Safety of Deep Sedation with General Anesthesia for Minor Invasive Procedures in Pediatric Hematology/Oncology Patients

Background: Multiple invasive procedures are routinely performed in diagnosis and treatment of hematologic/oncologic diseases. Because these procedures are painful, they may cause stress and anxiety in patients and their parents. Especially in patients with malignancies, the repeating procedures can lead to psychiatric disorders like depression and post-traumatic stress disorders. Therefore, general anesthesia is recommended during these invasive procedures for pain control. Objectives: The goal of this study was to evaluate safety and outcome of deep sedation with general anesthesia in hematology/oncology patients during invasive interventions in pediatric outpatient sedation unit. Methods: We retrospectively analyzed records of 129 patients (59 girls and 70 boys) who had undergone 155 invasive procedures with general anesthesia. Patient demographics, reason of operations, anesthesia complications, duration of procedures, and time for recovery from anesthesia were recorded from anesthesia charts. Patients received ketamine (maximum dosage 2 mg/kg) plus midazolam, ketamine plus midazolam plus sevoflurane inhaler (sevoflurane inhaler was added when 2 mg/kg of ketamine was inadequate to obtain deep sedation) and sevoflurane inhaler in 140, 10 and 5 of operations, respectively. Results: Complications occurred in 31 (20%) of these operations. Majority of complications were mild and included post-op agitation, vomiting and local pain which occurred in 6, 5 and 4 of the operations, respectively. Only 2 patients developed severe complications (fall off the stretcher and bronchospasm) which did not lead to any long term morbidity. The complication rate did not differ according to the anesthetic drugs, reason of operations or patient demographics. Conclusions: In this group of patients, deep sedation with general anesthesia in an outpatient sedation unit, administered by trained professionals, was safe, quick, and effective for short-term invasive painful procedures.