Anesthesia Practices for Interventional Radiology in Europe

Abstract

Significant country variations and regulations along with a controversial position of the anesthesia community on the issue of sedation administered by non-anesthesiologists substantially represent the biggest drawbacks for the expansion of peri-procedural anesthetic care for IR and for potential initiatives at an European level.

Propofol Compared to Midazolam Sedation and to General Anesthesia for Percutaneous Microwave Ablation in Patients with Hepatic Malignancies: A Single-Center Comparative Analysis of Three Historical Cohorts

“…Due to the expanding role of interventional radiology in liver cancer treatment, the amount and complexity of thermal ablation procedures have raised the demand for safe anesthetic management in the ambulatory interventional oncology suite [3]. This comparative analysis of three historical cohorts described the outcomes of patients undergoing percutaneous liver tumor MWA for CRLM or HCC to identify potential differences between general anesthesia, midazolam and propofol sedation.…”

“…Despite the fact that propofol administration should be reserved for anesthesia providers, a recently published survey showed that anesthesia providers are not uniformly available during interventional procedures [3]. This could result in situations where interventional radiologists are increasingly being involved in administering sedative drugs and managing complications, as was the case in our institution.…”

“…The role of anesthetic techniques in percutaneous tumor ablation procedures is a highly debated topic worldwide since it may have impact on pain, anxiety and intraprocedural patient’s movements, thereby achieving an adequate, complete ablation zone (ideally a > 5 mm circumferential safety margin) [1–8] Several anesthetic methods can be used, such as general anesthesia, spinal anesthesia, and sedation using midazolam/fentanyl (hereafter: midazolam) or propofol ( ± intravenous analgesia) [1, 3]. The choice of anesthetic technique differs among institutes and is often based on the clinician’s and patient’s preferences and local availability.…”

“…Over the past 15 years, propofol has become the drug of choice for many outpatient and short procedures, mainly due to its favorable pharmaceutical properties [3]. Guidelines for diagnostic and therapeutic purposes in gastrointestinal endoscopy were the first to describe clear consensus on sedation management with propofol [15–18].…”

Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part I. Ablation

“…There is some controversy and vast variation in practices surrounding sedation by nonanesthetists. 33 Regional analgesia can provide pain relief but also improves circulation to the region, and it helps prevent reflex sympathetic dystrophy. 34 Pre-and postprocedural visual analog pain scores are documented to assess response to the intervention and early detection of the need for further management.…”