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Invasive procedures still performed on conscious children despite new anaesthetic techniques

June 19, 2001

Many invasive bone marrow procedures are still carried out in conscious children despite the safety and effectiveness of modern anaesthetic and deep sedation techniques, finds a study in Archives of Disease in Childhood. The findings also show a striking difference between the North American and European approaches to managing painful procedures in children with cancer.

The research team surveyed 118 children's cancer centres in North America and Europe about their approaches towards managing painful procedures. They found that North American centres tended to use less effective techniques than European, especially for bone marrow procedures.

Furthermore, a much larger proportion of centres in North America reported still performing these procedures on conscious patients. Nearly one third of centres used neither general anaesthetic nor deep sedation for the majority of bone marrow procedures. Over a quarter of North American centres, but no European ones, reported using nothing or topical anaesthetic alone.

A move away from performing bone marrow procedures on conscious patients has long been anticipated, but appears to be happening slowly, say the authors. The reason for this reluctance is unclear, but it may reflect a misperception that the risks of adverse effects are high, or be related to practical difficulties in obtaining anaesthetic support, they conclude.


British Medical Journal (BMJ)