Efficacy and safety of procedural sedation and analgesia by paediatric intensivist in paediatric oncology unit.

Children with cancer especially acute leukaemia undergo multiple painful procedures like bone marrow biopsy (BM) and lumber puncture (LP) for intrathecal chemotherapy during their first year of treatment. The purpose of this study is to report safety and efficacy of Procedural Sedation and Analgesia (PSA) by paediatric intensivist for oncology procedures in controlled setting in paediatric oncology unit. During 20 months, 124 children received PSA for 499 procedures. 324 LP alone, 175 BM alone and 40 combined LP and BM were done. The most common diagnosis was acute leukaemia and lymphoma. All procedures were in compliance with American Society of Anaesthesiology guidelines. A small-dose of ketamine and intermittent doses of propofol was administered intravenously until needed. No procedure was aborted due to sedation. All patients tolerated the procedure well without any major adverse events. There were few transient respiratory adverse events which resolved with minor interventions. PSA for children undergoing oncology procedures, can safely and effectively be provided by paediatric intensivist in controlled setting by using a standardized sedation protocol outside the operating room.