No abstract

Supplemental Digital Content is Available in the Text.Analysis of a propensity-matched cohort determined that 82% to 84% of patients with spinal cord stimulation (SCS) will need at least 1 magnetic resonance imaging within 5 years of implant, with 59% to 74% requiring nonspine magnetic resonance imaging within 10 years. Magnetic resonance imaging–conditional SCS devices are needed that grant access of patients with SCS to this imaging modality.

Background: For Parkinson's disease (PD), essential tremor (ET), and dystonia patients with deep brain stimulation (DBS) implants, magnetic resonance imaging (MRI) requires additional safety considerations due to potentially hazardous interactions. Objective: A propensity-matched cohort of DBS-implanted patients was analyzed to determine the likelihood of needing MRI. Methods: Patients with new DBS full-system implants (n = 576) were identified in the Truven Health MarketScan® Commercial Claims and Medicare Supplemental Databases (2009-2012). Patients diagnosed with PD, ET, or dystonia and no DBS implant were identified (DBS-indicated patients: n = 11,216). The DBS-indicated patients were continuously enrolled for 4 years and matched for age, gender, and propensity score based on comorbid conditions to DBS-implanted patients (n = 4,878 and 543, respectively). A Kaplan-Meier survival curve of time to first MRI was extrapolated to 10 years. Results: An estimated 56-57% of DBS-indicated patients need an MRI within 5 years and 66-75% within 10 years after implantation. While 92% of DBS-implanted patients' MRI after implantation was of the head, for DBS-indicated patients, 62% of MRIs were of the body, potentially unrelated to the primary diagnosis. Conclusions: This analysis highlights the projected utilization of MRI in the DBS population for head and full-body images.

Nitrous oxide is an anesthetic gas that has been used extensively to decrease pain during dental procedures. Recent publications report that nitrous oxide administration to pediatric patients is safe and effective in reducing pain and anxiety associated with a variety of medical procedures. We completed a randomized, crossover, pilot study in our outpatient clinic to compare the efficacy of nitrous oxide (N2O) to standard conscious sedation (SCS) in providing analgesia during lumbar puncture (LP) in children with leukemia and lymphoma. Two nurses evaluated 12 subjects during a N2O LP and 10 subjects during a SCS LP (midazolam and either fentanyl or morphine). Inter-nurse reliability was not different for any measure. The mean time for clinic visit was statistically shorter for the N2O group, 34 minutes, compared to 57 minutes for SCS (p=0.010). The mean length of procedure was 9 minutes using N2O or SCS. The type of sedation did not affect the difficulty performing the LP. The incidence of side effects (nausea, vomiting, combative behavior, and unsteadiness when leaving for home) was similar in the N2O and SCS groups. Pain control was equivalent. The nurse, parent, and subject reported pain during the procedure as zero for 5/12 subjects with N2O and 3/10 subjects with SCS. Parents and subjects were very satisfied with N2O (parent=1.8, child=2.8) and SCS (parent=1.5, child=2.2) sedation (10-point Likert scale with 1=very satisfied, 10=very dissatisfied). After completion of both procedures, 8/12 subjects preferred N2O whereas 2/10 preferred SCS. All twelve subjects who received N2O returned to normal activity within an hour of leaving the clinic and 3/10 subjects who received SCS required longer than one hour. Nitrous oxide is effective in reducing procedural pain with few side effects while decreasing time required for clinic visit and return to normal activity. Patient and parent satisfaction was high with more patients and families preferring N2O sedation to SCS. Parent and Nurse Mean Pain Scores Before, During, and After Lumbar Puncture Using N2O and SCS (10-point Likert Scale) Pre-Procedure Pain During Procedure Pain Post-Procedure Pain Parent Nurse Parent Nurse Parent Nurse N2O 0.3 0 1.4 0.9 0.5 0.3 SCS 0.3 0.1 2.5 1.9 1.5 0.7

No abstract