title: Propofol/alfentanil and propofol/ketamine procedural sedation in children with acute lymphoblastic leukaemia: safety, efficacy and their correlation with pain neuromediator expression.
abstract: Invasive procedures, such as the lumbar puncture, can cause anxiety and pain in children undergoing treatment for acute lymphoblastic leukaemia (ALL). We investigated the safety and efficacy of two different protocols for analgo-sedation in 20 children with ALL undergoing lumbar puncture. We have conducted a prospective, cross-over study. Protocol A was composed of an association between propofol and alfentanil. Protocol B consisted in the combination of propofol and ketamine. We also evaluated the levels of nerve growth factor, substance P and enkephalins in the cerebrospinal fluid of these patients. All patients showed a satisfactory sedation and analgesia. We found a statistically significant difference of vital parameters between protocol A and protocol B, while there were no significant differences between sedation scores and the other parameters evaluated. Patients in protocol A showed a higher incidence of major side effects, such as respiratory depression. Pain neuromediator levels did not show any statistical difference between the two groups. This study shows that both protocols are effective to obtain a good sedation and analgesia in children with ALL undergoing lumbar puncture, but the association between propofol and ketamine appears to be safer due to the lower incidence of side effects.
authors.affiliation: Paediatric Intensive Care Unit, A. Gemelli Hospital, Catholic University of Rome, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Chiaretti
authors.forename: A
authors.initials: A
authors.lastname: Ruggiero
authors.forename: G
authors.initials: G
authors.lastname: Barone
authors.forename: A
authors.initials: A
authors.lastname: Antonelli
authors.forename: I
authors.initials: I
authors.lastname: Lazzareschi
authors.forename: O
authors.initials: O
authors.lastname: Genovese
authors.forename: S
authors.initials: S
authors.lastname: Paiano
authors.forename: M
authors.initials: M
authors.lastname: Sammartino
authors.forename: P
authors.initials: P
authors.lastname: Maurizi
authors.forename: R
authors.initials: R
authors.lastname: Riccardi
mesh_terms: D000293:Adolescent; D015760:Alfentanil / Q000008:administration & dosage; D001007:Anxiety / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods; D018592:Cross-Over Studies; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage; D008297:Male; D020932:Nerve Growth Factor / Q000134:cerebrospinal fluid; D010146:Pain / Q000134:cerebrospinal fluid / Q000517:prevention & control; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000134:cerebrospinal fluid / Q000523:psychology / Q000628:therapy*; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D013129:Spinal Puncture / Q000379:methods / Q000523:psychology*; D013373:Substance P / Q000134:cerebrospinal fluid; D016896:Treatment Outcome
chemical_list: D015760:Alfentanil; D013373:Substance P; D007649:Ketamine; D020932:Nerve Growth Factor; D015742:Propofol