| Primary Author: | Olga Taylor, MPH |
| Co-Principal Investigators/Collaborators: | Kathy McCarthy, Quinn Franklin, Chrystal U. Louis, Laura Torres, Marilyn J. Hockenberry |
| Organization: | Baylor College of Medicine, Section of Pediatrics |
Abstract
Background
Children with cancer experience repeated invasive and painful medical procedures. Pain and distress does not decrease with repeated procedures and may worsen if pain is not adequately managed.
Purpose
The last published guidelines for procedure management in children with cancer was almost 20 years ago, an evidence-based (EB) review was undertaken to develop a new guideline for care of children with cancer undergoing sedation for procedures.
Methods
Search engines were searched, from 1995 to 2010. 49 articles were reviewed. The GRADE criteria were used to evaluate the quality of research articles to develop this guideline.
Results
Based on the review of the evidence, the following strong recommendations were established with moderate quality evidence. To reduce development of anticipatory anxiety, patients should receive maximum treatment of pain/distress for initial procedures. Factors such as age, cognitive level, length of time since diagnosis and experience with previous procedures impact the patient’s anxiety. Education and preparation of the family and child prior to, during and after procedures helps minimize procedural anxiety. The information should be developmentally appropriate and interventions should be individualized to meet the needs of the patient. Cognitive behavioral interventions should be utilized to decrease pain and anxiety. Such methods should be used in conjunction with local anesthesia, sedation and analgesia. Local anesthesia should be used with sedation and analgesia. For first procedures, deep or general sedation should be used. Propofol is a safe and effective agent for deep sedation. Midazolam, fentanyl, and ketamine are safe and effective agents for moderate sedation.
Conclusion
This EB approach found essential components for a procedure management program must include effective parent teaching/education, procedure preparation for both parent and child, and appropriate analgesia and sedation. While new and better pharmacologic agents now exist, management of painful procedures in children with cancer must be tailored to the individual patient by effective communication between the child, parents and medical staff of successful multi-modal interventions.
© Improvement Science Research Network, 2011