One possibility would be the Mayo Clinic in Jacksonville, Florida. They published a study in 2004 (see below) about the use of general anesthesia in bone marrow biopsies and suggest it is standard procedure at their center. I would at least look into it and if they don't offer general anesthesia, ask them who does.
Burkle, CM, et al, "Morbidity and mortality of deep sedation in outpatient bone marrow biopsy," American Journal of Hematology, Oct 2004 (abstract, full text of article [pdf]).
Abstract:
"Deep sedation is being provided at an increasing rate for patients undergoing bone marrow biopsy and aspiration (BMBA). The aim of this study was to establish the safety of deep sedation used for adults undergoing BMBA. A nonrandomized database analysis and retrospective review of patient records from January 1997 to December 2000 was performed; 5,811 patients were identified as having undergone their first outpatient BMBA. Outcome measures included 30-day mortality and same-day hospital admission; surrogate measures included need for a surgical procedure or receipt of red blood cells within the 48 hr following the BMBA. Patients who received intravenously administered midazolam, fentanyl, and propofol for maintenance of deep sedation plus infiltration of a local anesthetic (n = 2,604; 45%) comprised the deep sedation group; those who received infiltration of a local anesthetic but no intravenous sedation or analgesia (n = 3,207; 55%) comprised the local anesthesia group. Patients in the deep sedation group compared to those in the local anesthesia group were less likely to die within 30 days (0.69% vs. 1.34%, P = 0.018) and less likely to receive red blood cells (1.27% vs. 2.25%, P = 0.006). No other differences between the groups were found. Although the study was retrospective and nonrandomized, the results suggest that the use of deep sedation for outpatient BMBA is as safe as using local anesthesia."
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Re: Where to get general anesthetic for bone marrow biopsy?
Thanks for pointing out that study, Mary.
I'm not a physician and I'm certainly not an anesthesiologist. However, as far as I understand it, the "deep sedation" described in the paper you mentioned is not really the same as general anesthetic. The "deep sedation" technique, for example, does not involve any inhaled anesthetic agents.
From what I can tell, it seem that the "deep sedation" technique is a slightly more intensive version of is commonly described as "twilight sedation" or "twilight anesthesia", which in this case is combining calming / memory-loss agents, such as midazolam (Versed) and propofol (Diprivan), with an opioid pain killer (fentanyl). Here's the Wikipedia article on twilight anesthesia:
https://en.wikipedia.org/wiki/Twilight_anesthesia
I believe you'll find doctors generally more willing to use twilight anesthesia, or even this "deep sedation" regimen, for something like a bone marrow biopsy, than true general anesthesia.
I'm not a physician and I'm certainly not an anesthesiologist. However, as far as I understand it, the "deep sedation" described in the paper you mentioned is not really the same as general anesthetic. The "deep sedation" technique, for example, does not involve any inhaled anesthetic agents.
From what I can tell, it seem that the "deep sedation" technique is a slightly more intensive version of is commonly described as "twilight sedation" or "twilight anesthesia", which in this case is combining calming / memory-loss agents, such as midazolam (Versed) and propofol (Diprivan), with an opioid pain killer (fentanyl). Here's the Wikipedia article on twilight anesthesia:
https://en.wikipedia.org/wiki/Twilight_anesthesia
I believe you'll find doctors generally more willing to use twilight anesthesia, or even this "deep sedation" regimen, for something like a bone marrow biopsy, than true general anesthesia.
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JimNY
Re: Where to get general anesthetic for bone marrow biopsy?
I had one here at The Toledo Hospital where they gave me an epidural. I didn't feel a thing and I was awake the whole time.
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Blackbird - Name: Rick Crow
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Feb, 2013
- Age at diagnosis: 53
Re: Where to get general anesthetic for bone marrow biopsy?
I was diagnosed in 2013 with myeloma. I knew I did not want to be awake for the bone marrow biopsy. I argued with my oncologist, who stated "I do them all the time in the office". Well, I informed him, "You will not do mine in the office".
Long story short, you can have a CT-guided bone marrow biopsy, you are in twilight just like they do for endoscopy procedures. They use the CT scan to locate the best location in your pelvis to aspirate the bone marrow. So they get the sample they need the first time.
My oncologist tried to make me feel like a child because I wanted sedation. As you can imagine, he didn't remain my oncologist for long. You have to fight for yourself, I figure having cancer is bad enough, I didn't need to suffer anxiety or pain before and after the procedure.
Long story short, you can have a CT-guided bone marrow biopsy, you are in twilight just like they do for endoscopy procedures. They use the CT scan to locate the best location in your pelvis to aspirate the bone marrow. So they get the sample they need the first time.
My oncologist tried to make me feel like a child because I wanted sedation. As you can imagine, he didn't remain my oncologist for long. You have to fight for yourself, I figure having cancer is bad enough, I didn't need to suffer anxiety or pain before and after the procedure.
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shar
Re: Where to get general anesthetic for bone marrow biopsy?
Moffitt Cancer Center in Tampa, Florida does bone marrow biopsies with propofol and I think some midazolam up front. I’ve had two bone marrow biopsies there. Painless.
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Dano - Who do you know with myeloma?: Me
- When were you/they diagnosed?: Jan 2014
- Age at diagnosis: 65
Re: Where to get general anesthetic for bone marrow biopsy?
I was asked (being MGUS, but needing to be tested) something like 'Are you ok with procedures?' before my bone marrow biopsy and aspiration. If I had researched it beforehand I might not have agreed to it.
I had a local, and started to suspect it wasn't going to be a pleasant 'procedure' when a very large male nurse came in and stood beside me as I was told to take the fetal position. The first needle (local) hurt. The other two (big ones) were quite intense.
They obviously thought there was a chance that I'd try to escape when the pain started. They know how painful it can be!
I'm smoldering, and will have to visit this again, I'll refuse any form of sedation; that's just me. I've spent so much energy getting rid of my fears. I refuse any anaesthetic with dental procedures. I know there'll be pain, but it won't last.
My next biopsy and aspiration will be painful, and I would never think less of anyone who asked for sedation. If you are stressed by any procedure, I'd like to think you have a concerned / sympathetic physician, one who'd ask (before you have to ask them) how they can lessen your trauma.
None of this is ever going to be pleasant, but you have to remember that all of the really bad stuff only lasts so long. Fear really is your biggest enemy.
I had a local, and started to suspect it wasn't going to be a pleasant 'procedure' when a very large male nurse came in and stood beside me as I was told to take the fetal position. The first needle (local) hurt. The other two (big ones) were quite intense.
They obviously thought there was a chance that I'd try to escape when the pain started. They know how painful it can be!
I'm smoldering, and will have to visit this again, I'll refuse any form of sedation; that's just me. I've spent so much energy getting rid of my fears. I refuse any anaesthetic with dental procedures. I know there'll be pain, but it won't last.
My next biopsy and aspiration will be painful, and I would never think less of anyone who asked for sedation. If you are stressed by any procedure, I'd like to think you have a concerned / sympathetic physician, one who'd ask (before you have to ask them) how they can lessen your trauma.
None of this is ever going to be pleasant, but you have to remember that all of the really bad stuff only lasts so long. Fear really is your biggest enemy.
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Colm - Name: Colm
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: smoldering April 2016
- Age at diagnosis: 56
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