Sedative preference of families for lumbar punctures in children with acute leukemia: Propofol alone or propofol and fentanyl

Propofol is a common sedative/anesthetic used for invasive procedures in children with cancer. The purpose of this study was to determine whether families of children with acute leukemia prefer propofol alone or propofol plus fentanyl for lumbar puncture (LP) sedation. We conducted a randomized, placebo controlled, double blind, crossover study. Each patient was studied twice, once with propofol/placebo and once with propofol/fentanyl. Data collected included the modified Yale Preoperative Anxiety Score (M-YPAS) at baseline and after placebo or fentanyl, Induction Compliance Checklist, recovery excitement, recovery time, and adverse events. After the study, families were asked which sedative regimen they preferred for future LPs. Twenty-two patients received 44 LP sedations: propofol 22, propofol/fentanyl 22. The average age was 6.4 +/- 4.2 years (mean +/- SD). There were no significant differences between groups in M-YPAS, Induction Compliance Checklist or recovery excitement. Adverse events occurred in 11/22 patients (50%) propofol and 4/22 (18.2%) propofol/fentanyl (P = 0.0196). Average recovery time (mean SD) was 36.86 +/- 17.1 minutes propofol versus 26.36 +/- 16.4 minutes propofol/fentanyl (P = 0.047), Sixteen families (72.7%) chose propofol with fentanyl for future LP sedations (P = 0.05). In conclusion, most families prefer propofol and fentanyl for LP's. Propofol with fentanyl was also associated with fewer adverse events and faster recovery.