Current status of procedural sedation and analgesia for pediatric cancer patients in Japan: A report from the JCCG (Japan Children’s Cancer Group)

Abstract

Background: A nationwide survey was conducted by the Japanese Pediatric Leukemia/Lymphoma Study Group (JPLSG: current JCCG) Supportive Care Committee to determine the current status of procedural sedation and analgesia for pediatric patients with cancer and to clarify issues encountered in such procedures.

Methods: A cross-sectional investigation at 155 institutions that are members of the JPLSG was conducted between October 2015 and March 2016 through a web survey (SurveyMonkey^®) to gather institutional information and details concerning procedural sedation and analgesia for pediatric patients with cancer.

Results: Valid responses were obtained from 89 (57%) institutions. Only 27% of the institutions had child life specialists (CLSs) and hospital play specialists (HPSs). Psychological preparation was routinely provided by 36% of the institutions prior to the procedures and treatments. The most common procedural sedation and analgesia medications used were oral triclofos for echocardiography and computed tomography, intravenous thiopental and thiamylal for magnetic resonance imaging and radiotherapy, intravenous midazolam and ketamine for lumbar puncture, bone marrow aspiration, and biopsy, and inhalational anesthetics in the operating room for central venous catheter (CVC) insertion. Sedation and pain management, except for CVC insertion, were performed by attending pediatricians in approximately 90% of cases.

Conclusions: Procedural sedation and analgesia were actively performed for pediatric cancer patients with the burden placed heavily on attending physicians. Therefore, inclusion of more CLSs and HPSs involved in pediatric cancer care is necessary to optimize procedural sedation and analgesia.