Propofol/alfentanil and propofol/ketamine procedural sedation in children with acute lymphoblastic leukaemia: safety, efficacy and their correlation with pain neuromediator expression
A. CHIARETTI md
Paediatric Intensive Care Unit, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome
Search for more papers by this authorCorresponding Author
A. RUGGIERO md
Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome Italy
Antonio Ruggiero, Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome, Italy (e-mail: [email protected]). Search for more papers by this authorG. BARONE md
Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome Italy
Search for more papers by this authorA. ANTONELLI phd, professor
Paediatric Intensive Care Unit, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome
Search for more papers by this authorI. LAZZARESCHI md
Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome Italy
Search for more papers by this authorO. GENOVESE md
Paediatric Intensive Care Unit, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome
Search for more papers by this authorS. PAIANO md
Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome Italy
Search for more papers by this authorM. SAMMARTINO md
Department of Anaesthesia, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome
Search for more papers by this authorP. MAURIZI md
Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome Italy
Search for more papers by this authorR. RICCARDI md, professor
Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome Italy
Search for more papers by this authorA. CHIARETTI md
Paediatric Intensive Care Unit, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome
Search for more papers by this authorCorresponding Author
A. RUGGIERO md
Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome Italy
Antonio Ruggiero, Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome, Italy (e-mail: [email protected]). Search for more papers by this authorG. BARONE md
Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome Italy
Search for more papers by this authorA. ANTONELLI phd, professor
Paediatric Intensive Care Unit, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome
Search for more papers by this authorI. LAZZARESCHI md
Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome Italy
Search for more papers by this authorO. GENOVESE md
Paediatric Intensive Care Unit, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome
Search for more papers by this authorS. PAIANO md
Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome Italy
Search for more papers by this authorM. SAMMARTINO md
Department of Anaesthesia, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome
Search for more papers by this authorP. MAURIZI md
Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome Italy
Search for more papers by this authorR. RICCARDI md, professor
Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome Italy
Search for more papers by this authorAbstract
CHIARETTI A., RUGGIERO A., BARONE G., ANTONELLI A., LAZZARESCHI I., GENOVESE O., PAIANO S., SAMMARTINO M., MAURIZI P. & RICCARDI R. (2010) European Journal of Cancer Care19, 212–220Propofol/alfentanil and propofol/ketamine procedural sedation in children with acute lymphoblastic leukaemia: safety, efficacy and their correlation with pain neuromediator expression
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.
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