To be or to not be anesthesias at sternal punctures?

[andle]

Dear colleagues, a question to you. Would like to spend such sotsopros in occasion of use or non-use of anesthesia at performance of a sternal puncture. As it is usual, there are the *quot; ?a*quot; and *quot; OO?o*quot; any variant, but I would like to hear as much as possible opinions of doctors-hematologists. How you usually do or make and why?

[terro]

Eslirech there is about sternalno punctures, that, in my opinion, to do or make high-grade mesnuju anesthesia of sense it is not present since oshchushchnija the patient during introduction mesnogo anesthetic (Lidocainum or Novocainum) sravnimy with sensations at the puncture (under condition of use of a good aspirating needle (disposable), except for that at carrying out of a puncture the primary patient should learn or find out an acceptability of anesthetics. Therefore when that is a question of adults or teenagers I use only contact anesthesia (an adhesive tape or gel) or in general without anesthesia. But if it is a question of small children or if it is necessary to spend a puncture from three points certainly anstezija och. It is desirable, usually it is a short narcosis. Though when the primary patient and the child recently low hemoglobin, that, with the purpose of acceleration of diagnostics acts has eaten or at it or him, it is necessary to refuse anesthesia, besides mestno-gel or an adhesive tape.

[Mesna]

Concerning adults I agree, but the child before a fence it is necessary even a little sedatirovat and to prepare, in fact similar analyses on cito are not done or made.

[terro]

*quot;, in fact similar analyses on cito are not done or made. And quot;

Well are not done or made, in view of what the majority of patients acts, for some reason on Friday in second half of day, and *quot; in O?aO*quot;, just very much even are done or made *quot; on cito*quot;. And as you offer sedirovat the child in that case: a hemoglobin where that nearby 60u/l, Tr-15. Pour 3000 in mkl and temperature febrile? And in fact application of hormones for now the diagnosis is not present och can be necessary. It would not be desirable since after hormones in immunotsitologii itself features a leg or foot will break.

[Mesna]

The dear interlocutor, not on longly present itself on a place of the child described by you. Whether all will be peer such situation to you, what with you do or make?

I speak about children with normal state of health and proper response to an event.

[terro]

And I about the same. I consider or count that when conditions allow it is necessary to relieve children from not the necessary suffering but when re goes about a survival necessary to solve a priority. By the way and n lumbar punctures at you children sedirujut?

[Dr. Makhotin]

In any circumstances (an emergency situation or scheduled, the child or the adult) the patient is desirable for relieving of any unpleasant or morbid sensations. And as to a choice of a method of anesthesia it depends on you own what method is better or what method is standard in your clinic, is doubtless from a level of morbid sensations, etc. So at carrying out of a sternal puncture to block notsitseptivnye stimulus of an integument and a periosteum enough... (from here deep sedatsija it is not required).

[terro]

For Dr. Makhotin

*quot; So at carrying out of a sternal puncture it is enough to block notsitseptivnye stimulus of an integument and a periosteum... (from here deep sedatsija it is not required). *quot;

And what sedatsiju you would offer for the patient of 2,5 years with Hb=70 a g/l, PLT = 25 in mkl, for carrying out stnrnalnoj to a puncture?





Dr. Makhotin

To look or see a structure

To send the personal report for Dr. Makhotin

[Dr. Makhotin]

Dear terro,



In the previous reports you wrote about an opportunity of use of contact local anesthesia (for example EMLA). Why to you to not use the saved up or saved experience and in this case?

In addition you can apply benzodiazepines or Ketaminum in per os or per rectum forms. Though and here there are the but...

[terro]

Certainly contact anesthesia it priemlimo, and here Ketaminum even r.o. To mine unjustified risk.

[Dr. Makhotin]

Mine *quot; ?*quot; in the previous report have been more likely caused by the subjective attitude or relation of children to a preparation (feeling of a burning sensation at intake), than objective risk of complications (undesirable displays).

[Hematolog]

I consider or count, that adults do not have necessity to do or make anesthesia at performance of a sternal puncture.

[Dr. Makhotin]

I consider or count, that adults do not have necessity to do or make anesthesia at performance of a sternal puncture.



And sedatsiju?

[terro]

The question on anesthesia and sedatsii should be solved individually proceeding from zmozhnyh complications of that and another, urgentnosti punctures, statuses of the patient, predpolagaemrj complexities of procedure (if it is necessary to type or collect mnog an osteal brain for example at primary diagnostics .kogda it is necessary immunofenotipirovanie and cytogenetics to do or make or when the expressed myelofibrosis is supposed and that certainly and will have to prick not once anesthesia and sedatsiju it is necessary)

[kuzyaeva]

To thicket punktiruemye patients already pretreated, chronic, transferred or carried about ten punctures (I speak about adults), and when them sprashivashivaesh as it is better with anesthesia or without that in 99,9 % of cases receive the answer, that with anesthesia, and 1 ml Lidocainum was personally a pity to me nikigda not.

[Hematolog]

Dear colleagues, allow to quote from classics: *quot; At an aspiration, even after anesthesia of 2 % a solution of Novocainum, the patient tests kratkovremennoju a pain (an indirect attribute of a successful puncture). *quot; A.I.management's sparrows on a hematology., 1985. .1. .51.