Lumbar puncture in pediatric oncology: conscious sedation vs. general anesthesia.
BACKGROUND
Lumbar punctures (LP) generally have been performed with conscious sedation (CS) but are increasingly performed using general anesthesia (GA) owing to the belief that this is less distressing. The aim of this study was to compare these two methods concerning distress, discomfort, pain, well-being and security after the LP, and problems with the LP.


METHODS
Twenty-five children with cancer participated in this prospective, randomized, crossover study. Children, parents, and nurses completed a visual analogue scale questionnaire to evaluate the efficacy of CS and GA. In addition, sedation and anesthesia protocols were reviewed.


RESULTS
The two methods seemed to be equivalent concerning distress, discomfort, pain, well-being and security after the procedure, and procedure problems. Most children (80%), parents (66%), and nurses (58%) preferred LP in CS. However, the LP was not performed in CS in five cases because the child did not cooperate. Younger children less often preferred CS.


CONCLUSIONS
Outcomes for CS and GA in LP were similar. Although there were failures with the CS model, most preferred it to GA. LP in CS also saved time and medical resources. An alternative approach would be to have a pediatric anesthesiologist available at the oncology ward for these elective LPs to provide the sedation or anesthesia required by each individual.
Unit for Pediatric Hematology and Oncology, Department of Women's and Children's Health, Uppsala University Children's Hospital, Sweden. gustaf.ljungman@pediatrik.uu.se
G
G
Ljungman
T
T
Gordh
S
S
Sörensen
A
A
Kreuger
D000293:Adolescent; D000768:Anesthesia, General; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001007:Anxiety / Q000517:prevention & control; D002648:Child; D002673:Child, Hospitalized / Q000523:psychology*; D002675:Child, Preschool; D016292:Procedural Sedation; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007223:Infant; D007278:Injections, Spinal; D007938:Leukemia / Q000188:drug therapy; D008223:Lymphoma / Q000188:drug therapy; D008297:Male; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D011446:Prospective Studies; D013129:Spinal Puncture; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000970:Antineoplastic Agents