Comparing TIVA Using Propofol or Dexmedetomidine Versus Sevoflurane During Anaesthesia of Children Undergoing Bone-Marrow Aspiration
Condition: Invasive Cancer; Pediatric Cancer
Study type: Interventional
Phase: Phase 2/Phase 3

Summary: 
      No doubt that children facing surgical procedures are subjected to perioperative distressing,
      anxious and worrying periods. Several factors included; parental deprivation, anxiety,
      previously mismanaged experience and anticipating pain from the procedure itself weather
      diagnostic or curative. Anaesthetic goals should focus at alleviating these unfavorable
      events that may exacerbate the inevitable associated neurohormal stress response with its
      injurious effects on the course of the procedure. Moreover, it likely to extend beyond the
      surgical procedure predisposing these vulnerable group of patients to psychological trauma
      and chronic behavioral changes.

      Bone marrow aspiration (BMA) is a frequent procedure that necessitate a meticulous
      anaesthetic plane that entails rapid non-traumatic induction together with adequate pain free
      maintenance and instant smooth recovery after a short time practice. Total intravenous
      anaesthesia (TIVA) had emerged as alternative anaesthetic technique to inhalational
      anaesthesia for conscious sedation in BMA cited by many authors.

      Propofol a popular anaesthetic/ sedative with a rapid onset, short duration and smooth
      recovery of consciousness and psychomotor functions with no cumulation. However it is poorly
      analgesic, depresses respiration and there is a possibility of loss of muscle tone leading to
      airway obstruction .

      Dexmedetomidine is a greatly active α2 adrenergic agonist with a valuable anaesthetic-
      analgesic saving effects. It augments sedation, hypnosis and preservation of muscle tone with
      negligible respiratory depression and hemodynamic derangements.

      The purpose of the current study is to compare between effects of TIVA using propofol or
      dexmedetomedine versus sevoflurane for maintenance of anaesthesia in children undergoing bone
      marrow aspiration.
    

Detailed description: 
      Background: although bone marrow aspiration in children is a familiar short duration
      procedure, nearly 65% of patients develop sever anxiety that may extend more beyond, up to
      chronic postoperative behavioral changes. Consequently, the objectives of any related
      anaesthetic technique is to afford smooth non-traumatic induction with safe maintenance and
      rapid recovery. The rational of the present study is to compare between TIVA using propofol
      or dexmedetomedine and sevoflurane for maintenance of anaesthesia in children scheduled for
      bone marrow aspiration.

      Patients and methods: 60 child aged 3-12 years with ASA physical status I and II planned for
      elective bone marrow biopsy and aspiration were enrolled randomly into 3 groups 20 child
      each; group(S): received sevoflurane- oxygen for induction and sevoflurane with fentanyl
      infusion for maintenance of anaesthesia. Group (P): received propofol for induction followed
      by propofol-fentanyl infusions for maintenance of anaesthesia. Group (D): received
      dexmedetomedine infusion for induction followed by dexmedetomedine-fentanyl infusions for
      maintenance of anaesthesia. The primary endpoint was postoperative sedation score on arrival
      to the post anaesthetic care unit (PACU) after surgery. Secondary outcomes included procedure
      duration, hemodynamic variables, parents and surgeons satisfaction and incidences of any
      adverse events.
    

Intervention name(s): Sevoflurane; Propofol infusion for maintance; Dexmedetomidine
Intervention type(s): Drug; Drug; Drug
Intervention description(s): inhalational anaesthesia for maintenance; propofol infusion after induction for maintenance of anaesthesia; 0.5 mic /kg dexmedetomedine is injected after induction of anaesthesia
Intervention MeSH terms: Dexmedetomidine; Propofol; Sevoflurane
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Sixty patients were randomized and assigned into 3 groups (n=20) each, using sealed envelope technique:
Group (S): received sevoflurane- oxygen for induction and sevoflurane with fentanyl (Fentanyl, Janssen-Cilag, Germany) infusion for maintenance of anaesthesia.
Group (P): received propofol (Diprivan, Astra Zeneca, Wedel, Germany) for induction followed by propofol-fentanyl infusions for maintenance of anaesthesia.
Group (D): received dexmedetomedine (Precedex, Dexmedetomedine HCL inj.,Hospira, Inc.,Lacke Forest, USA) infusion for induction followed by dexmedetomedine-fentanyl infusions for maintenance of anaesthesia. All solutions were prepared by a team member not participating in data recording of the study.
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Dex-Profol; sevoflurane