Anticipate high stimulation - Initial access to the inside of the bone will be moderately stimulating. The aspiration of bone marrow is VERY stimulating. Make sure to give adequate sedation 1- 2 minutes prior to these events. Approach - the positioning depends on the approach. By experience, these are usually done in the lateral position with a MAC. Some report to be doing these under GETA and in the prone position and 'superman' positioning of the arms. If GETA is used, it is very common for these patients to be very hypotensive, so be ready with pressors/fluids.
