General anaesthesia or conscious sedation for painful procedures in childhood cancer: The family's perspective

The Royal Children's Hospital, Melbourne, Victoria, Australia
Archives of Disease in Childhood (Impact Factor: 2.9). 04/2003; 88(3):253-7. DOI: 10.1136/adc.88.3.253
Source: PubMed


Until recently, midazolam sedation was routinely used in our institution for bone marrow aspirates and lumbar punctures in children with cancer. It has been perceived by many doctors and nurses as being well tolerated by children and their families. Aim: To compare the efficacy of inhalational general anaesthesia and midazolam sedation for these procedures.
A total of 96 children with neoplastic disorders, who received either inhalational general anaesthesia with sevoflurane, nitrous oxide, and oxygen (GA) or sedation with oral or nasal midazolam (SED) as part of their routine preparation for procedures were studied. The experiences of these children were examined during their current procedure and during their first ever procedure. Main outcome measures were the degree of physical restraint used on the child, and the levels of distress and pain experienced by the child during the current procedure and during the first procedure. The family's preference for future procedures was also determined.
During 102 procedures under GA, restraint was needed on four occasions (4%) when the anaesthetic mask was first applied, minimal pain was reported, and children were reported as distressed about 25% of the time. During 80 SED procedures, restraint was required in 94%, firm restraint was required in 66%, the child could not be restrained in 14%, median pain score was 6 (scale 0 (no pain) to 6 (maximum pain)), and 90% of the parents reported distress in their child. Ninety per cent of families wanted GA for future procedures. Many families reported dissatisfaction with the sedation regime and raised concerns about the restraint used on their child.
This general anaesthetic regime minimised the need for restraint and was associated with low levels of pain and distress. The sedation regime, by contrast, was much less effective. There was a significant disparity between the perceptions of health professionals and those of families with respect to how children coped with painful procedures.

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Available from: Roderic J Phillips, Oct 13, 2015
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    • "Pharmacological interventions for procedure-related pain in pediatric oncology may include local anesthetics, such as topical creams (e.g., lidocaine, prilocaine, and eutectic mixture of local anesthetics) and injectable lidocaine (which can be prepared in a pH-adjusted buffered solution that reduces the injection-associated pain; Luhmann, Hurt, Shootman, & Kennedy, 2004), sedation of varying levels ranging from premedication (Sandler et al., 1992) to conscious or deep sedation (Marx et al., 1997; Reeves, Havidich, & Tobin, 2004), and general anesthesia (Crock et al., 2003; Iannalfi et al., 2005). Pharmacological management of procedure-related pain in children with cancer is included as a major recommendation by the American Pain Society in their Guideline for the Management of Cancer Pain in Adults and Children; nonpharmacological alternatives for managing pain are recommended for patients who decline procedural sedation (Miaskowski et al., 2005). "
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