Optimizing anesthesia practices for children with acute leukemia undergoing lumbar punctures

Acute leukemia is the most common childhood cancer, with treatment often involving up to 16 routine lumbar punctures (LPs). Anesthesia is used in up to 90% of patients, despite repeated propofol exposure being linked to neurocognitive impairment. In a quality improvement project, researchers from Children’s National Hospital examined variables that could minimize anesthesia time and propofol exposure for patients. The findings, presented at the 56^th Congress of the International Society of Paediatric Oncology in Honolulu, HI., found about half of LPs met the goal of 15 minute of anesthetic exposure with significant differences in completion time between anesthesiologists.

The big picture

Researchers analyzed data from 199 LPs performed in the Non-Operating Anesthesia Room (NOAR) over a six-month period from July to December 2023 – including the start to stop time of anesthetic exposure, type of anesthetic, patient age and body mass index (BMI), proceduralist and anesthesiologist. A P-chart established a center line of 52.5% for procedures being completed within 15 minutes.

What’s next

Plan-Do-Study-Act (PDSA) cycles are being performed to align practices between anesthesiologists and identify successful changes with a goal to raise the center line to 75%.

“These findings highlight our commitment to improving care for children with acute leukemia by reducing anesthesia exposure during lumbar punctures,” said Shelby Smith, RN, MSN, CPNP, CPHON, nurse practitioner at Children’s National and the presenting author. “By identifying factors that impact procedure time and implementing targeted improvements, we aim to enhance patient safety and minimize potential risks associated with repeated propofol use.”

Other Children’s National authors include Birte Wistinghausen, MD.