Many invasive bone marrow procedures are still carried out in conscious children despite the availability of safe and effective modern anaesthetic and deep sedation techniques, a survey has found. A greater proportion of North American centres used less effective pain reducing methods than did comparable centres in Europe.
The study, reported in the journal Archives of Disease in Childhood (2001;85:12-5), consisted of a postal survey of 118 European and North American paediatric oncology centres. Questionnaires were sent to all units in the Pediatric Oncology Group and the United Kingdom Children's Cancer Study Group.
Sixty eight (58%) questionnaires were returned, 52 (out of 96) from North America (46 from the United States and six from Canada) and 16 (out of 22) from Europe (14 from the United Kingdom and one each from the Republic of Ireland and the Netherlands).
"Nearly one-third of North American centres used neither general anaesthetic nor deep sedation for the majority of bone marrow procedures. A significant minority of North American centres considered a local anaesthetic and anxiolytic combination, often with non-pharmacological distraction techniques to be sufficient, while only one centre in Europe did so," the report reported.
"Over a quarter of North American centres, but no European ones, reported using nothing or topical anaesthetic alone," said the authors, Dr Richard Hain of the University of Wales College of Medicine and Craig Campbell of the Children's Hospital of Eastern Ontario, Canada.
The explanation for the apparently greater reluctance on the part of North American centres to offer general anaesthesia "may be a misconception that the risks of adverse effects are high, or be related to practical difficulties in obtaining anaesthetic support," the report said.
In addition to the alternatives given in the questionnaire, nine North American centres reported the use of an opioid and anxiolytic combination.
In a commentary published with the survey results, Sharon Space, Sigmund Kharasch, and Howard Bauchner of Brown University School of Medicine, Boston Medical Centre, said that the limitations of using a questionnaire "are well-known, and include bias introduced by low response rates (58% in this study) as well as the validity of self reported behaviour."
They said that they did not believe that the survey's conclusion that many children in North America underwent bone marrow procedures while conscious and without adequate analgesia was "either accurate or supported by their results."
They acknowledged differences existed between North American and European centres in how adequate analgesia was provided for bone marrow related procedures. They added, however, that the decision about which type of anaesthesia was necessary for invasive medical procedures was "complicated and depends upon many factors... More work will be needed, however, to determine if general anaesthesia is superior to conscious sedation for specific invasive medical procedures."
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