Safe and effective sedation and analgesia for bone marrow aspiration procedures in children with alfentanil, remifentanil and combinations with midazolam

Paediatr Anaesth. 2005 Mar;15(3):214-9. doi: 10.1111/j.1460-9592.2004.01411.x.

Abstract

Background: Invasive procedures such as bone marrow aspiration in children may be painful and cause anxiety. We investigated the efficacy and safety of remifentanil (R) alfentanil (A), remifentanil-midazolam (RM), and alfentanil-midazolam (AM) combinations in providing analgesia and sedation for bone marrow aspiration.

Methods: Eighty children undergoing a diagnostic bone marrow aspiration whose ages ranged from 5-16 years (mean 9.20 +/- 3.00 years) were enrolled in this study. The patients were randomly assigned to one of 4 treatment groups. Vital signs, sedation and pain scores, somatic responses (sweating and tears) were recorded before, during bone marrow aspiration and after 5 and 15 min of the procedure.

Results: There were no statistical differences between sedation and the CHEOPS scores of the four groups during and after the procedures. The VAS scores were significantly higher for group A compared with groups R and RM during the procedure (P < 0.008). There were no differences between the VAS scores in group AM compared with groups R and RM (P > 0.008). There were also no statistical differences among the VAS scores of four groups after the procedure (P > 0.008). All patients had adequate sedation and analgesia. None of the patients in the study had deep sedation, hypotension, bradycardia, hypoxemia, or respiratory depression.

Conclusions: Remifentanil, alfentanil, remifentanil-midazolam, and alfentanil-midazolam combinations are effective in children and can be used safely in bone marrow aspiration which is a brief but painful procedure performed in the pediatric patient group.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Alfentanil*
  • Analgesia*
  • Anesthetics, Intravenous*
  • Bone Marrow Examination / methods*
  • Child
  • Child, Preschool
  • Conscious Sedation*
  • Female
  • Hemodynamics / drug effects
  • Humans
  • Hypnotics and Sedatives*
  • Male
  • Midazolam*
  • Pain Measurement
  • Piperidines*
  • Prospective Studies
  • Remifentanil

Substances

  • Anesthetics, Intravenous
  • Hypnotics and Sedatives
  • Piperidines
  • Alfentanil
  • Remifentanil
  • Midazolam