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.

Download full-text


Available from: Roderic J Phillips
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This integrative review aims to identify evidence in four electronic databases (MEDLINE, CINAHL, PsyINFO, and COCHRANE) regarding the effectiveness of complementary and alternative medical interventions, either alone or as an adjunct to pharmacological therapy, in alleviating procedure-related pain, anxiety, and distress in children and adolescents with cancer. A total of 32 articles met inclusion criteria. Results suggest that mind-body interventions, including hypnosis, distraction, and imagery, may be effective, alone or as adjuncts to pharmacological interventions, in managing procedure-related pain, anxiety, and distress in pediatric oncology.
    Full-text · Article · Dec 2010 · Journal of pediatric nursing
  • Source
    • "t interference risk. It is frequently used when sudden treatment discontinuation or intervention has the potential to induce life-threatening complications and is used particularly when children either have drain, cannulae or similar equipment in place during the post-operative period, or need to be protected from falling from their beds (Crock et al. 2003; Ofoegbu & Playfor 2005; Stacey et al. 2000). Children and adolescents may additionally need PR for various other procedures, because of disruptive behaviour, or potential injuries for them or others in psychiatric clinics (Bell 1997; Busch & Shore 2000; Committee on Pediatric Emergency Medicine 1997; Donovan et al. 2003; Jones & Timber"
    [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to determine paediatric nurses' ideas and attitudes towards physical restraint in Turkey, the consent obtained, physical restraint types used in paediatric units and complications developing in children subjected to physical restraint. Physical restraint, although controversial, is still common in paediatric units in Turkey and creates complications, which were observed or investigated by researchers. The research used descriptive, analytical and cross-sectional methods with 121 paediatric nurses working in paediatric surgical-internal medicine services and paediatric intensive care units of four hospitals. The questionnaire consisted of open-ended questions and was applied via face-to-face interviews. 66.9% of nurses reported that nurse shortages were the main reason for increased physical restraint applications, 58.7% tried alternative methods, and 71.1% indicated no need of written orders for physical restraint use. Physical restraint decreased while the mother accompanied her child (P = 0.0001) and increased while inexperienced clinic nurses were in charge (P = 0.003). Wrist (96.7%), ankle (81.0%), and whole body (17.4%) restraints were all used. No nurse had received any verbal or written consent from children or surrogates and 96.7% used physical restraint without any verbal or written physician order. Thirty (24.8%) respondents reported that children under physical restraint had developed various complications, for example, oedema and cyanosis by arm and wrist restraint, food rejection and agitation. Physical restraint could be reduced by a wiser combination of education and expert consultation in paediatric units in Turkey, although further detailed research is needed.
    Full-text · Article · Jan 2008 · International Nursing Review
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study assessed of the preferences 742 mothers regarding their own presence during invasive procedures performed on their children. The relationships between socio-demographical characteristics and preferences of the mothers and disease characteristics of the children were examined. A mother's desire to be present was found to increase with decreasing invasiveness of the procedure as well as with increasing analgesia and sedation provided. The desire to be present was higher in young mothers with higher socio-economic levels and educational backgrounds, with younger children and with children who had undergone prior recurrent interventions. This study demonstrated that most of the mothers preferred to be present during the procedure, and that the ratio of mothers willing to do so increased significantly if the children were sedated. The results suggested that pediatricians can improve the quality of service and physician-patient-family relationship by taking mothers' preferences into consideration.
    Preview · Article · Jan 2005 · The Turkish journal of pediatrics
Show more

We use cookies to give you the best possible experience on ResearchGate. Read our cookies policy to learn more.