Entonox® Efficacy for Procedural-Sedation and Analgesia in Pediatrics Undergoing Bone Marrow Aspiration: A Randomized Clinical Trial

Bone marrow aspirations and biopsies are very painful diagnostic procedures in pediatric candidates and must be done under sedation or analgesia. Objectives: The current study aimed at investigating the effect of using Entonox gas during sedation and analgesia induction in pediatric candidates of bone marrow aspiration. Methods: It was a single-blind, randomized clinical trial. All pediatric candidates of first time bone marrow aspiration were included and allocated to either group 1 or 2, using a random number table. In group 1, a combination of midazolam, fentanyl, ketamine, and propofol was injected intravenously. In group 2, the mentioned combination was injected intravenously and Entonox gas was used for patients’ ventilation. The goal was to reach level 4 sedation based on the Ramsay sedation scale. If needed, extra propofol was injected intravenously every minute. Physician and the helping nurse satisfaction of the procedure were evaluated. Duration of the procedure, the administered dosage for each patient, occurrence of any complications, and the recovery time were recorded. Results: A total of 88 cases with the mean age of 6.83.6 years, and mean weight of 25.412.5 kg were included in the study (50% female). Baseline and demographic data of the groups showed no significant difference. Propofol consumption was significantly lower in group 2, for whom Entonox gas was prescribed, compared with group 1 (P-value < 0.001). Decrease of recovery time in group 2 compared with group 1 was evident (P-value < 0.001). Physician and nurse’s satisfaction was higher in group 2 compared to group 1, and the difference was statistically significant. Conclusions: It is likely that Entonox prescription during bone marrow aspiration in pediatric leads to decrease in consumption of propofol to provide proper sedation, shorter recovery time of the patients, and increased satisfaction in both the physician and nurse in charge of performing the procedure.