Intravenous methohexital for brief sedation of pediatric oncology outpatients: physiologic and behavioral responses.

OBJECTIVE: In this successor to a preliminary retrospective study, we sought to confirm the apparent safety and efficacy of intravenous methohexital (MHX) for brief, unconscious sedation of pediatric hematology/oncology outpatients undergoing painful, invasive procedures. METHODS: This prospective study was conducted in a children's hospital-based hematology/oncology clinic. Following published monitoring guidelines for deep pediatric sedation, MHX (1.0 mg/kg) was administered immediately before each procedure, 1% xylocaine was given locally, and additional MHX was titrated to maintain minimal response to pain during the procedure. For each patient, the procedural and physiologic response data reported below were recorded from the onset of sedation through recovery. Behavioral distress responses were measured using a standardized pediatric observational tool (Procedure Behavioral Checklist). RESULTS: Two hundred and thirty-three procedures were carried out in 76 patients ranging .1 to 19.6 years of age. The mean cumulative MHX dose/procedure was 4.6 +/- 2.9 mg/kg. The mean lengths of time from initiation of sedation until completion of the invasive procedure, attainment of patient arousability, discontinuation of monitoring, and attainment of patient alertness were 8 +/- 5, 19 +/- 8, 19 +/- 9, and 22 +/- 9 minutes, respectively. Relative to presedation values, mean arterial pressure (MAP), heart rate, and respiratory rate showed maximum mean percent changes of -16.6, +17.8, and +13.4, respectively (all clinically insignificant). Complications among procedures were transient and included hiccoughs and myoclonus (each 10%); oropharyngeal secretions (6%); and pain at the injection site, emergence phenomena, and mild stridor (each

Brief unconscious sedation for painful pediatric oncology procedures. Intravenous methohexital with appropriate monitoring is safe and effective.

PURPOSE: We report here our experience in using intravenous methohexital (MHX), an ultrashort-acting barbiturate, for brief unconscious sedation of pediatric oncology outpatients undergoing painful, invasive procedures. METHODS: Following published monitoring guidelines for deep pediatric sedation, 1.0 mg/kg MHX was administered immediately before the procedure, 1% xylocaine was given locally, and MHX was additionally titrated to maintain minimal response to pain during the procedure. Clinical data reported here were gathered retrospectively from permanent medical records. RESULTS: Data reported here represent 132 evaluable consecutive procedures in 33 patients ranging in age from 1.6 to 20.5 years. Patients underwent an average of 4 +/- 3 procedures and received a mean total MHX dose per procedure of 5.8 +/- 2.1 mg/kg. The mean length of time from start of sedation to full arousability was 30 +/- 12 min. Twenty-three (17.4%) procedures were associated with clinically insignificant decreases in diastolic blood pressure or heart rate below resting normal ranges for age. Eight (6.1%) procedures in six patients were associated with minor complications requiring no intervention, such as transient behavioral changes, transient myoclonus, and minimal stridor. Five procedures (3.8%) in five patients required simple suctioning to manage secretions. Only two procedures (1.5%) in two patients required brief bag-mask ventilation plus suctioning for suspected laryngospasm. None required intubation. No differences in clinical features or MHX doses were noted for patients with, as compared to those without, complications. All procedures were completed with a satisfactory level of sedation. CONCLUSIONS: Our experience indicates that MHX, with appropriate monitoring as described here, is a safe and effective agent for use in pediatric oncology outpatient sedation programs.