A 13-year-old and 11-month-old patient with a history of thyroglossal cyst operated at 2 years of age, obesity under study, who presented with asthenia, headache, anorexia, frequent epistaxis and tachycardia after performing
The most common laboratory finding in leukocytes was ferritin in 235h, mucous membranes, laterocervical and submandibular lymph nodes 151; lymphocytic lymphomegaly of 6 cm and hepatomegaly of 2 cm.
After completing the cytogenetic, molecular, serological, microbiological and immunological study, the diagnosis of acute lymphoblastic leukemia (APL) type L2 was reached.
Chemotherapy was initiated according to SHOP 99 protocol for very high risk patients, obtaining complete remission at the end of the induction phase.
Four months after the consolidation phase, the patient relapses and the fourth phase of treatment, maintenance therapy, is necessary to keep the child in remission.
(5) The treatment of ALL is performed according to established protocols (4), and it is common for the child to undergo multiple lumbar punctures during the whole process of treatment of the disease for administration of chemotherapy and aspiration punctures.
After obtaining parental consent and explaining the treatment to the child, the sites for lumbar puncture and aspiration of bone marrow were chosen.
The patient was pre-medicated with midazolam (Dormicum®) 5 mg v.o. and OTFC sites transmucosal oral fentanyl citrate (Actiq®) 400 mcg MS lock dressing, and
Oxygen was administered via nasal spectacles at 4 l/m, and electrocardiogram, capnography, Spanish pulse oximetry and blood pressure were monitored from the beginning of the process to discharge from the anesthesia care unit.
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After 30 minutes, the skin of the puncture site was infiltrated with 2-5 ml of 1% lidocaine for later treatment.
On all occasions (4 lumbar punctures and 1 aspiration bone puncture), these could be performed without complications, being welcomed by the patient.
The assessment of pain according to the Visual Analogue Scale was 2.8 mm (0-10) and according to the verbal categorical 1 (0-4).
The overall assessment of the efficacy of analgesic treatment was 'good' in all situations, except on the day of lumbar and spinal puncture, which qualified it as 'regular'.
The parameters monitored during the procedure were within normal limits.
There were no nausea, vomiting or pruritus, and the patient was discharged from the hospital 60 minutes after the procedure.
