title: Morbidity and mortality of deep sedation in outpatient bone marrow biopsy.
abstract: Deep sedation is being provided at an increasing rate for patients undergoing bone marrow biopsy and aspiration (BMBA). The aim of this study was to establish the safety of deep sedation used for adults undergoing BMBA. A nonrandomized database analysis and retrospective review of patient records from January 1997 to December 2000 was performed; 5,811 patients were identified as having undergone their first outpatient BMBA. Outcome measures included 30-day mortality and same-day hospital admission; surrogate measures included need for a surgical procedure or receipt of red blood cells within the 48 hr following the BMBA. Patients who received intravenously administered midazolam, fentanyl, and propofol for maintenance of deep sedation plus infiltration of a local anesthetic (n = 2,604; 45%) comprised the deep sedation group; those who received infiltration of a local anesthetic but no intravenous sedation or analgesia (n = 3,207; 55%) comprised the local anesthesia group. Patients in the deep sedation group compared to those in the local anesthesia group were less likely to die within 30 days (0.69% vs. 1.34%, P = 0.018) and less likely to receive red blood cells (1.27% vs. 2.25%, P = 0.006). No other differences between the groups were found. Although the study was retrospective and nonrandomized, the results suggest that the use of deep sedation for outpatient BMBA is as safe as using local anesthesia.
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. burkle.christopher@mayo.edu
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Burkle
authors.forename: Barry A
authors.initials: BA
authors.lastname: Harrison
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Koenig
authors.forename: Paul A
authors.initials: PA
authors.lastname: Decker
authors.forename: David O
authors.initials: DO
authors.lastname: Warner
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Gastineau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D001706:Biopsy / Q000009:adverse effects* / Q000379:methods; D001854:Bone Marrow Cells / Q000166:cytology*; D016292:Procedural Sedation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008499:Medical Records; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D008012:Lidocaine; D008874:Midazolam; D005283:Fentanyl