Safety of Sedation for Patients Undergoing Bone Marrow Biopsy and Aspiration While Febrile

To determine the risks and outcomes of providing sedation to febrile patients scheduled for bone marrow aspiration or biopsy procedures.

During the 4-year period from January 1, 2013, through December 31, 2016, data from the periprocedural courses of 12,134 consecutive patients in an outpatient procedure center at a large tertiary medical center were collected retrospectively and analyzed to determine whether febrile patients undergoing bone marrow aspiration and/or biopsy with propofol sedation present a unique patient safety risk.

Eighty-four patients (0.7%) had preprocedural temperatures of greater than or equal to 38.3°C. Of these, 6 required unanticipated hospital admission for sustained hypoxemia and symptoms suggesting pneumonia. All 6 of these patients had a productive cough and room air oxygen saturations of less than 92% before their procedures. These 6 patients were diagnosed during their hospitalizations with either confirmed or presumed community-acquired pneumonia. All recovered without pulmonary sequelae. Only 2 of the other 78 febrile patients required unanticipated hospital admission, for both general weakness and dehydration.

Our findings suggest that patients who are febrile and who also have productive coughs and oxyhemoglobin saturations by pulse oximetry of less than 92% would be best served with outpatient evaluation of their pulmonary symptoms before undergoing their elective bone marrow aspiration procedures. In contrast, febrile patients without pulmonary symptoms fare well.