Safety and efficacy of sedation for pediatric patients with cancer and developmental disabilities.

BACKGROUND

Children with developmental disabilities (DDs) tend to have more fear of loud noises and needles than those without. However, how DDs affect sedation during painful procedures in pediatric patients with cancer is unclear. This study aimed to evaluate the sedative doses and adverse events (AEs) associated with sedation using a combination of midazolam and ketamine for bone marrow aspiration and intrathecal therapy.

METHODS

The AEs evaluated included hypoxia, vomiting, tremors, excitement, disturbances, apnea, and bradycardia. The study included seven participants with autism spectrum disorder, attention deficit hyperactivity disorder, and specific learning disorders, alongside 30 control participants without DD. The types of cancers included acute lymphoblastic leukemia, acute myeloid leukemia, and diffuse large B-cell lymphoma. A total of 107 procedures were performed in the DD group and 378 in the control group.

RESULTS

There were no significant differences in the sedative doses and AEs between patients with DD and controls, except for increased tremors after sedation in the DD group.

CONCLUSIONS

Sedation using a combination of midazolam and ketamine can be safely performed for painful procedures in pediatric patients with cancer and DD without excessive concern.