2021
DOI: 10.1002/pbc.29272
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Reducing sedated lumbar punctures in pediatric patients with acute lymphoblastic leukemia

Abstract: Background Sedation for lumbar punctures (LPs) in pediatric acute lymphoblastic leukemia (ALL) patients has been the standard for decades to reduce pain and anxiety. Recent studies on the potential long‐term neurocognitive effects of cumulative propofol exposure have raised concerns about this practice. The recent pandemic introduced additional burdens to patients, with the requirement of a negative COVID‐19 test prior to each sedated procedure. Procedure These factors prompted a quality improvement interventi… Show more

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Cited by 8 publications
(4 citation statements)
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“…Prompted by the COVID-19 pandemic and the consequent impacts on access to anesthesia, one center described reducing the percentage of children who received propofol anesthesia by 50% with the implementation of a program including education and simulation with the patient, topical lidocaine, preprocedure anxiolytic medication (oral lorazepam or IV midazolam), and the option of a guardian and child life practitioner presence during the procedure. 44 Other centers have reported using nitrous oxide, although there remain theoretical concerns about the use of this anesthetic agent in children receiving IT-MTX. 45,46 Developmentally appropriate nonpharmacologic interventions, including distraction, hypnosis, and music, have also demonstrated efficacy, although are not widely implemented care.…”
Section: Discussionmentioning
confidence: 99%
“…Prompted by the COVID-19 pandemic and the consequent impacts on access to anesthesia, one center described reducing the percentage of children who received propofol anesthesia by 50% with the implementation of a program including education and simulation with the patient, topical lidocaine, preprocedure anxiolytic medication (oral lorazepam or IV midazolam), and the option of a guardian and child life practitioner presence during the procedure. 44 Other centers have reported using nitrous oxide, although there remain theoretical concerns about the use of this anesthetic agent in children receiving IT-MTX. 45,46 Developmentally appropriate nonpharmacologic interventions, including distraction, hypnosis, and music, have also demonstrated efficacy, although are not widely implemented care.…”
Section: Discussionmentioning
confidence: 99%
“…The present 10% incidence of TLP associated with the successful first attempts agrees well with the 16% incidence observed in a recent study where the overall success rate at the first attempt was 90% 15 . Sedation most likely accounts for the low incidence of TLP among the pediatric patients with ALL, but acceptable results may also be obtained in intrathecal treatment LPs without sedation 28 . In further considering the incidence of TLP, the present study did not include the diagnostic LPs, which may show a substantially lower incidence of TLP than later intrathecal treatment punctures (19% vs 32%) 2 , but not necessarily (20% vs. 18%) 9 .…”
Section: Discussionmentioning
confidence: 99%
“…With this change, they identified additional benefits, including reduced clinical time for families, decreased cost, high levels of patient and family satisfaction, and fewer last-minute cancelations. 13…”
Section: Clinical Challenges In Treatmentmentioning
confidence: 99%