title: Safe lumbar puncture under analgo-sedation in children with acute lymphoblastic leukemia.
abstract: BACKGROUND
  Children with acute lymphoblastic leukemia (ALL) undergo multiple lumbar punctures (LPs) during their course of treatment for diagnostic and therapeutic purposes. LP is a stressful and painful procedure, affecting the quality of life of these children. Procedural analgo-sedation might improve the child's comfort and prevent the child's movements, reducing the risk of traumatic lumbar puncture with blasts (TLP+), mainly at diagnosis, when higher numbers of blast cells are circulating in the peripheral blood. The aim of this study was to evaluate the safety and efficacy of procedural analgo-sedation in children with ALL.
  
  
  METHODS
  From September 2006 to November 2008, we performed a total of 252 lumbar punctures under deep sedation with propofol and ketamine in 25 children with ALL treated at our division. During the procedures, vital parameters were monitored and side effects were recorded. The efficacy of deep sedation was evaluated using Ramsay and Children's Hospital Eastern Ontario Pain scales. Cerebrospinal fluid was collected for chemical and cytological examinations.
  
  
  RESULTS
  In all patients a satisfactory sedation and analgesia were achieved. The evaluation of vital parameters did not show any significant variation compared to baseline values. No side effects were recorded. Only 3 (1.2 %) of 252 lumbar punctures resulted in traumatic effects.
  
  
  CONCLUSIONS
  To strongly improve comfort and quality of life of children with ALL and reduce the risk of TLP+ mainly at diagnosis, we recommend performing the lumbar punctures under analgo-sedation because it is a safe and effective procedure.
authors: Department of Pediatric Oncology, "A. Gemelli" Hospital, UCSC, Catholic University of Rome, Largo A Gemelli, 8, 00168, Rome, Italy.
authors: Palma
authors: P
authors: Maurizi
authors: Ida
authors: I
authors: Russo
authors: Daniela
authors: D
authors: Rizzo
authors: Antonio
authors: A
authors: Chiaretti
authors: Paola
authors: P
authors: Coccia
authors: Giorgio
authors: G
authors: Attinà
authors: Antonio
authors: A
authors: Ruggiero
authors: Riccardo
authors: R
authors: Riccardi
mesh_terms: D000293:Adolescent; D002490:Central Nervous System / Q000187:drug effects* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D054810:Deep Sedation; D005260:Female; D006801:Humans; D007223:Infant; D007278:Injections, Spinal; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000473:pathology; D010147:Pain Measurement; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000473:pathology; D015742:Propofol / Q000008:administration & dosage; D013129:Spinal Puncture
chemical_list: D015742:Propofol
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