Sedation Practices for Lumbar Punctures in Patients With Acute Lymphoblastic Leukemia: A Multicenter Retrospective...

Area of Science:

• Pediatric Anesthesiology
• Oncology
• Pharmacology

Background:

• Sedation is vital for managing pain and anxiety during lumbar punctures (LPs) in pediatric patients with acute lymphoblastic leukemia (ALL).
• Concerns exist regarding potential long-term neurocognitive effects of repeated sedative exposures in young children.
• Understanding current sedation practices for LPs in ALL patients is crucial.

Purpose of the Study:

• To investigate and document the sedation practices for lumbar punctures (LPs) in pediatric patients diagnosed with acute lymphoblastic leukemia (ALL).
• To identify variations in anesthetic techniques and drug choices across multiple institutions.

Main Methods:

• A retrospective analysis of data from 48 hospitals within the Pediatric Health Information Systems (PHIS) database.
• Inclusion criteria: pediatric patients (1-18 years) with ALL receiving outpatient intrathecal chemotherapy between October 2015 and December 2019.
• Analysis focused on the prevalence and types of anesthetic agents utilized for LPs.

Main Results:

• Intravenous and inhaled anesthetics were predominantly used (98.2%) for LPs, with local anesthetics used in only 1.8% of cases.
• The most frequently administered sedatives included propofol (79.1%), midazolam (25.2%), inhaled fluranes (18.9%), and ketamine (12.5%).

Conclusions:

• Most children's hospitals in the U.S. employ intravenous and inhaled anesthetics for routine therapeutic LPs in pediatric ALL patients.
• Propofol emerges as a leading agent for sedation in this patient population.