Rupture of an ovarian artery aneurysm in the peripartum period occurs in both traumatic and atraumatic settings. To our knowledge, this is the first reported case of spontaneous atraumatic rupture of the bilateral ovarian arteries. This report describes a multiparous recently post-partum patient with abdominal pain and signs of hemodynamic compromise, the sequela of hemoperitoneum from ruptured bilateral ovarian arteries. With a multidisciplinary approach, this patient was successfully treated with transarterial embolization.

Interventional radiology procedures are typically performed with physician administered sedation and local anesthesia. With increasing patient comorbidities, baseline drug use, obesity and changing patient expectations, the ability to safely and effectively sedate patients has become more challenging. We reviewed our experience with sedation, evaluating patient and procedural factors to determine what increases risk of complications or pain during moderate sedation procedures. We designed a nursing tool to identify patients at risk. Materials: We performed a review of one year of sedation documentation that included patient factors such as pain score and sedation score before, during, and after procedure, comorbidities, ASA status, airway evaluation, and current medications. Observations were applied to specific procedure categories. Aggregated data were then used to create a nurse screening form for identification of patients likely to experience inadequate sedation or complication from sedation. Results: 1970 patient encounters were retrospectively analyzed, and 542 encounters were prospectively analyzed. Inadequate sedation cases were defined as sedation score of o 2 with pain score of 45. Overall, 3.2% of sedation procedures during the retrospective review period, and 9.4% during the prospective period, were reported as painful. 44% of those having pain reported 47/10 pain during the procedure, and 27% of patients experiencing significant pain arrived in IR with baseline pain scores 47/10. Four procedure classes were established: requires anesthesia (8.8%), painful (14.7%), patient dependent (55.9%), not painful (20.6%). Patient characteristics contributing to high risk for poor sedation outcome were baseline pain or anxiety, pain with positioning for procedure, current opioid or anxiolytic medication regimen, and specific patient comorbidities including advanced age, obesity, pulmonary or cardiac disease, or airway concerns. Conclusions: Patients at risk for pain or complication during IR procedures with moderate sedation can be identified prospectively using a simple, evidence-based nurse screening tool. This tool can allow prospective change to an alternate sedation/analgesia/anesthesia plan.

No abstract