Fatma Burcu BELEN, Ebru KESKİN YILMAZ, İdil YENİCESU, Turkiz GURSEL, Hulya KAYİLİOGLU, Melek ISİK, Nergiz ONER, Ulker KOCAK, Zuhre KAYA

Use of Low Dose Oral Midazolam During Invasive Procedures in Pediatric Hematology Patients

Amaç: Çocukluk çağında hematolojik hastalığı olan olgular sıklıkla kemik iliği aspirasyonu ve lomber ponksiyon ile intratekal kemoterapi verilmesi gibi ağrılı invazif girişimsel işlemlere maruz kalmakta ve bu durum altta yatan hastalığın neden olduğu stresi arttırmaktadır. Çalışmamızın amacı intravenöz sedoanaljezi ile beraber kullanılan oral midazolam tedavisinin olguların invazif girişimsel işlem kaynaklı korku ve stres üzerine etkisinin araştırılmasıdır. Yöntemler: Yaşları 1-18 yaş arasında değişen toplam 47 olgu çalışmaya dahil edildi. Hasta grubu akut lenfoblastik lösemi (ALL), akut myeloblastik lösemi (AML), immun trombositopenik purpura (İTP), trombositoz, kronik myeloid lösemi (KML) ve aplastik anemi tanılarıyla kemik iliği aspirasyonu veya lomber ponksiyon yapılan olgulardan oluşmaktaydı. Çift kör randomize kurgulanan çalışmamızda, olgular Plasebo grubu (n=23) ve Midazolam grubu (n=24) şeklinde sınıflandırıldı. Midazolam grubuna işlemden 30 dakika önce 0.1 mg/kg (maksimum 10 mg) oral midazolam içeren meyve suyu, Plasebo grubuna ise ilaçsız meyve suyu uygulandı. Her iki gruba işlemden hemen önce 0.5 mg/kg intravenöz ketamin uygulandı. İşlem sonrası 7 yaş altı olguların ebeveynlerine, 7 yaş üstü olguların kendilerine Vizuel Analog Skalası (VAS) ve Wong Baker Yüz Skalası uygulanarak korku ve stres dereceleri ölçüldü. CHEOPS skoru ise girişimleri uygulayan pediyatrik hematoloji uzmanı tarafından değerlendirildi. Bulgular: Plasebo ve midazolam grubunda VAS, Wong Baker Yüz Skalası ve CHEOPS skorları açısından fark saptanmadı (p>0.05). Plasebo ile karşılaştırıldığında oral midazolamın ağrı, korku ve stresi azaltmada katkı sağlamadığı saptandı (p>0.05). Midazolam uygulanan grupta bulantı yan etki olarak daha az oranda saptandı (p

Pediatrik Hematoloji Olgularında İnvazif Girişimler Öncesinde Düşük Doz Oral Midazolam Kullanımı

Objective: Children with hematological diseases (especiallly with leukemias) often undergo painfull procedures that adds more stress to their underlying illness. The aim of this study was to investigate whether oral midazolam can decrease fear and distress when given together with usual intravenous sedoanalgesia. Methods: A total of 47 patients with 1- 18 years of age who were followed at hematology inpatient setting were included in the study. The study group consisted of patients undergoing bone marrow aspiration or lumbar puncture for acute lymphoblastic leukemia (ALL) , acute myeloblastic leukemia (AML) ,immune thrombocytopenic purpura ( ITP) , thrombocytosis, chronic myeloid leukemia (CML) and aplastic anemia. Patients were divided into placebo (n=23) and oral midazolam (n=24) groups in this double-blind randomized study. Midazolam group received 0.1 mg/kg(maximum 10 mg) orally 30 minutes before the procedure. Both groups were administered 0.5mg/kg ketamine intravenously before the procedure. Parents and children>7 years reported their fear and distress with visual analogous scale(VAS) and Wong-Baker Fascies Scale. CHEOPS score was filled by the blinded pediatric hematologist performing the procedures. Results: There was no difference of fear and distress levels of placebo and midazolam groups according to VAS ,Wong Baker Fascies and CHEOPS scores(p>0.05). We found no additional effect in decreasing pain and stress of oral midazolam versus placebo when administered together with intravenous ketamineanalgesia. Nausea according to analgesia was found to be more reduced in the midazolam group (p< 0.05). Conclusion: Low dose oral midazolam does not have an additional effect in decreasing fear and distress in pediatric hematology patients when administered together with intravenous ketamineanalgesia. More studies to evaluate its effect when used without intravenous analgesia is warranted

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