Reducing sedated lumbar punctures in pediatric patients with acute lymphoblastic leukemia

Background Sedation for lumbar punctures (LPs) in pediatric acute lymphoblastic leukemia (ALL) patients has been the standard for decades to reduce pain and anxiety. Recent studies on the potential long‐term neurocognitive effects of cumulative propofol exposure have raised concerns about this pract...

Full description

Saved in:
Bibliographic Details
Published in:Pediatric blood & cancer 2021-11, Vol.68 (11), p.e29272-n/a
Main Authors: Waters, Torin W., Dickens, David S.
Format: Article
Language:English
Subjects:
Acute lymphoblastic leukemia
Anesthesia
Cognition
COVID-19
Diagnostic tests
Hematology
Leukemia
lumbar puncture
Lymphatic leukemia
Oncology
Pandemics
Patients
pediatric ALL
Pediatrics
Propofol
Quality control
sedation
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background Sedation for lumbar punctures (LPs) in pediatric acute lymphoblastic leukemia (ALL) patients has been the standard for decades to reduce pain and anxiety. Recent studies on the potential long‐term neurocognitive effects of cumulative propofol exposure have raised concerns about this practice. The recent pandemic introduced additional burdens to patients, with the requirement of a negative COVID‐19 test prior to each sedated procedure. Procedure These factors prompted a quality improvement intervention at our institution where we aimed to reduce postinduction sedated LPs by 50%. Our intervention included patient and family education, followed by a simulation of the procedure for selected patients. Those converted to unsedated LPs were queried for their preference. Comparative cost, clinical time, and LP success rates were collected for sedated and unsedated LPs. Results Following the intervention, the percentage of LPs performed with sedation dropped from 100% to 48%. All LPs were successful using both techniques. Most patients who experienced the unsedated LP technique, and their guardians, strongly preferred this approach. Unsedated LPs significantly reduced clinical time (169 vs. 83 minutes) for families, decreased expenditures ($5736 reduction per procedure), and improved institutional opportunity cost due to a decrease in last‐minute cancelations. Conclusion We have shown that it is feasible to significantly reduce the use of sedation for LPs in patients with ALL, which has the potential to improve health and patient experience at a lower cost.
ISSN:1545-5009
1545-5017
DOI:10.1002/pbc.29272