Midazolam premedication for pediatric bone marrow aspiration and lumbar puncture

Abstract

The ability of midazolam, a benzodiazepine, to reduce the distress associated with lumbar puncture and bone marrow aspiration was examined in 23 children with acute lymphocytic leukemia. Patients were randomized to receive 0.2 mg/kg midazolam HCl or placebo intravenously 3-5 min before the procedures, under double-blind conditions. Based on prior experiences, children in both groups anticipated severe pain from these procedures. Postprocedure pain ratings by patients were markedly reduced in the midazolam but not the placebo group. Both physicians and parents judged the midazolam group as significantly less distressed than controls during and after the procedures. Trained observers recorded significantly fewer pain- and anxiety-related behaviors in the midazolam group immediately before and after, but not during the procedures. The amnestic effects of midazolam, confirmed in a visual recall/recognition test, appear to account for the decreased pain ratings since the behavioral manifestations were similar in the two groups. There were no adverse drug reactions or significant changes in vital signs. Midazolam warrants further investigation as a premedication for painful diagnostic and treatment procedures in children with cancer.

Opportunities and limitations of bone marrow biopsy and bone marrow FDG-PET in lymphoma

“…In a series of 235 adult patients, about 70% of patients experienced procedurerelated pain, with one-third of these patients indicating severe pain [16]. Sedation with drugs such as lorazepam, midazolam or diazepam is often administered in addition to local anesthesia, which has been reported to reduce anxiety, pain perception and result in retrograde amnesia for the procedure in many patients [17][18][19]. However, apart from these beneficial effects, performing BMB under sedation has drawbacks, like requirement of additional staff and equipment and prolongation of hospital stay.…”

“…Bone marrow involvement is, either directly or indirectly through the Ann Arbor system, also an important factor in most clinical risk stratification indices, including the International Prognostic Score (IPS) for advanced Hodgkin lymphoma [4], the International Prognostic Index (IPI) and its successors for aggressive non-Hodgkin lymphoma and diffuse large B-cell lymphoma (DLBCL) [5][6][7], and the Follicular Lymphoma International Prognostic Index (FLIPI) and new FLIPI 2 for follicular lymphoma [8,9]. Importantly, it should be realized that these clinical risk stratification indices only used lymphomapositive bone marrow biopsy (BMB) specimens as proof of bone marrow involvement [4][5][6][7][8], and not bone marrow involvement as detected by 18 F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET). Third, the presence of bone marrow involvement may change the choice of therapy, particularly in patients who were thought to have early stage disease only before bone marrow evaluation.…”

Çocuklarda Ağri: Değerlendi̇rme Ve Yaklaşim

“…T Ta an nı ı v ve e t te ed da av vi i g gi ir ri iş şi im ml le er ri in ne e b ba ağ ğl lı ı a ağ ğr rı ı v ve e y ya ak kl la aş şı ım m Çocuklarda tedavi ve tanısal girişimler sırasındaki sedasyonun amacı bu sırada duyulan ağrı, anksiyete ve hastanın istenmeyen hareketlerini etkili ve güvenli bir şekilde kontrol ederek girişimin uygun şekilde yapılmasının sağlanmasıdır (14)(15)(16)(17). Uygulanacak girişimin tipine, hastanın sosyal ve emosyonel özelliklerine göre en uygun sedasyon ve ağrı kontrolu sağlan-malıdır.…”

Children's Reactions to Invasive Medical Procedures

“…Modeling packages (Jay et al, 1983), hypnosis (Katz, Kellennan, & Ellenberg, 1987;Zeltzer & LeBaron, 1982), and psychopharmacological management have been reported to reduce behavioral and, in some instances, subjective distress. Recent evaluations of midazolarn, a high-potency benzodiazapine, have yielded promising findings that support its use as a pharmacological intervention to reduce procedure-related distress (e.g., Friedman et al, 1991;Sandler et al, 1992).…”