title: The role of midazolam-induced sedation in bone marrow aspiration/trephine biopsies.
abstract: This study was undertaken in 102 adult patients to evaluate the safety and efficacy of intravenous (i.v.) midazolam in the setting of bone marrow aspiration and trephine biopsy (BMAT). Combined local anaesthetic (LA) and sedation was used in 87% of patients and 13% received LA alone. Amnesia occurred in all sedated patients with only 9% experiencing a mild degree of post-procedure pain. This contrasted sharply with the non-sedated group, in whom 85% had intense pain during the biopsy followed by protracted local discomfort in approximately 54%. Drowsiness and some psychomotor impairment were the only notable sedation-related side-effects in approximately 20%. None required assisted ventilation. There was a resounding patient preference for BMAT with sedation. Considering the ease of use, safety and efficacy of i.v. midazolam, the availability of flumazenil as a reversal agent and the undoubted positive effects on quality of life, we would advocate using it in BMAT provided that there were no contraindications.
authors.affiliation: Department of Haematology, Royal United Hospital, NHS Trust, Bath, UK.
authors.forename: C J
authors.initials: CJ
authors.lastname: Mainwaring
authors.forename: C
authors.initials: C
authors.lastname: Wong
authors.forename: R J
authors.initials: RJ
authors.lastname: Lush
authors.forename: J G
authors.initials: JG
authors.lastname: Smith
authors.forename: C R
authors.initials: CR
authors.lastname: Singer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000627:therapeutic use; D000931:Antidotes / Q000627:therapeutic use; D001364:Awareness / Q000187:drug effects; D001853:Bone Marrow / Q000473:pathology* / Q000601:surgery; D016292:Procedural Sedation; D000075202:Contraindications; D005260:Female; D005442:Flumazenil / Q000627:therapeutic use; D006261:Headache / Q000139:chemically induced; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008874:Midazolam / Q000627:therapeutic use*; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D010146:Pain / Q000139:chemically induced / Q000601:surgery; D012131:Respiratory Insufficiency / Q000139:chemically induced; D012640:Seizures / Q000139:chemically induced; D012894:Sleep Stages / Q000187:drug effects; D014207:Trephining
chemical_list: D000779:Anesthetics, Local; D000931:Antidotes; D006993:Hypnotics and Sedatives; D005442:Flumazenil; D008874:Midazolam