Propofol/alfentanil and propofol/ketamine procedural sedation in children with acute lymphoblastic leukaemia: safety, efficacy and their correlation with pain neuromediator expression A. CHIARETTI, md, Paediatric Intensive Care Unit, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome, A. RUGGIERO, md, Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome, G. BARONE, md, Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome, A. ANTONELLI, phd, professor, Paediatric Intensive Care Unit, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome, I. LAZZARESCHI, md, Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome, O. GENOVESE, md, Paediatric Intensive Care Unit, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome, S. PAIANO, md, Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome, M. SAMMARTINO, md, Department of Anaesthesia, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome, P. MAURIZI, md, Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome, & R. RICCARDI, md, professor, Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome, Italy CHIARETTI A., RUGGIERO A., BARONE G., ANTONELLI A., LAZZARESCHI I., GENOVESE O., PAIANO S., SAMMARTINO M., MAURIZI P. & RICCARDI R. (2010) European Journal of Cancer Care 19, 212–220 Propofol/alfentanil and propofol/ketamine procedural sedation in children with acute lymphoblastic leukaemia: safety, efficacy and their correlation with pain neuromediator expression Invasive procedures, such as the lumbar puncture, can cause anxiety and pain in children undergoing treatment for acute lymphoblastic leukaemia (ALL). We investigated the safety and efficacy of two different protocols for analgo-sedation in 20 children with ALL undergoing lumbar puncture. We have conducted a prospective, cross-over study. Protocol A was composed of an association between propofol and alfentanil. Protocol B consisted in the combination of propofol and ketamine. We also evaluated the levels of nerve growth factor, substance P and enkephalins in the cerebrospinal fluid of these patients. All patients showed a satisfactory sedation and analgesia. We found a statistically significant difference of vital parameters between protocol A and protocol B, while there were no significant differences between sedation scores and the other parameters evaluated. Patients in protocol A showed a higher incidence of major side effects, such as respiratory depres- sion. Pain neuromediator levels did not show any statistical difference between the two groups. This study shows that both protocols are effective to obtain a good sedation and analgesia in children with ALL under- going lumbar puncture, but the association between propofol and ketamine appears to be safer due to the lower incidence of side effects. Keywords: procedural sedation, lumbar puncture, pain neuromediators, acute lymphoblastic leukaemia. Correspondence address: Antonio Ruggiero, Division of Paediatric Oncology, ‘A. Gemelli’ Hospital, Catholic University of Rome, Rome, Italy (e-mail: ruggiero@rm.unicatt.it). Accepted 23 June 2008 DOI: 10.1111/j.1365-2354.2008.01006.x European Journal of Cancer Care, 2010, 19, 212–220 Original article © 2009 The Authors Journal compilation © 2009 Blackwell Publishing Ltd