Moderate intravenous sedation with fentanyl and midazolam for invasive procedures in children with acute lymphoblastic leukemia

Abstract

Data were collected prospectively on 100 consecutive invasive procedures, that is, lumbar and bone marrow punctures (alone or in combination), in 16 patients less than 21 years of age with acute lymphoblastic leukemia (ALL). Efficacy of sedation and the need for restraint were graded according to 2 multiple-point scales. All invasive procedures were successfully performed. Oxygen by face mask was needed in 5 cases, whereas no patient required sedation reversal; 92% of the time, the patient was calm, cooperative, and responding to verbal commands, whereas in 97 procedures, there was no or only minimal patient movement that did not interfere with the completion of the procedure. Inpatient administration of midazolam and fentanyl by trained pediatric providers is safe and effective for invasive procedures in children and adolescents with ALL. © 2009 by Association of Pediatric Hematology/Oncology Nurses.