I would like to know what kind of procedural sedation is normally used during pediatric lumbar puncture. I guess oral sucrose is commonly used in infants. Does most of the provider get ketamine for sedation in older age group? Do they sometimes just use local numbing like LET or lidocaine SQ?
Pediatric Lumbar puncture
- Thread starter rohit76
- Start date
D
deleted109597
Yes. If they're above the infant size, I sedate them with whatever I feel like. Versed, Ketamine, whatever.
- Joined
- Dec 19, 2010
- Messages
- 10,258
- Reaction score
- 13,594
With good technique and lots of local, routine use of sedation for an LP should generally not be needed. The sedation is more for parental anxiety than anything else. Kids' interlaminar spaces are wide open. A properly performed LP should not make someone feel like they're having an awake laminectomy or L2 bone-biopsy. In fact, a properly performed, well anesthetized LP often times hurts less than the IV attempt. That being said, yes, some people and parents just go bonkers at the thought of a non-sedated anything, so it's on a case by case basis. Also, if the patient is going to flail like a fish, sedation can be helpful. But adding sedation for an LP as a normal course of business probably extends your procedure time 4 fold or more.
/oldschool/
Last edited:
- Joined
- Mar 14, 2004
- Messages
- 1,529
- Reaction score
- 305
Agree with Birdstrike--I very rarely do sedation for peds LPs, or any LPs in general. One thing that really helps is the use of EMLA or LMX (not LET, which is for lacerations) about 30 min prior to the procedure. I put it on when I start thinking about the procedure. Also, it's probably better to do this yourself, since the nurses always find a way to mess it up. A tegaderm helps to keep it in place.
Also, an appropriate amount of local anesthetic is key to successful procedures.
- Joined
- Aug 5, 2006
- Messages
- 1,297
- Reaction score
- 136
This has been my practice:
Neonate: +/- on the lidocaine, no sedation
Pediatric: EMLA, lidocaine with epi, no sedation unless patient is anxious then would do 0.3 mg/kg midazolam IN for anxiolysis
Adult: lidocaine with epi, no sedation
In general, an LP with adequate local analgesia is not significantly painful but is high anxiety ("they're sticking a needle into my SPINE?!"), so I feel that anxiolysis is usually the most helpful.
What are everyone's thoughts on usage of lidocaine for LPs on neonates? I feel that there's a lot of practice variation.
Neonate: +/- on the lidocaine, no sedation
Pediatric: EMLA, lidocaine with epi, no sedation unless patient is anxious then would do 0.3 mg/kg midazolam IN for anxiolysis
Adult: lidocaine with epi, no sedation
In general, an LP with adequate local analgesia is not significantly painful but is high anxiety ("they're sticking a needle into my SPINE?!"), so I feel that anxiolysis is usually the most helpful.
What are everyone's thoughts on usage of lidocaine for LPs on neonates? I feel that there's a lot of practice variation.
My opinion on neonate approach: lidocaine means a pinching needle stick. tap means a pinching needle stick. why waste time with lido.
once they stop wiggling from the initial poke, advance needle slowly and grab some fluid. you needn't go far.
once they stop wiggling from the initial poke, advance needle slowly and grab some fluid. you needn't go far.
- Joined
- Sep 27, 2008
- Messages
- 3,015
- Reaction score
- 2,224
I sometimes use local for neonates, depends on my mood; always use sweeties and usually apply EMLA. For older children, say 6 mo and above, I'll sedate. I'm not as good at LPs as I'm sure Birdstrike is, so it helps me with the procedure (bc they are always flailing around like a fish) and I do think it's the kind thing to do. Personally, I've not had great success w/IN midazolam, as I find it leads to disinhibition and even more movement,but I do know some people swear by it.
