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

Abstract

Background: 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. Methods: 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 childen 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. Results: 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. Conclusions: 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.

Mothers' perceptions about pediatric dental sedation as an alternative to dental general anesthesia

“…Moderate sedation associated with protective stabilization is an alternative to general anesthesia 7 . Protective stabilization is necessary during pediatric dental sedation in 50-94% of cases [24][25] . Unexpectedly, protective stabilization of a fully conscious child did not cause any distress for the caregiver in the present study.…”

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

“…Oral or IV ketamine was associated with less distress during lumbar puncture and /or bone marrow aspiration in children with cancer (Tobias et al, 1992 Level III-3; Evans et al, 2005 Level IV). For some patients, general anaesthesia is preferred to sedation, and has been associated with less distress and pain for children requiring multiple procedures (Crock et al, 2003 Level III-3) (see also 10.1.8). Topical anaesthesia with EMLA® was effective for lumbar puncture (Juarez Gimenez et al, 1996 Level II).…”

Managing Painful Procedures in Children With Cancer

“…However, parent anxiety levels can be minimized when the child is adequately prepared. [7][8][9] Several studies report a positive impact on parental distress and satisfaction and no difference in technical complications when parents remain with children. 8,10,11 CBI CBI are techniques intended to alter the procedure experience by changing the child's thoughts through attention diversion, images, and self-determination.…”

“…Therefore, this agent must be administered in a controlled setting with experienced personnel trained in advanced airway management skills with resuscitative equipment readily available. 9,21,33,51,52,55,57,58 HOW TO CHOOSE THE SEDATION CATEGORY There are several choices for sedation that can be administered in outpatient and inpatient cancer settings. Minimal sedation can be safely administered in the clinic or an inpatient unit.…”