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Sedation Practices for Lumbar Punctures in Patients With Acute Lymphoblastic Leukemia: A Multicenter Retrospective
Mariah L Wright1, Sarah H O'Brien2, Brian Schloss3
1Departments of Pediatrics.
Insights
Pediatric hospitals commonly use intravenous and inhaled anesthetics for lumbar punctures in children with acute lymphoblastic leukemia (ALL). Propofol is a frequent choice for sedation during these procedures.
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.
Background:
Sedation is often used to reduce pain and anxiety in pediatric patients with acute lymphoblastic leukemia (ALL) undergoing lumbar punctures (LPs). There is a potential for long-term effects on neurocognition with repeat sedative exposures in young children. The purpose of this study is to determine the practice habits regarding sedation for LPs in pediatric patients with ALL among multiple institutions.
Methods:
This is a retrospective study of 48 hospitals in the Pediatric Health Information Systems (PHIS) between October 2015 and December 2019. Children 1 to 18 years old with ALL who received intrathecal chemotherapy in an outpatient setting were included. We analyzed the prevalence of anesthesia usage and the types of anesthetics used.
Results:
Of the 16,785 encounters with documented use of anesthetic medications, intravenous and inhaled anesthetics were used in 16,486 (98.2%) and local anesthetics alone in 299 (1.8%). The most commonly used medications used for sedation were propofol (n=13,279; 79.1%), midazolam (n=4228; 25.2%), inhaled fluranes (n=3169; 18.9%), and ketamine (n=2100; 12.5%).
Conclusion:
The majority of children's hospitals in the United States use intravenous and inhaled anesthetics for routine therapeutic LPs in pediatric patients with ALL. Propofol is one of the most common medications used for sedation.
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