title: Invasive procedures carried out in conscious children: contrast between North American and European paediatric oncology centres.
abstract: OBJECTIVE
  To define practice in managing repeated invasive procedures in selected paediatric oncology centres in North America and Europe, especially the United Kingdom; to define and contrast concerns that shape policy making, and to contrast practice, particularly regarding procedures performed on conscious patients.
  
  
  METHODS
  Postal survey: 118 centres of the Pediatric Oncology Group and the United Kingdom Children's Cancer Study Group received questionnaires.
  
  
  RESULTS
  68 questionnaires (58%) were returned (52 from North America, 12 from Europe). For all procedures, North American centres tended to use less effective techniques than European, especially for bone marrow procedures. Many North American centres reported performing these on conscious patients on at least three quarters (25%) or half (30%) the occasions. In contrast, corresponding figures for the European centres were 6% and 0%.
  
  
  CONCLUSIONS
  Many bone marrow procedures are still carried out in the conscious patient despite the safety and effectiveness of modern anaesthetic and deep sedation techniques. There appears to be a greater reluctance to offer these to patients in North American centres than in European ones. This may reflect a misperception that the risks of adverse effects are high. Several non-pharmacological techniques are used, but they remain uncommon.
authors: Paediatric Palliative Care, University of Wales College of Medicine, Llandough Hospital, Penarth CF64 2XX, UK. hainrd@cardiff.ac.uk
authors: R D
authors: RD
authors: Hain
authors: C
authors: C
authors: Campbell
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects / Q000706:statistics & numerical data*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001856:Bone Marrow Examination / Q000379:methods; D002648:Child; D016292:Procedural Sedation / Q000009:adverse effects / Q000706:statistics & numerical data*; D005060:Europe; D019538:Health Care Surveys; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis*; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010818:Practice Patterns, Physicians'; D016896:Treatment Outcome; D014481:United States