypnotics and Sedatives/administration & dosage/adverse effects
MH  - Male
MH  - *Neoplasms/diagnosis/surgery
MH  - Operative Time
MH  - Outcome Assessment, Health Care
MH  - *Propofol/administration & dosage/adverse effects
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Spinal Puncture/*methods
EDAT- 2016/01/16 06:00
MHDA- 2016/04/02 06:00
CRDT- 2016/01/16 06:00
PHST- 2016/01/16 06:00 [entrez]
PHST- 2016/01/16 06:00 [pubmed]
PHST- 2016/04/02 06:00 [medline]
AID - hpeds.2015-0065 [pii]
AID - 10.1542/hpeds.2015-0065 [doi]
PST - ppublish
SO  - Hosp Pediatr. 2016 Feb;6(2):95-102. doi: 10.1542/hpeds.2015-0065. Epub 2016 Jan 
      1.