How do we sedate children undergoing CSF opening pressure measurement? Results of a Germany-wide survey

The diagnosis "pseudotumor cerebri" requires documentation of an elevated CSF opening pressure. However, correct measurement in childhood maybe hindered by some methodological obstacles. We aimed to demonstrate policies of measurement of the CSF opening pressure in terms of the sedation and analgesia.

Methods: A Germany-wide survey was conducted between January and December 2008. Pediatric clinics were asked to report all children with newly diagnosed cases of IIH. Via a questionnaire detailed clinical information and details about sedation and analgesia during LP were obtained.

Results: Questionnaires of 61 cases with newly diagnosed IIH were analysed. Patients aged 6 months to 17 years. Twenty-nine patients (47%) did not receive any kind of sedation or analgesia before or during lumbar puncture. Of note, three of these children were younger than 2 years of age. Nine patients received ketamine either alone or in combination with midazolam. Seven patients were sedated with midazolam alone or in combination with piritramide (n=2). Propofol was given either alone (n=3) or combined with midazolam (n=1). One patient was investigated under general anaesthesia. No details were given which aneasthesia was used.

In 9 sedated children no details were given about sedative oder analgesic drugs.

Conclusion: There is a lack of standardised policies for measuring the CSF opening pressure in childhood in terms of sedation and analgesia. It may be speculated that falsely elevated or lowered pressure measurements due to insufficient sedation and analgesia or due to medication are not rare in children.