title: A survey of procedural sedation and analgesia practices in pediatric oncology centers in India.
abstract: OBJECTIVE
  Repeated lumbar punctures (LP) and bone marrow aspirations (BMA) are part of childhood cancer management. Adequate sedation and analgesia for these procedures in a safe environment is desirable. We evaluate current practice related to this in pediatric oncology centers in India.
  
  
  METHODS
  Clinicians attending the 2nd Annual India Pediatric Oncology Initiative meeting at New Delhi in February 2010 were invited to complete a questionnaire. Questionnaires were also sent by email to the remaining major pediatric oncology centers not represented at the meeting. Responses for LP and BMA were separately collated and variability by type of hospital and patient caseload was assessed.
  
  
  RESULTS
  Responses were obtained from 26 of 32 centers (81%) approached. A median of 3 personnel (mostly pediatric residents and nurses) were present during the procedures. Some form of sedation and analgesia was used for LP and BMA in 88.5% and 100% centers respectively. However, use of systemic sedation and analgesia (usually midazolam +/- ketamine) for LP and BMA in ≥75% patients was seen in 47.8% and 61.6% centers respectively. General anesthesia was not used in any center. Additional restraint was commonly used and its use was significantly more in public hospitals (p = 0.01). Monitoring was usually done by observation of vital signs, with use of pulse-oximetry in less than half of the centers.
  
  
  CONCLUSIONS
  There is varied use of sedation and analgesia for LP and BMA in pediatric oncology centers in India. Further research is needed to identify the reasons for this. Availability of resources is likely to be a factor.
authors.affiliation: Department of Pediatric Oncology, Alder Hey Hospital, Liverpool, UK. childhoodcancer@gmail.com
authors.forename: Ramandeep Singh
authors.initials: RS
authors.lastname: Arora
authors.forename: Ketan P
authors.initials: KP
authors.lastname: Kulkarni
authors.forename: Robert D
authors.initials: RD
authors.lastname: Alston
mesh_terms: D000698:Analgesia / Q000379:methods*; D001855:Bone Marrow Diseases / Q000175:diagnosis; D002173:Cancer Care Facilities; D016292:Procedural Sedation / Q000379:methods*; D006801:Humans; D007194:India; D008991:Monitoring, Physiologic; D059408:Pain Management; D010372:Pediatrics / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013129:Spinal Puncture