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 methohexit al (MHX), an ultrashort-acting barbiturate, for brief unconscious seda tion of pediatric oncology outpatients undergoing painful, invasive pr ocedures. 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 additionall y titrated to maintain minimal response to pain during the procedure. Clinical data reported here were gathered retrospectively from permane nt medical records. Results: Data reported here represent 132 evaluabl e consecutive procedures in 33 patients ranging in age from 1.6 to 20. 5 years. Patients underwent an average of 4 +/- 3 procedures and recei ved 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 clinical ly insignificant decreases in diastolic blood pressure or heart rate b elow resting normal ranges for age. Eight (6.1%) procedures in six pat ients were associated with minor complications requiring no interventi on, such as transient behavioral changes, transient myoclonus, and min imal stridor. Five procedures (3.8%) in five patients required simple suctioning to manage secretions. Only two procedures (1.5%) in two pat ients required brief bag-mask ventilation plus suctioning for suspecte d laryngospasm. None required intubation. No differences in clinical f eatures or MHX doses were noted for patients with, as compared to thos e without, complications. All procedures were completed with a satisfa ctory level of sedation. Conclusions: Our experience indicates that MH X, with appropriate monitoring as described here, is a safe and effect ive agent for use in pediatric oncology outpatient sedation programs.