Bone marrow aspiration/biopsy (BMA) and lumbar puncture with intrathecal chemotherapy administration (LP) are procedures of short duration but cause pain and anxiety and must be repeated during cancer treatment. Propofol produces a rapid onset of anesthesia and has a short duration of action, making it an ideal agent to facilitate such procedures. We prospectively evaluated our experience with propofol anesthesia in patients undergoing BMA and LP in our Pediatric Intensive Care Unit (PICU). Nineteen patients underwent 24 procedures (7 BMA, 16 LP, 1 both) during a 3 month period. All procedures (21 in outpatients, 3 in ward patients) were performed in the PICU with full cardiorespiratory monitoring. Thirteen patients had an established diagnosis of ALL and 6 patients had suspected malignancies. Patient age was 83.5 ± 55.3 months (7-253 mo). Propofol induction dose was 2.1 ± 0.9 mg/kg (1.0-4.3 mg/kg) and total dose was 6.7 ± 2.7 mg/kg (2.7-12.9 mg/kg). Induction time was 87 ± 42 seconds (30-175 sec), recovery time was 18.2 ± 11.5 minutes (2-45 min), and length of stay was 84 ± 21 minutes (58-132 min). Systolic blood pressure decreased by 27 ± 11%(6-46%) during the procedure, and a systolic blood pressure less than the fifth percentile for age was recorded in 67% of cases, with IV crystalloid (12± 12 ml/kg, 2.9-38.6 ml/kg) administered in 7 cases. No prolonged hypotension or associated sequelae were noted. The development of hypotension was not associated with the induction or total propofol dose (p > 0.05) but was associated with older age (p = 0.02). 21% of cases (2 BMA, 3 LP) developed partial airway obstruction necessitating airway positioning maneuvers. The need for airway positioning was not associated with propofol induction or total dose or patient age (p > 0.05). No apnea, hypoxemia, or need for assisted ventilation occurred. No patient reported recall of the procedure. All procedures were successful. The oncologist subjectively found the procedure to be more quickly and easily completed when propofol anesthesia was employed compared to when agents producing conscious or deep sedation were used.
Propofol anesthesia in the PICU setting successfully facilitates BMA and LP in pediatric oncology patients and is well tolerated. Since transient hypotension and partial airway obstruction occur unpredictably, close monitoring of cardiorespiratory function and the means for rapid therapeutic intervention is essential.
