Pediatric blood & cancer · 2026
Procedural Sedation outside the Operating Room in Pediatric Hematopoietic Stem Cell Transplant Patients.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Xiao Heather, Schoettler Michelle L, Huang Hui, He Zhulin, Gilbertson Laura, Kamat Pradip P, Burger Rebecca Kris
Аннотация
OBJECTIVE: Patients with hematopoietic stem cell transplant (HCT) frequently require procedural sedation (PS) or anesthesia for diagnostic and therapeutic procedures. They often have comorbidities that may increase the risk of sedation-related adverse events (AEs). The study objective was to compare the incidence of AEs and interventions during PS performed outside the operating room (OR) in patients pre- and post-HCT.
PATIENTS AND METHODS: Single-center, retrospective, case-control study of all patients with HCT who had PS outside the OR between 2015 and 2025.
RESULTS: A total of 118 patients had 332 sedation encounters. The median age was 7.6 years (IQR 3.5-11.9), and 42.4% were female. Procedures included bone marrow biopsy/aspiration (66%), lumbar puncture (9%), magnetic resonance imaging (10.8%), and nuclear medicine imaging (7.8%), with 36.7% undergoing two procedures during a single sedation encounter. A combination of propofol and fentanyl was used in 75.3% of sedation encounters. Hypoxia was the most frequent low-high-risk AE both pre- and post-HCT (11.4% and 20.5%, respectively, p < 0.021). Blow-by oxygen was the most common intervention and was required significantly more frequently post-HCT (10.2% vs. 25.3%, respectively, p < 0.001). Only one sedation failure was noted. There were no cardiac arrests, pulmonary aspiration events, or deaths.
CONCLUSION: PS performed outside the OR was not associated with any critical or high-risk AEs in patients post-HCT compared to patients pre-HCT. Based on this largest study to date, there is an important opportunity to minimize unnecessary exposure to anesthesia and optimize resource allocation in the HCT patient population.
PATIENTS AND METHODS: Single-center, retrospective, case-control study of all patients with HCT who had PS outside the OR between 2015 and 2025.
RESULTS: A total of 118 patients had 332 sedation encounters. The median age was 7.6 years (IQR 3.5-11.9), and 42.4% were female. Procedures included bone marrow biopsy/aspiration (66%), lumbar puncture (9%), magnetic resonance imaging (10.8%), and nuclear medicine imaging (7.8%), with 36.7% undergoing two procedures during a single sedation encounter. A combination of propofol and fentanyl was used in 75.3% of sedation encounters. Hypoxia was the most frequent low-high-risk AE both pre- and post-HCT (11.4% and 20.5%, respectively, p < 0.021). Blow-by oxygen was the most common intervention and was required significantly more frequently post-HCT (10.2% vs. 25.3%, respectively, p < 0.001). Only one sedation failure was noted. There were no cardiac arrests, pulmonary aspiration events, or deaths.
CONCLUSION: PS performed outside the OR was not associated with any critical or high-risk AEs in patients post-HCT compared to patients pre-HCT. Based on this largest study to date, there is an important opportunity to minimize unnecessary exposure to anesthesia and optimize resource allocation in the HCT patient population.