Procedural Sedation outside the Operating Room in Pediatric Hematopoietic Stem Cell Transplant Patients

Patients with hematopoietic stem cell transplant (HCT) frequently require procedural sedation (PS) or anesthesia for diagnostic and therapeutic procedures. They often have comorbidities that may increase the risk of sedation-related adverse events (AEs). The study objective was to compare the incidence of AEs and interventions during PS performed outside the operating room (OR) in patients pre- and post-HCT.

Single-center, retrospective, case-control study of all patients with HCT who had PS outside the OR between 2015 and 2025.

A total of 118 patients had 332 sedation encounters. The median age was 7.6 years (IQR 3.5-11.9), and 42.4% were female. Procedures included bone marrow biopsy/aspiration (66%), lumbar puncture (9%), magnetic resonance imaging (10.8%), and nuclear medicine imaging (7.8%), with 36.7% undergoing two procedures during a single sedation encounter. A combination of propofol and fentanyl was used in 75.3% of sedation encounters. Hypoxia was the most frequent low-high-risk AE both pre- and post-HCT (11.4% and 20.5%, respectively, p < 0.021). Blow-by oxygen was the most common intervention and was required significantly more frequently post-HCT (10.2% vs. 25.3%, respectively, p < 0.001). Only one sedation failure was noted. There were no cardiac arrests, pulmonary aspiration events, or deaths.

PS performed outside the OR was not associated with any critical or high-risk AEs in patients post-HCT compared to patients pre-HCT. Based on this largest study to date, there is an important opportunity to minimize unnecessary exposure to anesthesia and optimize resource allocation in the HCT patient population.