title: Safe and effective sedation and analgesia for bone marrow aspiration procedures in children with alfentanil, remifentanil and combinations with midazolam.
abstract: BACKGROUND
  Invasive procedures such as bone marrow aspiration in children may be painful and cause anxiety. We investigated the efficacy and safety of remifentanil (R) alfentanil (A), remifentanil-midazolam (RM), and alfentanil-midazolam (AM) combinations in providing analgesia and sedation for bone marrow aspiration.
  
  
  METHODS
  Eighty children undergoing a diagnostic bone marrow aspiration whose ages ranged from 5-16 years (mean 9.20 +/- 3.00 years) were enrolled in this study. The patients were randomly assigned to one of 4 treatment groups. Vital signs, sedation and pain scores, somatic responses (sweating and tears) were recorded before, during bone marrow aspiration and after 5 and 15 min of the procedure.
  
  
  RESULTS
  There were no statistical differences between sedation and the CHEOPS scores of the four groups during and after the procedures. The VAS scores were significantly higher for group A compared with groups R and RM during the procedure (P < 0.008). There were no differences between the VAS scores in group AM compared with groups R and RM (P > 0.008). There were also no statistical differences among the VAS scores of four groups after the procedure (P > 0.008). All patients had adequate sedation and analgesia. None of the patients in the study had deep sedation, hypotension, bradycardia, hypoxemia, or respiratory depression.
  
  
  CONCLUSIONS
  Remifentanil, alfentanil, remifentanil-midazolam, and alfentanil-midazolam combinations are effective in children and can be used safely in bone marrow aspiration which is a brief but painful procedure performed in the pediatric patient group.
authors.affiliation: Department of Pediatric Hematology, Cukurova University, Faculty of Medicine, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Antmen
authors.forename: Ilgen
authors.initials: I
authors.lastname: Saşmaz
authors.forename: Handan
authors.initials: H
authors.lastname: Birbiçer
authors.forename: Hayri
authors.initials: H
authors.lastname: Ozbek
authors.forename: Refik
authors.initials: R
authors.lastname: Burgut
authors.forename: Geylan
authors.initials: G
authors.lastname: Işik
authors.forename: Yurdanur
authors.initials: Y
authors.lastname: Kilinç
mesh_terms: D000293:Adolescent; D015760:Alfentanil; D000698:Analgesia; D018686:Anesthetics, Intravenous; D001856:Bone Marrow Examination / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008874:Midazolam; D010147:Pain Measurement; D010880:Piperidines; D011446:Prospective Studies; D000077208:Remifentanil
chemical_list: D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D010880:Piperidines; D015760:Alfentanil; D000077208:Remifentanil; D008874:Midazolam