Anaphylaxis with midazolam in pediatric hematologyoncology unit: a case report

Safety and Efficacy of Procedural Sedation and Analgesia in Pediatric Oncology Patients

“…Procedural sedation provides safe and effective control of pain and anxiety, which leads to an adequate degree of memory loss and minimal awareness of the procedure [2]. There are guidelines proposed by the American Academy of Pediatrics (AAP) and Joint Commission International Accreditation (JCIA) regarding the management of pain and anxiety associated with these procedures in children [3][4].…”

“…Critical aspects of PSA include pre-procedural evaluation of the patients, constant monitoring of the child before, during and after the procedure, proper procedure documentation, equipment as well as the staff needed in addition to the type of medication that is recommended [3]. Various national and international studies done on this topic have reported evaluating these outcomes in pediatric departments, but specifically, in oncology units, such studies are only a handful [4,[7][8][9].…”

Çocuklardaki tıbbi işlemlerde sedatif-analjezik ilaç seçimi ve anafilaksi tedavisinde adrenalin uygulama yolu

“…We read the article of Çakmakcı et al (1) published in the final issue of your journal. The authors presented a pediatric case of anaphylaxis that developed secondary to midazolam administered for the objective of sedation before bone marrow aspiration and lumbar puncture.…”

“…After mentioning all these drugs, we can conclude that sedative and anxiolytic drugs should be used for painless procedures including radiological imaging and EEG, and sedative, analgesic and amnestic (if possible) drugs should be used in combination for painful procedures including lumbar puncture and bone marrow aspiration, which were mentioned to have been performed in the relevant article by the authors in their case (1). The lack of use of analgesic drugs in painful procedures makes the performance of the procedure difficult by decreasing patient comfort and causes use of an increased dose of sedative drug because the patient will feel pain.…”

“…Increasing the dose of sedative drugs increases the risk of respiratory and circulatory depression. Accordingly, we think that it was not appropriate for the authors to use midazolam alone, as mentioned in their article, because it has no analgesic properties (1). Midazolam should be used in association with analgesic drugs including fentanyl or ketamine before these procedures, which are considerably painful.…”