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Background and Aim Procedural sedation and analgesia is the standard of care for painful procedures in children that require immobility. Children with cancer are subjected to many procedures for their treatment which are painful and cause anxiety in them. Our aim was to assess the safety and efficacy of procedural sedation and analgesia in pediatric oncological patients in a large tertiary care hospital in Karachi. Methods A retrospective study was done and records were reviewed of children receiving PSA (procedural sedation and analgesia) for pediatric oncological procedures. This included patients for oncology procedures (lumber puncture, intrathecal chemotherapy and/or bone marrow aspiration ± trephine). PSA was provided by non-anesthesiologists. These patients were assessed according to PSA protocol guidelines by American Society of Anesthesiology (ASA). Low dose Ketamine (0.5 mg/kg) and Propofol (2 mg/kg) were used. Results A total of 1216 oncological procedures were performed out of which lumber puncture was the commonest procedure performed (n=956; 78.6%) followed by bone marrow aspirate only (n=137, 11.3%) and both (n=123, 10.1%). A total of 565 children were enrolled in the study out of which majority (65.1%) were males and 34.9% were females (Table 1). Only eight (0.7%) of the patients were found to have hypoxia as an adverse effect of propofol-ketamine drug with 50% procedures utilizing propofol 1 mg/kg for sedation. Conclusion This study concludes that the combination of Ketamine and Propofol is safe for procedures. There were no major complications. None of the patients required CPR or endotracheal intubation.

Objective: To assess the pattern of antibiotics use among pediatrics in two tertiary care hospitals in Lahore, Punjab, Pakistan. Methods: The study was conducted from 1st December, 2016 to 30th April, 2017 in two tertiary care hospitals of Lahore, Punjab province of Pakistan. Sampling population consisted of 322 pediatric patients aged <18 years, suffering from any disease. Statistical Package for Social Sciences (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) and Microsoft Excel, 2013 were used to analyze the data. P-value < .05 was taken as the mark of significance for statistical tests. Results: The most frequently diagnosed infections among the study population were; gastrointestinal tract infections (n = 136, 42.2%), fever (n = 117, 36.3%) and upper respiratory tract infections (n = 79, 24.5%). Cephalosporins (n = 235, 73%), penicillins (n = 80, 24.8%), and fluoroquinolones (n = 76, 23.6%) were most frequently prescribed antibiotic classes. Most frequently prescribed antibiotics agents were; ceftriaxone (n = 235, 73%), ciprofloxacin (n = 76, 23.6%) and co-amoxiclav (n = 71, 22%). Frequently prescribed antibiotics combinations were; co-amoxiclav+ceftriaxone (n = 42, 13%), ceftriaxone+vancomycin (n = 26, 8.1%) and ceftriaxone+ciprofloxacin (n = 12, 3.7%). The parenteral route was most commonly used for the administration of antibiotics. Conclusions: Current study concluded that antibiotic prescribing in pediatrics is quite high, an unfavorable trend which paves the way towards antimicrobial resistance.