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Published on: January 17, 2011
Intravenous methohexital for brief sedation of pediatric oncology outpatients: physiologic and behavioral responses
D R Freyer1, A E Schwanda, D J Sanfilippo
1Division of Pediatric Hematology/Oncology, DeVos Children's Hospital, 100 Michigan NE, Grand Rapids, MI 49503, USA.
Objective:
In this successor to a preliminary retrospective study, we sought to confirm the apparent safety and efficacy of intravenous methohexital (MHX) for brief, unconscious sedation of pediatric hematology/oncology outpatients undergoing painful, invasive procedures.
Methods:
This prospective study was conducted in a children's hospital-based hematology/oncology clinic. Following published monitoring guidelines for deep pediatric sedation, MHX (1.0 mg/kg) was administered immediately before each procedure, 1% xylocaine was given locally, and additional MHX was titrated to maintain minimal response to pain during the procedure. For each patient, the procedural and physiologic response data reported below were recorded from the onset of sedation through recovery. Behavioral distress responses were measured using a standardized pediatric observational tool (Procedure Behavioral Checklist).
Results:
Two hundred and thirty-three procedures were carried out in 76 patients ranging .1 to 19.6 years of age. The mean cumulative MHX dose/procedure was 4.6 +/- 2.9 mg/kg. The mean lengths of time from initiation of sedation until completion of the invasive procedure, attainment of patient arousability, discontinuation of monitoring, and attainment of patient alertness were 8 +/- 5, 19 +/- 8, 19 +/- 9, and 22 +/- 9 minutes, respectively. Relative to presedation values, mean arterial pressure (MAP), heart rate, and respiratory rate showed maximum mean percent changes of -16.6, +17.8, and +13.4, respectively (all clinically insignificant). Complications among procedures were transient and included hiccoughs and myoclonus (each 10%); oropharyngeal secretions (6%); and pain at the injection site, emergence phenomena, and mild stridor (each
Conclusion:
MHX appropriately administered provides sedation which is effective, safe, well tolerated, and of short duration, making MHX attractive for use in pediatric oncology outpatients and other populations with similar sedation needs.
Insights
Intravenous methohexital (MHX) provides safe and effective brief sedation for pediatric oncology outpatients undergoing painful procedures. This method ensures minimal patient distress and rapid recovery, making it ideal for this population.
Area of Science:
- Pediatric Anesthesiology
- Oncology Supportive Care
Background:
- Brief, unconscious sedation is crucial for pediatric hematology/oncology outpatients undergoing invasive procedures.
- Previous studies suggested methohexital (MHX) as a potentially safe and effective option.
Purpose of the Study:
- To confirm the safety and efficacy of intravenous methohexital (MHX) for brief, unconscious sedation in pediatric hematology/oncology outpatients.
- To evaluate MHX's effectiveness in managing pain and distress during invasive procedures.
Main Methods:
- A prospective study involving 76 pediatric patients undergoing 233 procedures in a children's hospital clinic.
- Intravenous MHX (1.0 mg/kg) administered pre-procedure, with local xylocaine and titrated MHX for pain management.
- Physiological parameters and behavioral distress (using Procedure Behavioral Checklist) were monitored.
Main Results:
- MHX sedation was effective, with 92% of assessed procedures showing absent to mild pain responses.
- Physiological changes (MAP, heart rate, respiratory rate) were clinically insignificant.
- Transient complications occurred, with no procedures requiring intubation or early termination.
Conclusions:
- Intravenous methohexital provides effective, safe, and well-tolerated sedation of short duration.
- MHX is an attractive option for pediatric oncology outpatients needing procedural sedation.
- The findings support MHX's utility in similar patient populations with comparable sedation requirements.
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